Our Preparing for series allows a patient to prepare themselves for a procedure properly. We answer questions about how long the procedure 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 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