• Hysterectomy—Laparoscopic Surgery

    (Surgical Removal of the Uterus [or Womb]; Abdominal Hysterectomy)

    Click here to view an animated version of this procedure.

    Definition

    Hysterectomy is the surgical term for the removal of the uterus (womb). This results in the inability to become pregnant.
    There are different types of surgeries, such as:
    • Supracervical hysterectomy—removal of the uterus only
    • Total hysterectomy—removal of the uterus and cervix (the opening of the uterus leading to the vagina)
    • Radical hysterectomy—removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, and the pelvic lymph nodes
    • Salpingo-oophorectomy —removal of the ovaries and fallopian tubes (may be combined with any of the above procedures)

    Reasons for Procedure

    You may have a hysterectomy if your uterus is causing health problems that cannot be treated by other means. Some reasons a woman may have a hysterectomy are to:
    Explore your options before having a hysterectomy. There are other treatments for many of these problems.

    Possible Complications

    If you are planning to have hysterectomy, your doctor will review a list of possible complications, which may include:
    Some factors that may increase the risk of complications include:
    • Obesity
    • Smoking
    • Heart or lung disease
    • Diabetes
    • Previous pelvic surgery or serious infection
    • Use of medicines during the past month
    Discuss the risks with your doctor before surgery.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Blood and urine tests
    • Pap smear
    • X-ray of abdomen and kidneys—a test that uses radiation to take a picture of structures inside the body
    • Pelvic ultrasound —a test that uses sound waves to show organs in the abdomen
    • Dilation and curettage (D&C)—surgical removal of tissue from the lining of the uterus
    You should do the following:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners, such as warfarin (Coumadin)
      • Clopidogrel (Plavix)
    • Arrange for a ride home and for help at home.
    • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

    Anesthesia

    General anesthesia will be used. You will be asleep during the surgery.
    LAVH
    Laparoscopic hysterectomy
    Copyright © Nucleus Medical Media, Inc.

    Description of the Procedure

    You may be given antibiotics just before your surgery.
    Laparoscopic procedures are minimally invasive. This means that small incisions are made, rather than the large incisions that are used during open surgery.
    Supracervical Hysterectomy
    During this procedure, the doctor will make small incisions in the area of your navel and hip bone. A laparoscope (a small tool with a camera on one end) will be inserted through one of the incisions. The tool will allow the doctor to view your pelvic organs on a monitor. Other tools will also be inserted to do the surgery. Next, the doctor will detach the uterus from the cervix. A tool will be used to break down the uterus into smaller pieces. The doctor will then remove this tissue through the small incisions.
    Laparoscopic-Assisted Vaginal Hysterectomy
    Similar to the above surgery, the doctor will make small incisions in the abdominal area and insert tools. The doctor will then make an incision in the vagina to help detach the lower portion of the cervix and the uterus. The cervix and uterus will then be removed through the vaginal opening.
    Robot-Assisted Hysterectomy
    A hysterectomy can also be done using robotic technology. Like the laparoscopic procedures, tools are placed through small incisions in the abdominal area. The doctor, though, sits at a console and views the organs via a monitor that displays a 3D image. The surgery is done using a joystick-like device to control the tools.

    Immediately After Procedure

    You will be given IV fluids and medicines.

    How Long Will It Take?

    1-3 hours

    Will It Hurt?

    You will not have pain during the surgery because of the anesthesia. During your recovery time, your doctor will give you pain medicine.

    Average Hospital Stay

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

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital, you may receive the following care:
    • On the first night, the nurse will help you sit up and walk.
    • During the next morning, the IV will be removed if you are eating and drinking well.
    • You may need to wear special stockings or boots to help prevent blood clots.
    • You may have a Foley catheter for a short time to help you urinate.
    At Home
    During the first few days, you may have pain, bloating, vaginal bleeding, and vaginal discharge.
    When at home, take these steps to care for yourself:
    • To prevent infection, take proper care of the incision areas.
    • Slowly increase your activities. Begin with light chores and short walks.
    • During the first two weeks, rest and avoid strenuous activities, like heavy lifting.
    • Ask your doctor when it is safe for you to return to work and drive.
    • Ask your doctor when you will be able to shower, bathe, or soak in water.
    • Eat a diet rich in fruits and vegetables.
    • Pain medicines can cause constipation. To avoid constipation:
    • Ask your doctor when you can use tampons.
    • Wait six weeks before resuming sexual activity.
    • Ask your doctor if you should do Kegel exercises to strengthen the pelvic floor muscles.
    • Follow your doctor's instructions.
    Note: If the doctor has not removed your cervix, you will need to continue to have Pap smears to check for cervical cancer.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, leakage, or any discharge from the incision sites
    • Nausea and/or vomiting
    • Dizziness or fainting
    • Cough, shortness of breath, or chest pain
    • Heavy bleeding
    • Pain that you cannot control with the medicines you have been given
    • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
    • Swelling, redness, or pain in your leg
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Family Physicians http://www.aafp.org/

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

    CANADIAN RESOURCES

    Canadian Medical Association http://www.cma.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Hysterectomy. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq008.pdf?dmc=1&ts=20120815T1040007858. Published August 2011. Accessed August 16, 2012.

    Hysterectomy. Bon Secours St. Francis Health System website. Available at: http://www.stfrancishealth.org/our-services-surgical-care-surgical-procedures-hysterectomy.html. Accessed August 16, 2012.

    Laparoscopic supracervical hysterectomy. Shawnee Mission Medical Center website. Available at: http://videocenter.shawneemission.org/videos/laparoscopic-supracervical-hysterectomy. Accessed August 16, 2012.

    McCoy K. Robot-assisted laparoscopic procedures. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated December 30, 2011. Accessed August 16, 2012.

    The treatment: robot-assisted laparoscopic hysterectomy. UC Davis Health System website. Available at: http://www.ucdmc.ucdavis.edu/obgyn/specialties/robotic%5Fsurgery/hysterectomy.html. Accessed August 16, 2012.

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