TOTAL LAPAROSCOPIC HYSTERECTOMY

 

What is a total laparoscopic hysterectomy?

Is the removal of the uterus and cervix through four small (1/2’- 1’) abdominal incisions. Removal of tubes at the same time is very common, but removal of the ovaries depends on the patient.

Why is this surgery used?

To treat disease of the uterus

  • Fibroids
  • Endometriosis
  • Infection in the ovaries or tubes
  • Pelvic pain
  • Overgrowth of tissue in the lining of the uterus
  • Abnormal vaginal bleeding

How do I prepare for surgery?

  • Before surgery, you will have an appointment with your doctor to discuss the benefits of the surgery, the risks of the surgery, and any available alternatives to surgery.
  • Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery.
  • If you need lab work done, we work with anesthesia team and Pre-Admission Testing to help you get it done. 
  • Some medications need to be stopped before the surgery. A list of medications will be provided at your Pre-Admission Testing appointment.
  • Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, quit as soon as possible. It is best to quit at least 6-8 weeks before surgery.
  • If you are unable to stop smoking before surgery, your doctor can order a nicotine patch while you are in the hospital.
  • You will need to shower at home before surgery. 
  • Do not wear makeup, nail polish, lotion, deodorant, or antiperspirant on the day of surgery.
  • Remove all body piercings and acrylic nails.
  • If you have a “Living Will” or an “Advance Directive”, bring a copy with you to the hospital on the day of surgery.
  • Most women recover and are back to most activities in 4-6 weeks. You may need a family member or a friend to help with your day-to-day activities for a few days after surgery.

What can I expect during the surgery?

  • Once in the operating room, you will receive general anesthesia before the surgery to keep you from feeling pain. The choice of anesthesia is a decision that will be made by anesthesia based upon your history and your wishes.
  • After you are asleep and before the surgery starts:
    • A tube to help you breathe will be placed in your throat.
    • Another tube will be placed in your stomach to remove any gas or other contents to reduce the likelihood of injury during the surgery. The tube is usually removed before you wake up.
    • A catheter will be inserted into your bladder to drain urine and to monitor the amount of urine coming out during surgery.
    • Compression stockings will be placed on your legs to prevent blood clots in your legs and lungs during surgery.
  • After you are asleep the laparoscope is inserted into the abdomen and carbon dioxide gas is blown into the abdomen to inflate the belly wall away from the internal organs.
  • After you are asleep the doctor will remove the uterus, cervix, tubes, and possibly the ovaries through the 4-5 small abdominal incisions. The vaginal opening is then closed with suture.
  • Photographs may be taken during the surgery. If so, copies of them will be placed in your medical records.

What are possible risks from this surgery?

  • Although there can be problems that result from surgery, we work very hard to make sure it is as safe as possible. However, problems can occur, even when things go as planned. You should be aware of these possible problems, how often they happen, and what will be done to correct them.
  • Possible risks during surgery include:
    • Bleeding: If there is excessive bleeding, you will receive a blood transfusion. If you have personal or religious reasons for not wanting a transfusion, you must discuss this with your doctor prior to surgery.
    • Conversion to an open surgery requiring an up and down or Bikini incision: If a bigger open incision is needed during your surgery, you may need to stay in the hospital for one or two nights.
    • Damage to the bladder, ureters (the tubes that drain the kidneys into the bladder), and to the bowel: Damage occurs in less than 1% of surgeries. If there is damage to the bladder, ureters, or to the bowel they will be repaired while you are in surgery.
    • Death: All surgeries have a risk of death. Some surgeries have a higher risk than others.
  • Possible risks that can occur days to weeks after surgery:
    • Blood clot in the legs or lungs: Swelling or pain, shortness of breath, or chest pain are signs of blood clots.
    • Bowel obstruction: A blockage in the bowel that causes abdominal pain, bloating, nausea and/or vomiting.
    • Hernia: Weakness in the muscle at the incision that causes a lump under the skin.
    • Incision opens: The abdominal or vaginal incision.
    • Infection: Bladder or surgical site infection. This may cause fever, redness, swelling or pain.
    • Scar tissue: Tissue thicker than normal skin forms at the site of surgery

What happens after the surgery?

  • You will be taken to the recovery room and monitored for a short time before going to the observation unit.
  • Depending on the length of your surgery, you may not be able to eat or drink anything until the next morning or you will be started on a liquid diet. When you are feeling better you may return to a regular diet.
  • You may have cramping, feel bloated, or shoulder pain.
  • You may have a scratchy or sore throat from the tube used for your anesthesia.
  • You will:
    • Be given medications for pain and nausea if needed.
    • Have the tube in your bladder removed.
    • Have the compression stockings on your legs to improve circulation.
    • Be restarted on your routine medications.
    • Start walking as soon as possible after the surgery to help healing and recovery.
    • Stay in the hospital overnight.

When will I go home after surgery?

Most women spend one night in the hospital and are ready to go home around noon-time the day after surgery. You should plan for someone to be at the hospital by noon to drive you home.

At home after surgery:

It is common not to have a bowel movement for a few days after surgery.

Call your doctor right away if you:

  • develop a fever over 100.4°F (38°C)
  • start bleeding like a menstrual period or (and) are changing a pad every hour
  • have severe pain in your abdomen or pelvis that the pain medication is not helping
  • have heavy vaginal discharge with a bad odor
  • have nausea and vomiting
  • have chest pain or difficulty breathing
  • leak fluid or blood from the incision or if the incision opens
  • develop swelling, redness, or pain in your legs
  • develop a rash
  • have pain with urination

Caring for your incision:

  • Your incision will be closed with dissolvable stitches.

Vaginal Bleeding:

  • Spotting is normal.
  • Discharge will change to a brownish color followed by yellow cream color that will continue for up to four to eight weeks.
  • It is common for the brownish discharge to have a slight odor because it is old blood.

Menopausal Symptoms:

  • If your ovaries are removed you will be in surgical menopause. It is uncommon for Dr. Stewart to remove ovaries in patients younger than age 25.
  • Symptoms of menopause may include hot flashes, vaginal dryness, mood changes, and vaginal discomfort with intercourse. If you experience these symptoms, please talk with your doctor.
  • Before the age of 45 there is a greater risk of thinning and broken bones after your ovaries are removed. It is important to get the right amount of calcium and vitamin D from your diet or a supplement. Your doctor may want you to have a bone density scan to evaluate your bone health.

Diet:

  • You will continue with your regular diet.

Medications:

  • Pain: Medication for pain will be prescribed for you after surgery. Do not take it more frequently than instructed.
  • Laxative, Fiber, or Stool softener: Narcotic pain medications may cause constipation. A laxative, fiber supplement, or stool softener may be needed while taking these medications.
  • Nausea: Anti-nausea medication is not typically prescribed. Tell your doctor if you have a history of severe nausea with general anesthesia.

Activities:

  • Energy level: It is normal to have a decreased energy level after surgery. During the first week at home, you should minimize any strenuous activity. Once you settle into a normal routine at home, you will slowly begin to feel better. Walking around the house and taking short walks outside can help you get back to your normal energy level more quickly.
  • Showers: Showers are allowed within 24 hours after your surgery.
  • Climbing: Climbing stairs is permitted, but you may require some assistance when you first return home.
  • Lifting: For 4-6 weeks after your surgery, you will probably want to restrict your lifting. In general, let your body be your guide, move slowly, and follow a rule of “if it hurts, don’t do it.” 

Disclaimer: This document contains information for the typical patient with your condition. It may include links to online content that was not created by Dr. Stewart and he assumes no responsibility for their content.  It does not replace medical advice from your health care provider because your experience may differ from that of the typical patient. Talk to your health care provider if you have any questions about this document, your condition or your treatment plan.

The information above is an adaptation of patient education originally created by Michigan Medicine and is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International Public License. Author: Laurie, Crimando RNC,MSN Reviewer: K., Wang, MD Revised: 01/17/2021 by Ryan Stewart, DO.