Hysterectomy—Laparoscopic Surgery Overview

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Hysterectomy is the surgical term for the removal of the uterus (womb). This results in the inability to become pregnant. The surgery may be done through the abdomen or the vagina.

This type of surgery can be:

• Partial or subtotal hysterectomy—removal of the uterus (without removing the cervix)
• Total, complete, or simple hysterectomy—removal of the uterus and cervix (the opening of the uterus leading to the vagina)
• Radical hysterectomy—removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, and the pelvic lymph nodes
• Salpingo-oophorectomy —removal of the ovaries and fallopian tubes (may be combined with any of the above procedures)

Prior to Procedure

Your doctor may do the following:

• Blood and urine tests
• Pap smear
• X-ray of abdomen and kidneys—a test that uses radiation to take a picture of structures inside the body
• Pelvic ultrasound —a test that uses sound waves to show organs in the abdomen
• Dilation and curettage (D&C)—surgical removal of tissue from the lining of the uterus
• Ask you to use an enema to clean out the intestines

You should do the following:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs
• Blood thinners, such as warfarin (Coumadin)
• Clopidogrel (Plavix)
• If instructed, take antibiotics.
• Arrange for a ride home and for help at home.
• Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia will be used. You will be asleep during the surgery.

Description of the Procedure

Laparoscopically-Assisted Vaginal Hysterectomy (LAVH)

The doctor will make a small cut near the navel to insert a laparoscope (instrument with a camera on the end). This device will allow the doctor to see the pelvic organs. To better view the organs, the abdomen will be inflated with carbon dioxide. The doctor will make more small cuts in the abdomen. Through these cuts, other small tools will be inserted. A cut will also be made where the uterus joins the vagina. The bladder and rectum will be gently pushed off the uterus. The uterus will then be removed through the cut in the vagina. Lastly, the doctor will close the cut with stitches.

LAVH © 2009 Nucleus Medical Media, Inc.

A "packing" is placed in the vagina. This will be removed after 1-2 days.

In some cases, the doctor may switch to open surgery .

Immediately After Procedure

You will be given IV fluids and medicines.

How Long Will It Take?

1-3 hours

Will It Hurt?

You will likely have pain, fullness, bloating, and vaginal bleeding or discharge during the first few days. Your doctor will give you pain medicine.

Average Hospital Stay

You may be able to leave the hospital on the same day or the next day. You will stay longer if you have complications.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

• On the first night, the nurse will help you sit up and walk.
• During the next morning, the IV will be removed if you are eating and drinking well.
• You may need to wear special socks or boots to help prevent blood clots.
• You may have a foley catheter for a short time to help you urinate.

At Home

When at home, do the following:

• Follow your doctor's instructions .
• Take proper care of the incision site. This will help to prevent an infection.
• Take showers instead of baths. However, baths are allowed.
• During the first two weeks, rest and avoid lifting.
• Slowly increase your activities. Begin with light chores and short walks. Depending on your job, you may be able to return to work.
• Check with your doctor to see when it is safe to drive again.
• Eat a diet rich in fruits and vegetables . Ask your doctor if you need to take iron .
• Avoid constipation by:

• Eating high-fiber foods
• Drinking plenty of water
• Using stool softeners if needed
• Ask your doctor when you can use tampons. Also ask about Kegel exercises .
• Wait six weeks before resuming sexual activity.
• If you still have a cervix, you will still need regular Pap smears .

RESOURCES:

The American Congress of Obstetricians and Gynecologists
http://www.acog.org/publications/patient_education/

Women's Health.gov
http://www.womenshealth.gov/

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

American Medical Association website. Available at: http://www.ama-assn.org/ . Accessed September 8, 2009.

Bren L. Alternatives to hysterectomy: new technologies, more options. US Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2001/601_tech.html . Accessed February 20, 2008.

Hysterectomy. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org . Published March 2006. Accessed September 8, 2009.

Hysterectomy: frequently asked questions. Women's Health.gov website. Available at: http://www.4woman.gov/faq/hysterectomy.htm . Updated July 2006. Accessed September 8, 2009.

Women's reproductive health: hysterectomy. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/reproductivehealth/WomensRH/Hysterectomy.htm .Updated January 2008. Accessed February 20, 2008.