What is a hysterectomy?

A hysterectomy is a surgery to remove the uterus. Hysterectomies are performed for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse, and gynecologic cancer.

A hysterectomy is a surgery to remove the uterus. When the entire uterus is removed, this is called a total hysterectomy. If the entire uterus, tubes, and ovaries are removed this is called a total hysterectomy with bilateral salpingo-oophorectomy. Sometimes the uterus is removed, but the cervix is left behind. This surgical technique is called a supracervical hysterectomy.

During hysterectomies, Obgyns often recommend fallopian tube removal (bilateral salpingectomy) to reduce ovarian cancer risk. Some women will also need the removal of the ovaries (oophorectomy). Hormonal changes only occur when the ovaries are removed.

Gynecologists perform hysterectomies through a variety of techniques. The size of the uterus, surgeon experience, the patient’s body type, and the prior surgical history help determine the proper surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy
3. Laparoscopic hysterectomy (total or supracervical)
4. Laparoscopic-assisted vaginal hysterectomy
5. Robotic hysterectomy

What are the advantages of laparoscopic supracervical hysterectomy?

Many patients who need a hysterectomy are concerned about a long recovery and missing time off work. A laparoscopic supracervical hysterectomy is an excellent option for hysterectomy candidates who do not have any cervix problems.

The cervix is the opening of the uterus at the back of the vagina. Some women are not candidates for supracervical hysterectomy due to a history of cervical dysplasia, HPV, or abnormal pap smears.

This minimally invasive technique allows faster recovery, reduced pain, and shorter hospital stay. Patients benefit from small incisions, a short hospital stay, and a quicker return to work, exercise, and everyday activities.

During laparoscopic surgery, the surgeon places a camera through the umbilicus (belly button). This technique allows the surgeon to use small instruments to perform the surgery and monitor the surgical field through these tiny incisions.

How long will I be in the hospital?

Surgeons perform a laparoscopic supracervical hysterectomy as an outpatient procedure or inpatient surgery with an overnight stay. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Most laparoscopic supracervical hysterectomy patients can leave the hospital much faster after a traditional abdominal hysterectomy.

Can my family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center for a laparoscopic supracervical hysterectomy. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary from region to region due to the Covid-19 pandemic.

Does my procedure require an anesthetic?

A laparoscopic supracervical hysterectomy requires general anesthesia. An anesthesiologist will temporarily put the patient to sleep so they will feel no pain during surgery. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

Because any hysterectomy will eliminate the possibility of child-bearing, your doctor will ask questions to make sure you are confident you will not want children in the future.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

After arrival at the hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. Your nurse will place an IV at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens on the day of surgery?

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and prep the abdomen for surgical sterility. The team then performs a “surgical time-out.” The head nurse will read a surgical safety checklist aloud, requiring all surgical team members to be present and attentive.

The gynecologic surgeon will insert a speculum into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in place and the cervix visualized, the surgeon inserts a device called a uterine manipulator into the cavity of the uterus. This step facilitates the surgeon’s ability to safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon will mark the surgical sites with a small marking pin and insert a small camera through an incision in the belly button. Air inflates and distends the abdomen to allow visualization of the pelvis. My preference is to insert a specialized instrument called Gel point mini by Applied Medical. This type of port will enable me to use one incision to perform the procedure.

The surgical team positions the laparoscopic camera to show the pelvic anatomy. We pass small instruments through the additional ports.

Many surgeons recommend complete removal of the fallopian tubes (bilateral salpingectomy) at the time of surgery as this technique reduces the risk of ovarian cancer.

The fallopian tubes are located and grasped with one instrument. Using the other hand, the surgeon clamps and cuts the fallopian tubes from the adjacent anatomy.

The surgeon travels down the sides of the uterus, freeing it from the connecting tissues. The round ligament and uterine/ovarian ligaments are clamped, cauterized, and then cut. At each step, the surgeon will take precautions to control and avoid bleeding.

Critical anatomy lies towards to lower end of the uterus. The surgeon will separate the bladder from the lower uterine segment to allow visualization of the cervix and avoid bladder injury.

The surgeon will focus careful attention on the uterine arteries, the main blood supply to the uterus. These two blood vessels travel over the ureters, which are the tubes connecting the kidney to the bladder.

At this point, we can separate the uterus from the cervix for removal. There are various techniques, but I prefer to use a product called the bipolar Lina Loop.

The surgeon lassos the loop over the uterus and positions it at the uterus and the cervical junction. We perform a safety check to make sure no other anatomy is in contact with the loop. Then the uterus is amputated from the cervix.

The uterus is now free but still needs to be removed. We place the uterus into a surgical bag for tissue retrieval.

The surgeon examines all of the surgical sites for bleeding. When safe, the Obgyn removes the uterus safely located inside the bag through the umbilical (belly button) incision. We removal the operative ports and sew the surgical incisions closed.

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake the patient up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for laparoscopic supracervical hysterectomy varies. The surgeon’s experience, surgical technique, patient body type, uterine size, and previous surgeries are all factors. For example, a small uterus is a much easier surgery than a large, fibroid uterus.

In general, the patient should expect 1–2 hours of total operative time.

When can I go home?

Postoperative recovery time will vary from person to person. Some surgeons will recommend an outpatient procedure, while others prefer an overnight stay. The patients underlying health status, surgical complexity, and physician preference are all factors.

To be able to go home, each patient must meet specific discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. The recovery room team will control postoperative nausea, vomiting, and pain and monitor for postoperative bleeding.

The nursing team will go over discharge instructions, and confirm postoperative pain management plans.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time?

Most women should be able to return to normal daily activities within a few weeks of surgery. The nursing team will help patients walk and move around a few hours after surgery to reduce blood clots’ risk, improve lung function, and expedite bowel function return.

Most patients will require pain medication like NSAIDs and narcotics for a time. Many experience discomfort in the right shoulder due to air irritating the nerves of the diaphragm.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are safe to use.

What aftercare is required?

You should speak with your physician regarding the resumption of exercise and sexual activity. Most can return to basic activities in one to two weeks. Sexual activity is typically restricted for 6–8 weeks to allow complete healing.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure to evaluate the incisions.

Danger Signals to look out for after the procedure

You should call your doctor if you experience heavy vaginal bleeding, fevers, severe nausea or vomiting, worsening abdominal pain, or the inability to pass gas.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Laparoscopic procedures require very little postoperative care. Keep the incisions clean and dry. Patients should avoid sexual activity until cleared by their doctor. One may resume a normal diet the day of surgery and begin light exercise the day after the procedure or when you feel ready.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for: Laparoscopic Supracervical Hysterectomy appeared first on Medika Life.

When the baby is delivered through an incision in the abdomen and uterus, it is called a cesarean delivery or C-section. Most women will have a horizontal lower abdominal incision. Sometimes surgeons make a vertical incision if a woman has an extensive past surgical history or large uterine fibroid or if there is an emergency. 

Some women will choose to have a permanent contraception surgery, or tubal ligation, with their c-section.

Why do some women need a cesarean delivery?

Some women with a history of a prior c-section will have a scheduled cesarean delivery. Some women require cesarean delivery during labor. The most common reasons for a cesarean birth during labor are unsuccessful labor and fetal distress. Sometimes during labor, the contractions fail to open the cervix enough for the baby to pass through the birth canal.

Fetal distress means that the baby’s heart rhythm is abnormal and indicates that the baby’s health is in danger. Delivery via cesarean section may be the fastest way to remove the baby from the stress of labor and also the fastest way for the medical team to evaluate the baby. 

Other common reasons for a scheduled cesarean delivery include:

1. Breech or fetal malpresentation (not head down) 
2. Twin pregnancy
3. Prior uterine surgery (myomectomy)
4. Placenta disorders like placenta previa  

What are the possible complications of cesarean delivery?

Most women will have an uncomplicated C-section. A small percentage of women may develop complications and these are usually easily treated. Potential complications include bleeding, infection, injury to the bowel or bladder, blood clots in legs or lungs, and reactions to anesthesia.

For most women, vaginal delivery carries less risk of heavy bleeding, infection, and injury to abdominal organs compared to c-section. Vaginal delivery is also associated with less risk of postoperative complications and shorter recovery times compared to cesarean delivery. However, some women may not be candidates for vaginal delivery and some women may develop unavoidable indications for cesarean delivery during labor. You and your doctor will determine which approach is most suitable for you.

How long will I be in the hospital?

Most women will need to stay 48-72 hours after cesarean delivery. Various factors, such as the reason for C-section, surgical complexity and postoperative recovery course help determine the surgical plan.

Can my family visit me?

A trusted family member should drive you to and from the hospital. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary with the ongoing COVID-19 pandemic.

Does my procedure require an anesthetic?

Most women receive regional anesthesia for cesarean delivery. This can be an epidural and/or a spinal block. During regional anesthesia, only the lower half of the body is numbed and the patient is awake during the procedure. This technique allows the mom to be awake during delivery and enjoy the experience of seeing their newborn baby.  To place a regional block, a tiny incision is made in the lower back. For an epidural, a small tube is placed to deliver medication through the tube when needed. For a spinal block, the drug is injected directly into the spinal fluid. 

Rarely, general anesthesia is needed for cesarean delivery. This means that the patient will not be awake during the delivery. General anesthesia is used only if the regional block does not work or if there is an emergency without enough time to administer a regional block.  

How should I prepare?

For scheduled cesarean sections, at your final OB appointment, the doctor will review your specific instructions. You should also confirm the date, time, and location of the surgery. We will need to carefully review your medications and plan when the last dose should be taken prior to the surgery and when to resume medications. This is particularly important for patients taking aspirin, blood pressure medicines, and diabetes medicines. 

Your doctor should review all medication and food allergies. We remind patients to avoid alcohol 24 hours before the surgery. We also instruct patients to refrain from eating or drinking at least 8 hours prior to the surgery time. 

Please keep in mind that the hospital will perform a car seat check prior to discharge (it needs to be purchased prior to discharge). Also if you are planning on cord blood banking, please bring your kit with you to the hospital. 

The hospital will supply almost everything you and your baby will need for your stay, including gowns, pads, underwear, baby clothing, diapers, breast pumps, formula, and bottles. However, you will need to bring clothes and supplies for your trip home. Some women also prefer to bring some of their own things to be more comfortable, such as their toothbrush, comfortable clothing, and lotion.   

What happens after I check-in at the hospital?

After checking in on Labor & Delivery, you will change into a surgical gown and store your belongings. You will meet the nursing team who will provide care during your surgery. They will review your medical history. The surgical consent form is reviewed, signed, or updated with any changes. An IV will be placed at this time. 

The anesthesia team will also interview you and answer questions. Typically your surgeon will review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure. Then the anesthesiologist will place the regional block. 

After the anesthesiologist has confirmed the regional block is functioning appropriately, the OR team will lay you down and adjust your position. The anesthesiologist will administer IV antibiotics through your IV. The OR nursing team will then apply an antibacterial fluid to your abdomen, trim the pubic hair if needed, and cover your body with drapes. In addition, a tube called a foley catheter will be placed in your bladder to drain urine. 

The team then performs a “surgical time-out.” A surgical safety check-list is read aloud, requiring all surgical team members to be present and attentive. One family member is allowed to be with you during the procedure and is called to your side at this time. 

The OB/Gyn begins by making a skin incision in the lower abdomen. It is typically horizontal, but sometimes a vertical incision is needed if there is an extensive surgical history, a known pelvic mass such as a large fibroid, or if there is an emergency. 

The abdominal muscles are separated and the uterus is visualized. An incision is then made in the uterine wall. This incision is also typically horizontal. The baby is delivered through these incisions and the umbilical cord is clamped and cut. The baby is given to a special team of nurses for immediate evaluation. After the baby is evaluated, the baby will be brought to the mother. 

The placenta is then removed and the uterus is sewed closed with stitches that will dissolve as the uterus heals over the next few weeks. The surgeons then confirm there is no active bleeding. If permanent birth control is planned, it is performed at this time. Finally, the abdomen and pelvis are washed in a warm saltwater solution and all the abdominal wall layers are closed. The skin is closed with dissolvable sutures or staples.

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the team will transfer the patient to the recovery room.

What happens in the recovery room and postpartum ward?

The recovery room is equipped to monitor patients’ blood pressure, heart rate, and bleeding after surgery. In the recovery room, we encourage mothers to begin breastfeeding. 

You will remain in the recovery room for observation for 1-2 hours. Afterward, you will be moved to a hospital room in the postpartum ward.

Immediately after the C-section, you will need to stay in bed until the regional block wears off and you are able to use your legs.  You will need someone to assist the first few times you move out of bed.  Because the lower half of the body is still numb, the bladder catheter is usually removed the next morning. 

As soon as possible, your nurses will encourage you to move around as much as you can. You may be encouraged to get out of bed and walk after your operation. Walking helps reduce the risk of blood clots. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal. 

Your incision may be sore for the first few weeks. The nursing team will give pain medicine as needed to help keep you comfortable. 

If you want to breast-feed, the lactation consultant will typically visit to provide guidance and support. The neonatal team will be monitoring the baby’s health for the first few days of life.

AFTERCARE AND RECOVERY QUESTIONS 

What preparations should I make for aftercare at home?

You should speak with your physician regarding the resumption of exercise and sexual activity. Your doctor will also review wound care instructions. We generally recommend avoiding strenuous activity, heavy lifting, and sexual intercourse for 6 weeks after cesarean delivery. Also please avoid inserting anything into the vagina (no sex, tampons, or douching) until cleared by your doctor. 

Some mild cramping and light bleeding are expected after c-sections. You may have more cramping if you are breast-feeding.

Most women can return to basic activities in one to two weeks. Generally, we recommend patients stick to light activity only for the first 4–6 weeks. Light exercise helps your body heal and prevents some postoperative complications. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. 

You may resume a regular diet on the day of surgery. It may be helpful to prepare some meals and do your grocery store shopping and laundry before surgery. If you are breast-feeding, it is recommended to continue the prenatal vitamins to ensure good nutrition for you and your baby.

You will be given instructions to help control postoperative pain during healing. Some pain is expected for the first few weeks after the surgery. You may also have light bleeding and vaginal discharge for a few weeks. Sanitary pads can be used after the surgery. Constipation is common after cesarean deliveries. Try a stool softener and fiber supplement. Some women have temporary problems with emptying the bladder. 

Your doctor will schedule a postpartum visit 4–6 weeks after the procedure. We also schedule a wound check 1-2 weeks after delivery. At this time, the incision is inspected for appropriate healing. We also review your contraception options and evaluate for postpartum depression. 

After your postpartum visit, we recommend continuing your annual routine gynecologic exams.

Danger Signals to look out for after the procedure

Call your doctor or report to the ER if you experience:

• Pain not controlled with prescribed medication
• Fever > 101
• Severe nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas or have a bowel movement

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

This article was contributed by MacArthur Medical Center’s Dr. Reshma Patel

The post Preparing for Cesarean Delivery (C-Section) appeared first on Medika Life.

A hysterectomy is a surgery to remove the uterus. Gynecologists perform hysterectomies for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse, and gynecologic cancer.

During a hysterectomy, a surgeon removes the uterus. Gynecologists often recommend removing the fallopian tubes (bilateral salpingectomy) to reduce the risk of ovarian cancer. Some women will also need the removal of the ovaries (oophorectomy). Removal of the ovaries triggers hormonal changes. After a hysterectomy, a woman can longer get pregnant.

Gynecologists perform hysterectomies through a variety of techniques. The patient’s uterus size, body type, and prior surgical history help determine the surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy
3. Laparoscopic hysterectomy
4. Laparoscopic-assisted vaginal hysterectomy
5. Robotic hysterectomy

What are the advantages of abdominal hysterectomy?

In an abdominal hysterectomy, the uterus is removed through an incision in the lower abdomen. The abdominal incision gives a large clear view of the pelvis and allows us to work through adhesions from prior surgeries or endometriosis most carefully. It can be performed even if the uterus is huge.

However, abdominal hysterectomy is associated with a greater risk of complications than a vaginal hysterectomy or laparoscopic hysterectomy.

Wound infections, bleeding, blood clots, and nerve and tissue damage are more common. Abdominal hysterectomy also requires a more extended hospital stay and a longer recovery time.

Some patients may not be candidates for minimally invasive approaches because of uterine size or prior surgical history. Your doctor will determine which surgical approach is most suitable for you.

Is a hysterectomy safe?

Hysterectomy is a very safe surgical procedure, and complications are rare. However, as with any surgery, problems can occur, such as:

• Fever and infection
• Heavy bleeding during or after surgery
• Injury to the urinary tract or nearby organs
• Blood clots in the leg that can travel to the lungs
• Breathing or heart problems related to anesthesia
• Death

Some problems are discovered immediately, and some may not show until days, weeks, or even years after surgery. These problems include the formation of a blood clot, infection, or bowel blockage. Complications are generally more common after an abdominal hysterectomy and in women with certain underlying medical conditions.

How long will I be in the hospital?

Most women will need to stay 1–2 nights after an abdominal hysterectomy. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Can my family visit me?

A trusted family member should drive you to and from the hospital. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary with the ongoing COVID-19 pandemic.

Does my procedure require an anesthetic?

An abdominal hysterectomy requires general anesthesia, meaning patients will temporarily be put to sleep. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

Why do I need a preoperative clinic visit?

Most surgeries will involve a preoperative visit with your surgeon to review the procedure’s risks and benefits and answer your questions regarding the upcoming surgery. Because hysterectomies will eliminate the possibility of child-bearing, your doctor will confirm that you do not want children in the future.

It is essential to provide your doctor with an updated list of all medications, vitamins, and dietary supplements before surgery. The surgical team will review your medications. Together we can plan when to take the last dose when to resume medications. Medication management is particularly important for patients taking aspirin, blood pressure medicines, and diabetes medicines. Your doctor should review all medication and food allergies. We remind patients to avoid alcohol 24 hours before the surgery.

If any blood work or preoperative testing is required, it will be scheduled and confirmed. If appropriate, share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon before your surgery. Some patients may need to supply a surgical clearance letter from their primary care physician.

Finally, the doctor will give instructions regarding your diet before the surgery.

Try to avoid wearing jewelry, make-up, nail polish/acrylic nails on the day of surgery. If you wear contacts, glasses or dentures, please bring a case.

You should also confirm the date, time, and location of the surgery.

What happens after I check-in at the hospital?

After arrival at the hospital, the staff will guide you to the pre-operative holding area to change into a surgical gown and store your belongings. You will meet the nursing team who will provide care during your surgery. They will review your medical history. The surgical consent form is reviewed, signed, or updated with any changes. An IV will be placed at this time. You may be given special stockings to help prevent a blood clot.

The anesthesia team will also interview you and answer questions. Typically your surgeon will review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure. Then the anesthesiologist will give medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and apply an antibacterial fluid to your abdomen and vagina. After you are asleep, a tube called a catheter will be placed in your bladder to drain urine. The team then performs a “surgical time-out.” A surgical safety check-list is read aloud, requiring all surgical team members to be present and attentive.
The gynecologist begins by making an incision in the lower abdomen. It is typically horizontal, but sometimes a vertical incision is needed if there is a large uterus or large mass.

Once the uterus and ovaries are visualized, we place a metal retractor to maintain a clear view of the pelvis. This step helps us safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon works carefully from the outer edges inward. First, we dissect the broad ligament, the thin layer of connective tissue covering the female organs. If the plan is to remove the ovaries, we start with this step. Otherwise, we begin by separating the tubes from the surrounding tissues until the uterus is reached. 

The surgeon then separates the uterus from the surrounding connective tissue by moving downward toward the cervix. At this point, the surgeons detach the bladder from the uterus. After the bladder is safely out of the way, the surgeon will focus on the uterine arteries.

These two blood vessels are the main blood supply to the uterus and travel over the ureters, the tubes which connect the kidney to the bladder. Once the uterine arteries are controlled, the surgeon then safely gradually separates the uterus from the body. Depending on the anatomy, bleeding, or scar tissue, the surgeon may decide not to removal the cervix. 

The uterus and tubes (and sometimes ovaries) are sent to the pathology lab for microscopic analysis. The surgeon examines all of the surgical sites for bleeding.

The surgeon then sews the edges of the vagina closed to form the vaginal cuff. If the cervix has not been removed, it is carefully inspected for bleeding.
Afterward, the abdomen and pelvis are washed in a warm saltwater (saline) solution. Then, the layers of the abdominal wall and skin are carefully closed.
Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake up the patient and then transfer her to the recovery room.

AFTERCARE AND RECOVERY QUESTIONS

What happens in the recovery room?

Once the operation is over, you will be moved into the recovery area. This area is equipped to monitor patients after surgery.

Many patients feel groggy, confused, and chilly when they wake up after an operation. You may have muscle aches or a sore throat shortly after surgery. These problems should not last long. You can ask for medicine to relieve them. You will remain in the recovery room until you are stable. Afterward, you will be moved to a hospital room for the rest of your stay.

As soon as possible, your nurses will have you move around as much as you can. You may be encouraged to get out of bed and walk around more quickly after your operation. Walking helps reduce the risk of blood clots. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal.

What preparations should I make for aftercare at home?

You should speak with your physician regarding the resumption of exercise and sexual activity. Your doctor will also review wound care instructions. Sexual activity is typically restricted for 6–8 weeks to allow the vagina to heal. Do not insert anything into your vagina — no sex, tampons, or douching — until cleared by your doctor.

Most women can return to basic activities in one to two weeks. Generally, we recommend patients stick to light activity only for the first 4–6 weeks. Light exercise helps your body heal and prevents some postoperative complications. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. Avoid strenuous exercise and heavy lifting.

You may resume a regular diet on the day of surgery. It may help prepare some meals and do your grocery store shopping and laundry before surgery.

You will be given instructions to help control postoperative pain during healing. Some pain is expected for the first few weeks after the surgery. You may also have light bleeding and vaginal discharge for a few weeks. Sanitary pads can be used after the surgery. Constipation is common after hysterectomies. Try a stool softener and fiber supplement. Some women have temporary problems with emptying the bladder after a hysterectomy. Some women have an emotional response to hysterectomy. You may feel depressed that you are no longer able to carry a pregnancy, or you may be relieved that your former symptoms are gone.

Your doctor will schedule a postoperative examination 4–6 weeks after the procedure.

After recovery, we recommend continuing your annual routine gynecologic exams. Depending on your age and reason for the hysterectomy, you may still need pelvic exams and pap tests.

Danger Signals to look out for after the procedure

Call your doctor or report to the ER if you experience:

• Pain not controlled with prescribed medication
• Fever > 101
• Severe nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas or have a bowel movement

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

This article was contributed by MacArthur Medical Center’s Dr. Reshma Patel

The post Preparing for: Abdominal Hysterectomy appeared first on Medika Life.

What is a hysterectomy?

A hysterectomy is a surgery to remove the uterus. Gynecologists perform hysterectomies for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse, and gynecologic cancer.

During a hysterectomy, a surgeon removes the uterus. Gynecologists often recommend removing the fallopian tubes (bilateral salpingectomy) to reduce the risk of ovarian cancer. Some women will also need the removal of the ovaries (oophorectomy). Removal of the ovaries triggers hormonal changes. After a hysterectomy, a woman can longer get pregnant.

Gynecologists perform hysterectomies through a variety of techniques. The uterus’ size, the patient’s body type, and prior surgical history help determine the surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy
3. Laparoscopic hysterectomy
4. Laparoscopic-assisted vaginal hysterectomy
5. Robotic hysterectomy

What are the advantages of vaginal hysterectomy?

Vaginal hysterectomies are performed through the vagina. The uterus is slowly detached from the pelvis and then removed through the vagina. There is only a single incision inside the vagina; there are no abdominal incisions.

Vaginal hysterectomy is a minimally invasive surgery that benefits patients by having only a vaginal incision, shorter hospital stay, faster recovery, reduced pain, and a shorter hospital stay.

The American College of Obgyn states that a vaginal hysterectomy is the preferred minimally invasive approach because it is associated with better outcomes. However, some patients may not be candidates because of uterine size or prior surgical history. Your doctor will determine which approach is most suitable for you.

Is a hysterectomy safe?

Hysterectomy is a very safe surgical procedure, and complications are rare. However, as with any surgery, problems can occur, such as:

• Fever and infection
• Heavy bleeding during or after surgery
• Injury to the urinary tract or nearby organs
• Blood clots in the leg that can travel to the lungs
• Breathing or heart problems related to anesthesia
• Death

Some problems are seen immediately, and some may not show until days, weeks, or even years after surgery. These problems include the formation of a blood clot, infection, or bowel blockage. Complications are generally more common after an abdominal hysterectomy and in women with certain underlying medical conditions.

How long will I be in the hospital?

Surgeons perform vaginal hysterectomies as an outpatient procedure (meaning the patient can go home the same day) or inpatient surgery with an overnight stay. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Most vaginal hysterectomy patients can leave the hospital sooner than after an abdominal hysterectomy.

Can my family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary with the ongoing COVID-19 pandemic.

Does my procedure require an anesthetic?

A vaginal hysterectomy requires general anesthesia meaning patients will temporarily be put to sleep. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

Why do I need a preoperative clinic visit?

Most surgeries will involve a preoperative visit with your surgeon to review the procedure’s risks and benefits and to answer your questions regarding the upcoming surgery. Because hysterectomies will eliminate the possibility of child-bearing, your doctor will confirm that you do not want children in the future.

It is essential to provide your doctor with an updated list of all medications, vitamins, and dietary supplements before surgery. This will help us carefully review your medications and plan when to stop certain medicines, when the last dose should be taken prior to the surgery and when to resume medications. This is particularly important for patients taking aspirin, blood pressure medicines, and diabetes medicines. Your doctor should review all medication and food allergies. We remind patients to avoid alcohol 24 hours before the surgery.

If any blood work or preoperative testing is required, it will be scheduled and confirmed. If appropriate, share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon before your surgery. Some patients may need to supply a surgical clearance letter from their primary care physician.

Finally, the doctor will give instructions regarding your diet before the surgery.

Try to avoid wearing jewelry, make-up, nail polish/acrylic nails on the day of surgery. If you wear contacts, glasses or dentures, please bring a case.

You should also confirm the date, time, and location of the surgery.

What happens after I check-in at the hospital?

After arrival at the hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your belongings. You will meet the nursing team who will provide care during your stay. They will review your medical history. The surgical consent form is also reviewed, signed, or updated with any changes. An IV will be placed at this time. You may be given special stockings to help prevent a blood clot.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure. Then the anesthesiologist will give medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and apply an antibacterial fluid to your abdomen and vagina. After you are asleep, a tube called a catheter may be placed in your bladder to drain urine. The team then performs a “surgical time-out.” A surgical safety checklist is read aloud, requiring all surgical team members to be present and attentive.

The gynecologist will insert a speculum into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in place and the cervix is visualized, the surgeon will grasp the cervix with an instrument called a tenaculum. This step helps us safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

Then we work to detach your bladder from the uterus. After the bladder is safely out of the way, we begin to gradually detach the uterus from the pelvis. The surgeon will first focus attention on the uterine arteries. These two blood vessels are the main blood supply to the uterus and travel over the ureters, which connect the kidney to the bladder. Once the uterine arteries are controlled, the surgeon then safely gradually separates the uterus from the body. If indicated, then the tubes and ovaries are also removed.

The uterus is delivered through the vagina and sent to the pathology lab for microscopic analysis. The surgeon examines all of the surgical sites for bleeding.

The surgeon then sews the edges of the vagina closed to form the vaginal cuff.

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake up the patient and then transfer her to the recovery room.

What happens in the RECOVERY ROOM?

Once the operation is over, you will be moved into the recovery area. This area is equipped to monitor patients after surgery.

Many patients feel groggy, confused, and chilly when they wake up after an operation. You may have muscle aches or a sore throat shortly after surgery. These problems should not last long. You can ask for medicine to relieve them. You will remain in the recovery room until you are stable.

As soon as possible, your nurses will have you move around as much as you can. You may be encouraged to get out of bed and walk around more quickly after your operation. Walking helps reduce the risk of blood clots. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal.

What preparations should I make for aftercare at home?

You should speak with your physician regarding the resumption of exercise and sexual activity. Sexual activity is typically restricted for 6–8 weeks to allow the vagina to heal. Do not insert anything into your vagina — no sex, tampons, or douching — until cleared by your doctor.

Most women can return to basic activities in one to two weeks. Generally, we recommend patients stick to light activity only for the first 4–6 weeks. Light exercise helps your body heal and prevents some postoperative complications. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. Avoid strenuous exercise and heavy lifting.

You may resume a regular diet on the day of surgery. It may help prepare some meals and do your grocery store shopping and laundry before surgery.

You will be given instructions to help control postoperative pain during healing. Some pain is expected for the first few weeks after the surgery. You may also have light bleeding and vaginal discharge for a few weeks. Sanitary pads can be used after the surgery.

Constipation is common after hysterectomies. Try a stool softener and fiber supplement. Some women have temporary problems with emptying the bladder after a hysterectomy. Some women have an emotional response to hysterectomy. You may feel depressed that you are no longer able to carry a pregnancy, or you may be relieved that your former symptoms are gone.

Your doctor will schedule a postoperative examination 4–6 weeks after the procedure.

After recovery, we recommend that continuing your annual routine gynecologic exams. Depending on your age and reason for the hysterectomy, you may still need pelvic exams and pap tests.

DANGER SIGNALS

Call your doctor or report to the ER if you experience:

• Pain not controlled with prescribed medication
• Fever > 101
• Severe nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

This article was contributed by MacArthur Medical Center’s Dr. Reshma Patel 

The post Preparing for: Vaginal Hysterectomy appeared first on Medika Life.

A hysterectomy is a surgery to remove theuterus. Hysterectomies are performed for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse and gynecologic cancer. 

During a hysterectomy, the uterus is removed. Obgyns often recommend fallopian tube removal (bilateral salpingectomy) to reduce the risk of ovarian cancer. Some women will also need the removal of the ovaries (oophorectomy). Hormonal changes only occur when the ovaries are removed.

Gynecologists perform hysterectomies through a variety of techniques. The size of the uterus, surgeon experience, the patient’s body type, and the prior surgical history help determine the proper surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy 
3. Laparoscopic hysterectomy 
4. Laparoscopic-assisted vaginal hysterectomy 
5. Robotic hysterectomy robotic

What are the advantages of robotic hysterectomy?

Contrary to the name, robots do not perform the surgery. A human gynecologic surgeon attaches a surgical system to intraabdominal ports. While sitting at a surgical console, the surgeon controls the robotic arms while monitoring the surgical field in a 3D view..

Through 4–5 small incisions, the surgeon detaches the uterus from the surrounding tissues. Robotic surgery is a minimally invasive surgery that allows for faster recovery, reduced pain, and shorter hospital stay.

The American College of Obgyn acknowledges this type of hysterectomy’s growing popularity but recommends robotic hysterectomy be reserved for more complex cases that can not be safely completed through other minimally invasive techniques.

Experienced robotic surgeons prefer the precise control of the surgical arms allowing complex cases to be completed in a minimally invasive fashion. Patients benefit from small incisions, a short hospital stay, and a faster return to work, exercise, and everyday activities.

How long will I be in the hospital?

Surgeons perform robotic hysterectomies as an outpatient procedure or as an inpatient surgery with an overnight stay. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Most robotic hysterectomy patients are able to leave the hospital much faster after a traditional abdominal hysterectomy. 

Can family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center for a robotic hysterectomy. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary from region to region due to the Covid-19 pandemic.

Does my procedure require an anesthetic?

Laparoscopic robotic surgery requires general anesthesia meaning patients will be temporarily put to sleep. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

Because robotic hysterectomies will eliminate the possibility of child-bearing, your doctor will ask questions to make sure you are confident you will not want children in the future.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

After arrival at the hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and prep the abdomen for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read aloud, requiring all surgical team members to be present and attentive.

The gynecologic surgeon will insert a speculum into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in place and the cervix visualized, the surgeon inserts a device called a uterine manipulator into the cavity of the uterus. This step facilitates the surgeon’s ability to safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon will mark the surgical sites with a small marking pin. A small camera is inserted through an incision into the belly button. Air inflates and distends the abdomen to allow visualization of the pelvis. Three or four secondary ports are placed to allow the robotic arms to function. 

The robot is then positioned over the body and attached to the ports. The laparoscopic camera is positioned to show the pelvic anatomy. Small instruments are passed through the additional ports. Scissors are attached to one robotic arm and a grasping device in the other. This allows the surgeon to operate with both hands. 

The surgeon then moves away from the patient to the surgical consult to control the robot. 

As the surgeon takes her seat, she adjusts the camera and robotic arms’ position to begin the surgery.

Many surgeons recommend complete removal of the fallopian tubes (bilateral salpingectomy) at the time of surgery as this technique reduces the risk of ovarian cancer.

The fallopian tubes are located and grasped with one instrument. Using the other hand, the surgeon clamps and cuts the tubes from the adjacent anatomy.

The surgeon travels down the sides of the uterus freeing it from the connecting tissues. The round ligament and utero-ovarian ligaments are clamped, cauterized and then cut. At each step, the surgeon will take precautions to control and avoid bleeding. 

Towards to lower end of the uterus lies important anatomy. The surgeon will separate the bladder from the lower uterine segment to allow visualization of the cervix. 

The surgeon will focus attention on the uterine arteries. These two blood vessels are the main blood supply to the uterus and travel over the ureters, which are the tubes connecting the kidney to the bladder. 

Once the uterine arteries are controlled, the surgeon can safely separate the uterus from the vagina. 

The surgeon makes a circular incision just below the cervix freeing the uterus. The uterus is delivered through the vagina and sent to the pathologist to analyze the tissue. 

The surgeon then sews the edges of the vagina closed to form the vaginal cuff. 

The surgeon examines all of the surgical sites for bleeding. When safe, the Obgyn removes the operative ports and sews the surgical incisions closed. 

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake the patient up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for robotic hysterectomy varies. The surgeon’s experience, surgical technique, patient body type, uterine size, and patient’s previous surgeries are all factors.

In general, patient should expect 1–2 hours of total operative time.

When can I go home?

Postoperative recovery time will vary from person to person. Some surgeons will recommend an outpatient procedure while others prefer an overnight stay. The patients underlying health status, surgical complexity and physician preference are all factors. 

To be able to go home, each patient must meet specific discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

What is the usual recovery time

Most women should be able to return to normal daily activities within a few weeks of surgery. The nursing team will help patients walk and move around a few hours after surgery to reduce blood clots’ risk, improve lung function, and expedite bowel function return.

Most patients will require pain medication like NSAIDs and narcotics for a time. Many experience discomfort in the right shoulder due to air irritating the nerves of the diaphragm.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are safe to use.

What aftercare is required?

You should speak with your physician regarding the resumption of exercise and sexual activity. Most can return to basic activities in one to two weeks. Sexual activity is typically restricted for 6–8 weeks to allow the vaginal cuff to heal.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure to evaluate the incisions.

Danger Signals to look out for after the procedure

You should call your doctor if you experience heavy vaginal bleeding, fevers, severe nausea or vomiting, worsening abdominal pain, or the inability to pass gas.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Robotic procedures require very little postoperative care. Keep the incisions clean and dry. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet the day of surgery and begin light exercise the day after the procedure or when you feel ready.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for: Robotic Hysterectomy appeared first on Medika Life.

An endometrial biopsy is a simple office-based procedure where a doctor removes a small amount of tissue from inside the uterine cavity. This tissue is called the endometrium. To find out if any abnormal cells are present, the doctor must sample the endometrial tissue to be tested and evaluated under a microscope.

An endometrial biopsy is used to diagnose or rule out endometrial cancer or precancerous changes in the tissue called endometrial hyperplasia.

Women with postmenopausal bleeding, heavy periods, irregular periods, or abnormal findings on a sonogram may be candidates for this procedure. Most often, an endometrial biopsy is performed as part of the evaluation of abnormal uterine bleeding, but it also is used in cases of infertility.

What does this procedure involve?

The gynecologist inserts a thin, flexible tube called a pipelle into the uterine cavity through the cervix’s opening called the cervical os. Using negative pressure, the doctor pulls a small amount of endometrial tissue into the pipelle for sampling. The procedure takes only a few minutes and causes mild cramps.

Where is an endometrial biopsy procedure performed?

Gynecologists perform endometrial biopsy procedures in an office setting.

Can my family visit me?

Endometrial biopsies are performed in a medical office setting. The vast majority of patients will be able to drive themselves to and from the procedure. Some may prefer a trusted family member to bring them. 

Does my procedure require an anesthetic?

Anesthesia is not typically required for an endometrial biopsy procedure. Some physicians spray a topical anesthetic directly onto the cervix. Occasionally, gynecologists provide local anesthesia via a paracervical anesthetic.

A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery.

Some gynecologists recommend oral medication to reduce anxiety

What’s the procedure when I check in?

Most procedures will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed.

The consent form is reviewed, signed, or updated with any changes.

Because an endometrial biopsy is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

What happens in the procedure room?

Your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in position to allow visualization of the cervix, the procedure will attempt to pass a small pipelle through the cervix into the endometrial cavity. If the cervical os (opening) is too narrow, then the doctor will attach an instrument called a Tenaculum to the top of the cervix to stabilize the uterus. Then, they will use a small tool to dilate the cervix wide enough for the pipelle to enter. 

Once the pipelle is safely inside the uterus a small amount of endometrial tissue is pulled into the tube for sampling. 

These cells are sent to a pathologist for evaluation. 

After the biopsy, the speculum is removed and the procedure is complete. Some patients will experience mild bleeding, spotting or a brown, coffee-ground vaginal discharge over the next few days.

How long will I be in the procedure?

Once the patient enters the procedure room a series of safety steps must occur.

An endometrial biopsy procedure takes approximately 2–5 minutes. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments

When can I go home?

After an office-based endometrial biopsy procedure, patients may go home after getting dressed as long as you are feeling normal.

Post-procedure recovery time will vary from person to person.

Endometrial biopsy procedures require a minimal amount of recovery. Patients may leave as soon as the procedure is complete.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time

You should be able to resume all work and household activities on the same day as your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

• Some patients will require mild pain medication like NSAIDs.
• It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.
• You will be instructed to abide by pelvic rest for approximately 1–2 days. This includes no douching, no sex, and no tampons.
• You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the same day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is to avoid vaginal intercourse for 1–2 days.

You should not use tampons for 1–2 days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination to review the pathology report findings. If any abnormalities are found on the biopsy, your doctor will discuss the next steps

Danger Signals to look out for after the procedure

After an endometrial biopsy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge

What should I pack at home?

Nothing special is required after an endometrial biopsy procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for an Endometrial Biopsy appeared first on Medika Life.

The doctor’s office calls a few days after your annual pap smear. This can’t be good news. They say you have an “abnormal” pap smear. You get scheduled for a diagnostic procedure called a colposcopy to rule out cervical cancer.  

What is a Colposcopy

Before you hit the panic button, let’s break down exactly what you need to know about a colposcopy procedure. 

A colposcopy is a common office procedure that follows an abnormal pap smear. Using a microscope, doctors examine the magnified cervix to identify abnormal cervical tissue to prevent cervical cancer. 

Precancerous cells are caused by HPV, the human papillomavirus.

80% of Americans will contract HPV, making it the most common sexually transmitted infection. HPV causes genital warts, and persistent strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. 

Cervical screening through pap smear is how women’s health practitioners detect HPV effects. Paps smears are the first step in cervical cancer prevention. 

A pap (Papanicolaou) smear is a screening test for cervical cancer. The cervix is the opening of the uterus located at the back of the vagina. During a pap smear, doctors place a device called a speculum into the vagina. This allows the walls of the vagina to be spread apart allowing visualization of the cervix.

Cervical cells are then collected using a small brush. These cells are sent to a lab for analysis. The cells are processed under a microscope to evaluate for precancerous changes called cervical dysplasia. 

The goal of pap screening is to detect abnormal cervical changes so we can intervene long before cervical cancer develops.

When someone has an abnormal pap smear, the next step is a diagnostic procedure called a colposcopy.

A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye. 

Areas of the cervix concerning for pre-cancer or cancer can then be biopsied (sampled) during the exam.

If the biopsy shows a precancerous lesion then, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

Where is a colposcopy procedure performed?

A colposcopy procedure is performed in an office setting.

Can my family come with me?

Colposcopy procedures are performed in a medical office setting. A trusted family member should drive you to and from the appointment. 

Does my procedure require an anesthetic?

Anesthesia is not typically required for a colposcopy procedure. Some physicians spray a topical anesthetic directly onto the cervix. Occasionally local anesthesia can be provided via a paracervical anesthetic. 

A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery. 

Some gynecologists recommend oral medication to reduce anxiety.

What’s the procedure when I check-in?

Most procedures will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed.

The consent form is reviewed, signed, or updated with any changes.

Because a colposcopy is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions..

What happens in the procedure room?

Your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

The provider will position the colposcope (microscope) to allow visualization of the cervix. A chemical called acetic acid is applied to the cervix. Acetic acid, also known as vinegar, is applied to the cervix. (We call it acetic acid so we can sound smarter).  

Cells infected with HPV will absorb this chemical causing them to turn white. During the colposcopy, the doctor will see these characteristic changes, and any abnormal areas are may be sampled.

After the biopsy, a drying chemical called Monsel’s solution is painted onto the cervix to prevent bleeding later on. This chemical is messy and will cause a brown, coffee-ground vaginal discharge over the next few days.

How long will I be in the operating room?

Once the patient enters the procedure room a series of safety steps must occur. 

A colposcopy procedure takes approximately 2–5 minutes. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments.

When can I go home?

After an office-based colposcopy procedure, patients may go home after getting dressed as long as you are feeling normal.

Postoperative recovery time will vary from person to person.

Colposcopy procedures require a minimal amount of recovery. Patients may leave as soon as the procedure is complete.

What is the usual recovery time

You should be able to resume all work and household activities on the same day as your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

Some patients will require mild pain medication like NSAIDs.

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons.

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the same day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is to avoid vaginal intercourse for 1–2 weeks.

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination to evaluate your cervix 1–2 weeks after the procedure. The cervical specimen pathology report will be reviewed during this visit.

If cervical dysplasia is proven on the biopsy, your doctor will discuss the next steps. If the biopsy is normal or mild cervical dysplasia is found, a follow-up pap smear will be scheduled. If moderate or severe cervical dysplasia is identified, the provider will discuss treatment options.

Danger Signs to look out for after the procedure

After a colposcopy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge

What should I pack at home to take with?

Nothing special is required after a colposcopy procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

This is a video presentation of the procedure, explaining how it works.

The post Preparing for: Colposcopy appeared first on Medika Life.

What is a hysteroscopic polypectomy?

Hysteroscopy is a simple procedure where a doctor uses a small camera called a hysteroscope to evaluate the inside of the uterine cavity. During a hysteroscopy, a surgeon can remove uterine fibroids (myomectomy) and polyps (polypectomy) without having to cut or remove any part of the uterus.

Endometrial polyps are small overgrowths of tissue hanging inside the cavity of the uterus. The vast majority are benign, but in rare, cases polyps can be cancerous.

Many women have endometrial polyps without having symptoms (asymptomatic). Others, have irregular menstrual bleeding and spotting.

A hysteroscopic polypectomy combines the visualization of hysteroscopy with a cutting device to remove the polyps. The polyps are removed without having to make any incisions on your body.

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the polyp to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel to allow surgical removal.

How long will I be in hospital?

Hysteroscopic polypectomies are outpatient procedures. You may go home after the surgery is complete.

Can family visit me?

Some hysteroscopic procedures can be performed in a medical office setting. A trusted family member should drive you to and from the appointment. 

Most hysteroscopic procedures are performed in a hospital or Ambulatory Surgery Center. A trusted family member should drive you to and from the appointment. Your family is welcome to stay with you before and after this outpatient procedure

Does my procedure require an anesthetic?

Anesthesia is required for a hysteroscopic polypectomy procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and office equipment availability.

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

If the procedure is being performed in an office setting, the process may feel like a normal office visit.

Most hysteroscopic myomectomies are performed in a hospital or Ambulatory Surgery Center.

The staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute question.

What happens in the operating theater?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV if the procedure is being done outside of the office setting.

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in theater?

Multiple medical device technologies can be used to perform hysteroscopic polypectomy. Gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options. Each medical device works by combining the visualization of hysteroscopy with a cutting device to remove the fibroids. 

The most common technologies include hysteroscopic scissors, lasso, graspers or a resecting device such as Myosure, Symphion, and True Clear. While each system functions differently, each subscribes to the same basic concept: polyp resection under visual surveillance. 

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the polyp to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel. A small cutting instrument slides down the operative channel to allow surgical removal.

The polyp is cut into small pieces and removed. The procedure is complete once we have restored a normal-appearing uterine cavity. 

When the treatment is complete, the devices are safely removed.

How long will I be in theater?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for a hysteroscopic polypectomy varies. Small, soft polyps may take only a few minutes. Large, dense, or hard to reach polyps may take longer. 

In general, 30 minutes of operative time should be expected.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Hysteroscopic polypectomy procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

The short term effects on menstrual bleeding vary. Some may see immediate improvement. Others will continue to see menstrual cycle lightening for a few weeks as fibroid fragments and endometrial tissue are expelled. 

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time.

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons.

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is no intercourse for 1–2 weeks.

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure. The fibroid specimen pathology report will be reviewed during this visit.

Danger Signals to look out for after the procedure

After a hysteroscopic polypectomy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

DANGER SIGNALS TO BE AWARE OF POST PROCEDURE

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home??

Hysteroscopic procedures require very little postoperative care. Vaginal discharge and spotting are expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

The post Preparing for: Hysteroscopic Polypectomy appeared first on Medika Life.

Endometrial Ablation explained

A heavy period (Menorrhagia) is a common gynecological problem affecting one in twenty women. Menorrhagia is frequently treated by hysterectomy, but many women can benefit from uterine-sparing minimally invasive approaches.

Endometrial ablation is a minimally invasive treatment designed to minimize, or in some cases, eliminate menstrual bleeding. Endometrial Ablation is an alternative treatment option for premenopausal women suffering from menorrhagia, for whom childbearing is complete.

Endometrial ablation is a short, outpatient surgical procedure to treat abnormal uterine bleeding without the need for incisions. The procedure destroys the endometrial lining, the tissue responsible for menstrual bleeding. This low-risk option has a 95% patient satisfaction rate and requires minimal patient downtime.

After the procedure, patients may never bleed again. If they do, their bleeding is generally reduced. In approximately half of the women that have the ablation they no longer experience menstrual cycles. Of the 50% that do continue to have a cycle, most have little bleeding and are satisfied with their results. The overall satisfaction rate is approximately 95%.

As not all patients experience a satisfactory reduction in bleeding, all treatment options should be discussed with your doctor.

Candidates for endometrial ablation include those who:

1. Have periods lasting longer than seven days
2. Use more than 3 pads or tampons per day
3. Pass clots during menstrual cycles
4. Period bleeding affects your work, social, athletic, or sexual activities
5. Medical management has failed to control heavy bleeding
6. Anemia due to heavy periods
7. Wish to reduce menstrual bleeding without major surgery

Where is the procedure performed?

Endometrial ablation can be performed in a variety of settings. Many Obgyns perform this procedure in the office setting using oral sedation medication and a paracervical anesthetic. A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery.

Other gynecologic surgeons perform this outpatient procedure in an ambulatory surgery center or a hospital setting.

The office, surgery center, or hospital are all reasonable and appropriate surgical settings.

How does the procedure work?

Multiple technologies can be used to perform an endometrial ablation. Gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options. Each medical device works by destroying the endometrial lining.

The most common technologies include Novasure, Genesys HTA, and Minerva. While each system functions differently, each subscribes to the same basic concept. Heat is employed to destroy the endometrial lining of the uterus to eliminate or reduce bleeding to normal levels.

Her Option is the exception to the rule. This device uses freezing technology called cryoablation. Cryoablation utilizes cold temperature to affect the uterine lining.

First, your cervix will be slightly dilated to allow the introduction of the device through the cervix and into the uterus. Once the gynecologist confirms proper placement the ablation is performed. Novasure and Minera typically last 60-90 seconds. Genesys HTA is a ten-minute procedure. Her Option takes up to 20 minutes.

When the treatment is complete, the devices are safely removed. The uterine lining has been treated and will slough off similar to a menstrual period over the next few weeks.

Does my procedure require an anesthetic?

Anesthesia is required for endometrial ablation. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and the endometrial ablation technology. Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options.

If general anesthesia is required, instructions will be given to avoid any food or liquid intake starting the night before surgery.

What’s the procedure when I check in?

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

Most surgeries will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed. The surgical consent form is reviewed, signed, or updated with any changes.

After arrival for the procedure, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. If an IV is required, it will be placed at this time. You will meet the nursing team who will provide care during your stay. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV.

The OR nursing team will cover your body with sterile drapes after cleaning the surgical site for sterility. The team then performs a “surgical time-out.” A surgical safety check list is read out loud requiring all surgical team members to be present and attentive. The surgeon then performs the surgical procedure.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. Once complete, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room a series of safety steps must occur. This process takes about 20 minutes. Endometrial ablation procedures can take between 2-20 minutes of operative time depending on which ablation technology is used.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding. The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Endometrial ablation procedures require a minimal amount of post operative recovery. Patients are often discharged as early as 30-60 minutes after the procedure.

What is the usual recovery time

After the procedure, you may experience some cramping that should be controlled with minimal pain medication. Most patients will probably have a pink or yellow watery discharge for a few weeks after your treatment. Many patients may return to work the following day.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

The short term effects on menstrual bleeding vary. Some may see immediate improvement. Others will continue to see menstrual cycle lightening for a few months. Optimal improvement typically occurs in the first six months.

Danger Signals to look out for after the procedure

After Endometrial ablation, if you experience two days of heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

What preparations should I make for aftercare at home?

Endometrial ablation requires very little postoperative care. Vaginal discharge and spotting is expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

The post Preparing for: Endometrial Ablation appeared first on Medika Life.

“Don’t make me laugh, cough, or sneeze.” For the one in four women over forty who suffer from stress urinary incontinence (SUI), one funny joke can lead to an embarrassing moment.

Stress urinary incontinence is the temporary loss of bladder control. SUI is triggered when bladder pressure overcomes the surrounding muscles designed to keep urine contained. Exercising, laughing, sneezing, or lifting heavy objects increases bladder pressure and can lead to accidents.

Stress urinary incontinence may be common, but it is never normal. No one has to live with bladder leaking.

Lifestyle changes improve symptoms. Overweight women often notice an improvement after weight loss. Reducing the intake of inflammatory chemicals like caffeine also helps. Eliminating smoking can decrease the number of times you leak.

Nonsurgical options such as pelvic muscle exercises and physical therapy can play a roll in the treatment of stress incontinence. Some women benefit from local injections of Botox or bulking agents like Collagen.

A minimally invasive surgical repair called a mid-urethral sling is an effective treatment to stop the leak,

Getting prepared for surgery can be scary. Learning about an upcoming procedure alleviates fear and anxiety. Let’s talk about a mid-urethral sling procedure and answer questions about how long it will last, what’s involved, what to expect, and even advice on packing your bag. While your surgeon preps, we’ll make sure you’re ready.

What is a Mid-urethral Sling?

A mid-urethral sling is the most common type of surgery used to correct SUI. A small, supportive material of synthetic mesh is placed under the bladder neck and then anchored to the other pelvic tissues creating a “hammock-like support” to prevent leakage.

The goal is to restore the natural support system for the bladder. These procedures are performed from a vaginal approach to minimizes incisions, pain, and recovery time. Mid-urethral slings are performed as outpatient surgery.

Where is a mid-urethral sling performed?

A mid-urethral sling can be performed in various settings, but most commonly, Obgyns performs this procedure in an Ambulatory Surgery center or hospital. Some Obgyns will do these surgeries in the office.

Choosing the appropriate surgical setting depends on a few different factors, including the physician’s experience, the availability of equipment impact the decision, and the extent of pelvic organ prolapse.

How long will I be in the hospital?

A mid-urethral sling is an outpatient procedure. Patients may go home after the surgery is complete. An overnight stay is not needed unless we are combining it with other gynecological surgeries.

Can my family visit me?

Most incontinence procedures are performed in a hospital or Ambulatory Surgery Center. A trusted family member should drive you to and from the appointment. Your family is welcome to stay with you before and after this outpatient procedure.

Does my procedure require an anesthetic?

Anesthesia is required for a mid-urethral sling procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and office equipment availability.

Oral sedation, IV sedation, and general anesthesia are all potential anesthetic options. General anesthesia is the most common anesthetic choice for this type of surgery.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

The staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV.

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure.

Once the procedure is complete, a post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake you up for transfer to the recovery room.

How does the procedure work?

Multiple medical device technologies can be used to perform mid-urethral sling surgeries. Urologists, urogynecologist, and gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options.

Each medical device works similarly by providing support to the urethral to reduce the risk of stress incontinence. The entry point and attachment sites vary between different technologies.

The surgeon identifies the urethra and makes a small incision. The bladder is pushed away from the vaginal tissue to create a space. The synthetic mesh is placed under the bladder neck. The mesh is attached to the surrounding pelvic tissues to create support and prevent leakage.

The incisions are closed with sutures. Many surgeons examine the inside of the bladder with a camera to confirm no injuries occurred. This is called a cystoscopy.

Once the surgeon confirms, the bleeding is under control and the bladder is intact, then the procedure is complete.

What are the risks of a mid-urethral sling procedure?

The following risks are associated with any type of surgery for SUI:

• Injury to the bladder, bowel, blood vessels, or nerves
• Bleeding
• Infection of the urinary tract or wound infections
• Urinary retention (difficulty urinating or urgency symptoms)
• Problems related to the anesthesia

Synthetic mesh has a small risk of vaginal erosions when the mesh will erode through the vaginal tissue. Vaginal erosions are more common in patients with diabetes, obesity, and smokers. Additional surgery may be required to repair mesh erosion.

How long will I be in surgery?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for incontinence surgery varies if other gynecologic or urologic procedures are required.

In general, 30–60 minutes of total operative time should be expected.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Mid-urethral sling procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

Most women should be able to return to normal daily activities within a few days. Patients will need to avoid heavy lifting or sexual activity until cleared by the doctor. Typically, the recommendation is no intercourse for 4–6 weeks

Some patients may notice difficulty starting the urine stream when trying to void. The tissue surrounding the urethra swells after surgery. This issue typically resolves quickly as the swelling subsides.

In rare cases, if a woman is not able to void, the stitches or the sling may need to be adjusted or removed.

Vaginal soreness and a small amount of bleeding are expected.

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time.

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.

What aftercare is required?

Most women should be able to return to normal daily activities and work within a few days.

After surgery, discomfort may last for a few days or weeks. During this time, avoid anything that puts stress on the surgical area, such as the following activities:

• Excessive straining
• Strenuous exercise
• Heavy lifting
• Sexual activity

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure.

Danger Signals to look out for after the procedure

After a mid-urethral sling procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Inability to void (urinate)
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Incontinence procedures require very little postoperative care. Vaginal discharge and spotting are expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

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The post Preparing for: Midurethral Sling appeared first on Medika Life.