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.

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.