Preparing for a Hysterectomy Surgery

You’ve discussed the benefits and risks of having a hysterectomy with your doctor. You’ve considered and tried alternative treatments, if any. And you’ve finally decided that a hysterectomy is the best way to proceed based on your personal and medical reasons for having the procedure.

Now, it’s time to get ready for your hysterectomy. “It’s helpful to be mentally and physically prepared,” says Hye-Chun Hur, MD, the director of minimally invasive gynecological surgery at Beth Israel Deaconess Medical Center and an assistant professor of obstetrics and gynecology at Harvard Medical School in Boston. Taking these steps — and others your doctor may have recommended — can help ease worries and speed recovery.

A Month (or More) Before a Hysterectomy Surgery

• Gather information. Learn as much as you can about having a hysterectomy. Make sure you understand how the procedure will go, as well as what is involved in the recovery process. “You need to be comfortable with what to expect,” says Sarah L. Cohen, MD, MPH, director of research at the division of minimally invasive gynecologic surgery at Brigham and Women’s Hospital.
• Lose weight, if you’re overweight. Being overweight can increase the risks associated with surgery and anesthesia, and severe obesity can increase surgery time and blood loss. If you’re overweight, talk to your doctor about the best way to go about losing weight before your surgery.
• Stop smoking. “Stopping or cutting down on smoking as much as possible can help with general anesthesia and recovery from surgery,” Dr. Cohen says. Smokers may have problems breathing during surgery, and they tend to heal more slowly afterward.
• Discuss your medication with your doctor. Talk to your doctor about whether you need to change your usual medication routine before having a hysterectomy. You should also let your doctor know about any over-the-counter medications, such as aspirin, or dietary supplements you’re taking. Some supplements can help prepare you for a hysterectomy. For example, taking a daily multivitamin can help improve general health, and vitamin C can help promote healing. Talk to your doctor about recommended supplements you might take before your hysterectomy surgery.
• Make sure other medical conditions are well-controlled. If you have diabetes, high blood pressure, sleep apnea, or other medical conditions, check with your doctor to make sure they’re under control before you have a hysterectomy. When other pre-existing conditions are managed, Cohen says, surgery is likely to be safer and recovery faster.
• Plan to take time off work to fully recover. Fill out any necessary paperwork for medical leave before your hysterectomy. Depending on the type of surgical procedure performed, recovery time may take two to six weeks. During that time, you may not be able to drive or lift heavy objects, so also arrange for someone to help you on a day-to-day basis.

A Week Before a Hysterectomy Surgery

• Drink lots of liquids. Being well-hydrated can help prevent constipation, a common side effect of surgery that can cause particular discomfort after a hysterectomy.
• Get your post-op prescriptions filled. “Ask if your doctor can write your post-op prescriptions ahead of time, and have them filled,” Cohen says. It will save you from having to make an uncomfortable stop on the way home from the hospital.
• Don’t worry about your menstrual cycle. Being on your period will not delay or affect your surgery.
• Plan ahead for an easier recovery at home. Shop for and prepare easy-to-make meals for the weeks following surgery. “Also think about your home’s layout,” Cohen says. “Limit the need to climb stairs during recovery, and move things around for easier access.”
• Make arrangements for someone to drive you home after the procedure. You will not be allowed to drive after undergoing anesthesia and will be required to have someone drive you home after the procedure. Your doctor will likely recommend that you don’t drive for up to two weeks after the surgery.

A Day Before a Hysterectomy Surgery

• Eat light. Limiting heavy foods and avoiding big meals can help you feel better before and after the procedure. “Eating healthy is always important, but even more so when you plan to have surgery,” Dr. Hur says.
• Gather your medical information. This may include your medical records, a list of any drugs or supplements you’re taking, any imaging results, such as X-rays, and allergy information. You’ll be required to provide this medical information at your pre-op appointment.
• Follow your doctor’s instructions for eating, drinking, and bowel preparation. In most cases, you won’t be able to have any solid foods or liquids after midnight the night before surgery. Prior to any abdominal surgery, your doctor may also prescribe a bowel cleansing oral solution. However, if you have certain conditions, such as a perforated bowel, a bowel obstruction, or severe constipation, this step may not apply for you. It’s important to follow your doctor’s instructions when it comes to this and other kinds of preparation before surgery.
• Relax the night before your procedure. The anticipation of surgery is stressful for some women. When you’re stressed, your body releases stress hormones, which can weaken the immune system and disrupt the body’s ability to manage pain and infection. For this reason, it’s important to relax the night before surgery — and even earlier. Make sure you get plenty of rest, and if you’re very anxious, try deep breathing and positive visualization (picture the surgery going well, and think about how much better you’ll feel afterward).

The Day of a Hysterectomy Surgery

• Skip breakfast. Don’t eat or drink anything unless you have been specifically told by the anesthesiologist that it’s OK to do so. Even if you brush your teeth, do not swallow the water.
• Don’t wear jewelry to the hospital. “You should remove all jewelry in preparation for surgery,” Hur says. “If you can’t, it doesn’t mean you have to cut it off, such as with a wedding ring that hasn’t been taken off for many years.” Talk to your doctor about what’s appropriate.
• Reschedule the procedure if you’re sick. Any illness that affects your respiratory system, like pneumonia or the flu, may be a reason to delay the procedure. Minor problems like having the sniffles shouldn’t be a problem, but tell your doctor if you’re not feeling well on the day of surgery.

About Your Robotic-Assisted or Laparoscopic Hysterectomy

This guide will help you get ready for your robotic-assisted or laparoscopic hysterectomy at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.

Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

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About Your Surgery

A hysterectomy is a surgery that removes the uterus. You may be having a hysterectomy because you have uterine, cervical, or ovarian cancer, uterine fibroids, endometriosis, heavy vaginal bleeding, or pelvic pain. Your healthcare provider will explain why you’re having the surgery.

About your uterus

Your uterus is located in the lower abdomen (belly) between your bladder and rectum. The lower narrow end of your uterus is called your cervix (see Figure 1). Your ovaries and fallopian tubes are attached to your uterus.

Figure 1. Your uterus

After your hysterectomy, you won’t be able to have children naturally. Menstruation (getting your period) will also stop. A hysterectomy does not cause menopause unless your ovaries are removed. If you would like to have biological children in the future, ask your healthcare provider for a referral to a fertility specialist.

Robotic-assisted and laparoscopic hysterectomy

You’ll have either a robotic-assisted or a laparoscopic hysterectomy. Both types will allow your surgeon to perform a precise and less invasive procedure than open surgery.

In both types of hysterectomies, your surgeon will make several small incisions (surgical cuts) on your abdomen. A laparoscope, (a tube-like instrument with a camera) will be placed into your abdomen. The tool is connected to a video camera and television that allows your surgeon to see the inside of your abdomen. Gas (carbon dioxide) will be pumped into your abdomen to create space, which gives your surgeon more room to perform the surgery. Tiny tools will also be inserted into the incisions on your abdomen.

In a laparoscopic hysterectomy, your surgeon sees the image on a monitor and can remove tissue with the instruments. In a robotic-assisted hysterectomy, your surgeon uses a robot as a tool to do the surgery. Your surgeon sits at a console with a 3-dimensional view of the surgical site. They do the surgery from there, using a robot that they control.

In both approaches, your surgeon will remove your uterus and cervix through your vagina, if possible. If your uterus or cervix can’t be removed through your vagina, your surgeon will make one of your incisions larger, and remove the organs from there. Your incisions will be closed with sutures (stitches).

Your surgeon may also perform one or both of the procedures listed below. If so, this is done at the same time as your hysterectomy.

Salpingo-oophorectomy

Depending on your surgery, one or both of your ovaries and fallopian tubes may be removed. This is called a salpingo-oophorectomy.

If both ovaries are removed, you’ll go into menopause, if you have not already. If you have already gone through menopause, you should not notice any changes. If you have not started menopause, you may experience common symptoms, including night sweats, hot flashes, and vaginal dryness. Speak with your healthcare provider about ways to manage these symptoms.

Sentinel lymph node mapping and lymph node dissection

Lymph nodes are small, bean-like structures that are found throughout your body. They make and store the cells that help fight infections. Sentinel lymph nodes are the lymph nodes that are most likely to be affected if you have cancer and it has spread.

Your surgeon may do sentinel lymph node mapping and remove some of your lymph nodes, which is called a lymph node dissection. You’ll get anesthesia (medication to make you sleep) before these procedures.

For sentinel lymph node mapping, your surgeon will inject a small amount of dye in the area where the cancer may be. Your surgeon will discuss with you the type of dye they’ll use. This dye travels to the sentinel nodes and turns them blue or green. Once the sentinel node(s) are located, your surgeon will make a small incision. They’ll remove the sentinel node(s) (the nodes that have turned blue or green) and the nodes will be examined to see if they contain cancer cells.

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Before Your Surgery

The information in this section will help you get ready for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.

Write down your questions and be sure to ask your healthcare provider.

Getting ready for your surgery

You and your healthcare team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

• I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin^®), clopidogrel (Plavix^®), enoxaparin (Lovenox^®), dabigatran (Pradaxa^®), apixaban (Eliquis^®), and rivaroxaban (Xarelto^®). There are others, so be sure your healthcare provider knows all the medications you’re taking, including patches and creams.
• I take prescription medications, including patches and creams.
• I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I have had a problem with anesthesia (medication to make you sleep) in the past.
• I am allergic to certain medication(s) or materials, including latex.
• I am not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke.
• I use recreational drugs.

About drinking alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

• If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
• If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

• Be honest with your healthcare providers about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
• Tell your healthcare provider if you can’t stop drinking.
• Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. If you smoke, your healthcare provider will refer you to our Tobacco Treatment Program. You can also reach the program by calling 212-610-0507.

About sleep apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device (such as a CPAP device) for sleep apnea, bring it with you the day of your surgery.

Within 30 days of your surgery

Presurgical Testing (PST)

Before your surgery, you’ll have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

You can eat and take your usual medications the day of your PST appointment.

During your appointment, you’ll meet with a nurse practitioner (NP) who works closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s very helpful to bring the following things to your PST appointment:

• A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
• Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
• The name(s) and telephone number(s) of your healthcare provider(s).

Complete a Health Care Proxy form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. If you have completed one already, or if you have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent.

Talk with your healthcare provider if you’re interested in completing a health care proxy. You can also read the resources Advance Care Planning and How to Be a Health Care Agent for information about health care proxies, other advance directives, and being a health care agent.

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.

For caregivers

‌  Resources and support are available to help manage the responsibilities that come with caring for a person going through cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read A Guide for Caregivers.

Do breathing and coughing exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.

Exercise

Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Follow a healthy diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% Chlorhexidine Gluconate (CHG) Solution Antiseptic Skin Cleanser (such as Hibiclens®), if Needed

Your nurse will tell you if you need to wash with a 4% CHG solution antiseptic skin cleanser before your surgery.

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Don’t stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil^®, Motrin^®) and naproxen (Aleve^®), 2 days before your surgery. These medications can cause bleeding. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Note the time of your surgery

A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you on the Friday before. If you don’t get a call by 7:00 pm, call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

Begin bowel preparation, if needed

You may also need to do a bowel preparation in order to empty your bowels before surgery. If you need to do this, your nurse will give you instructions.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens), if needed

The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.

1. Use your normal shampoo to wash your hair. Rinse your head well.
2. Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
3. Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
4. Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Don’t put it on your face or genital area.
5. Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
6. Dry yourself off with a clean towel after your shower.
7. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for eating before your surgery

‌  
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
 

The Morning of Your Surgery

Instructions for drinking before your surgery

‌  You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.

Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take your medications

If your doctor or NP instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens), if needed

If your healthcare provider told you to, shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

• Don’t put on any lotions, creams, deodorants, makeup, powders, or perfumes.
• Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
• Leave valuables, such as credit cards, jewelry, or your checkbook at home.
• Before you are taken into the operating room, you’ll need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles.
• Wear something comfortable and loose-fitting.
• If you wear contact lenses, wear your glasses instead.
• If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

• Only the money you may need for a newspaper, bus, taxi, or parking.
• Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.
• Your incentive spirometer, if you have one.
• Your breathing machine for sleep apnea (such as your CPAP), if you have one.
• A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, if you have it.
• Your Health Care Proxy form, if you have completed one.
• This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Once you’re in the hospital

You’ll be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.

Get dressed for surgery

When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet with your nurse

You’ll meet with your nurse before surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Meet with your anesthesiologist

Your anesthesiologist will:

• Review your medical history with you.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you’ll receive.
• Answer any questions you may have about your anesthesia.

Prepare for surgery

You’ll walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs. You may also have a blood pressure cuff and EKG pads to monitor you during surgery.

Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.

Once you are fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You may also have a urinary (Foley) catheter placed to drain urine from your bladder.

Once your surgery is finished, your incisions will be closed Steri-Strips^™ (thin pieces of tape) or Dermabond^® (surgical glue) and covered with a dry dressing. Your breathing tube is usually taken out while you are still in the operating room.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You’ll learn how to safely recover from your surgery.

Write down your questions and be sure to ask your healthcare provider.

What to expect

When you wake up after your surgery, you’ll be in the Post-Anesthesia Care Unit (PACU) or your recovery room.

A nurse will be monitoring your body temperature, blood pressure, pulse, and oxygen levels.

You may have a urinary catheter in your bladder to help monitor the amount of urine you are making. It should come out before you go home. You’ll also have compression boots on your lower legs to help your circulation.

Your pain medication will be given through an IV line or in tablet form. If you are having pain, tell your nurse.

Your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.

• You’ll be encouraged to walk with the help of your nurse or physical therapist. We’ll give you medication to relieve pain. Walking helps reduce the risk for blood clots and pneumonia. It also helps to stimulate your bowels so they begin working again.
• Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, read How to Use Your Incentive Spirometer.

Commonly asked questions

Will I have pain after surgery?

Yes, you’ll have some pain after your surgery, especially in the first few days. Your healthcare provider will ask you about your pain often. You’ll be given medication to manage your pain as needed. If your pain is not relieved, please tell your healthcare provider. It is important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.

Will I be able to eat?

Yes, you’ll be able to eat a regular diet or eat as tolerated. You should start with foods that are soft and easy to digest such as apple sauce and chicken noodle soup. Eat small meals frequently, and then advance to regular foods.

If you experience bloating, gas, or cramps, limit high-fiber foods, including whole grain breads and cereal, nuts, seeds, salads, fresh fruit, broccoli, cabbage, and cauliflower.

Will I have pain when I am home?

The length of time each person has pain or discomfort varies. You may still have some pain when you go home and will probably be taking pain medication. Follow the guidelines below.

• Take your medications as directed and as needed.
• Call your healthcare provider if the medication prescribed for you doesn’t relieve your pain.
• Don’t drive or drink alcohol while you’re taking prescription pain medication.
• As your incision heals, you’ll have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol^®) or ibuprofen (Advil^®) will relieve aches and discomfort. However, large quantities of acetaminophen may be harmful to your liver. Don’t take more acetaminophen than the amount directed on the bottle or as instructed by your healthcare provider.
• Pain medication should help you as you resume your normal activities. Take enough medication to do your exercises comfortably. Pain medication is most effective 30 to 45 minutes after taking it.
• Keep track of when you take your pain medication. Taking it when your pain first begins is more effective than waiting for the pain to get worse.

Pain medication may cause constipation (having fewer bowel movements than what is normal for you).

How can I prevent constipation?

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.

• Go to the bathroom at the same time every day. Your body will get used to going at that time. But, if you feel like you need to go, don’t put it off.
• Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. The reflexes in your colon are strongest at this time.
• Exercise, if you can. Walking is an excellent form of exercise.
• Drink 8 (8-ounce) glasses (2 liters) of liquids daily, if you can.
  • Choose liquids such as water, juices (such as prune juice), soups, and ice cream shakes.
  • Avoid liquids with caffeine (such as coffee and soda). Caffeine can pull fluid out of your body.
• Slowly increase the fiber in your diet to 25 to 35 grams per day. If you have an ostomy or have had recent bowel surgery, check with your healthcare provider before making any changes in your diet. Foods high in fiber include:
  • Bran
  • Whole-grain cereals and breads
  • Unpeeled fruits and vegetables
  • Mixed green salads
  • Apricots, figs, and raisins
• Both over-the-counter and prescription medications are available to treat constipation. Check with your healthcare provider before taking any medications for constipation, especially if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medications for constipation include:
  • Docusate sodium (Colace^®). This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Don’t take it with mineral oil.
  • Polyethylene glycol (MiraLAX^®). This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
  • Senna (Senokot^®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.

  If any of these medications cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if needed.

• Call your healthcare provider if you haven’t had a bowel movement in 2 days.

Can I shower?

Yes, you should shower 24 hours after your surgery. Be sure to shower every day.

Taking a warm shower is relaxing and can help decrease muscle aches. Use soap when you shower and gently wash your incision. Pat the areas dry with a towel after showering, and leave your incision uncovered (unless there is drainage). Call your healthcare provider if you see any redness or drainage from your incision.

Don’t take tub baths until you discuss it with your healthcare provider at the first appointment after your surgery.

How do I care for my incisions?

You’ll have several small incisions on your abdomen. The incisions are closed with Steri-Strips or Dermabond. You may also have square white dressings on your incisions (Primapore^®). You can remove these in the shower 24 hours after your surgery. You should clean your incisions with soap and water.

If you go home with Steri-Strips on your incision, they’ll loosen and may fall off by themselves. If they haven’t fallen off within 10 days, you can remove them.

If you go home with Dermabond over your sutures (stitches), it will also loosen and peel off.

What are the most common symptoms after a hysterectomy?

It’s common for you to have some vaginal spotting or light bleeding. You should monitor this with a pad or a panty liner. If you have having heavy bleeding (bleeding through a pad or liner every 1 to 2 hours), call your healthcare provider right away.

It’s also common to have some discomfort after surgery from the air that was pumped into your abdomen during surgery. To help with this, walk, drink plenty of liquids and make sure to take the stool softeners you received.

When is it safe for me to drive?

You may resume driving 2 weeks after surgery, as long as you aren’t taking pain medication that may make you drowsy.

When can I resume sexual activity?

Do not place anything in your vagina or have vaginal intercourse for 8 weeks after your surgery. Some people will need to wait longer than 8 weeks, so speak with your healthcare provider before resuming sexual intercourse.

Will I be able to travel?

Yes, you can travel. If you are traveling by plane within a few weeks after your surgery, make sure you get up and walk every hour. Be sure to stretch your legs, drink plenty of liquids, and keep your feet elevated when possible.

Will I need any supplies?

Most people do not need any supplies after the surgery. In the rare case that you do need supplies, such as tubes or drains, your nurse will order them for you.

When can I return to work?

The time it takes to return to work depends on the type of work you do, the type of surgery you had, and how fast your body heals. Most people can return to work about 2 to 4 weeks after the surgery.

What exercises can I do?

Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your healthcare provider before starting more strenuous exercises.

When can I lift heavy objects?

Most people should not lift anything heavier than 10 pounds (4.5 kilograms) for at least 4 weeks after surgery. Speak with your healthcare provider about when you can do heavy lifting.

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support.

The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you’re in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

When is my first appointment after surgery?

Your first appointment after surgery will be 2 to 4 weeks after surgery. Your nurse will give you instructions on how to make this appointment, including the phone number to call.

What if I have other questions?

If you have any questions or concerns, please talk with your healthcare provider. You can reach them Monday through Friday from 9:00 am to 5:00 pm.

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the person on call for your healthcare provider.

When to call your healthcare provider

Call your healthcare provider if you:

• Have a fever of 101 °F (38.3 °C) or higher
• Have pain that doesn’t get better with pain medication
• Have redness, drainage, or swelling from your incisions
• Have swelling or tenderness in your calves or thighs
• Cough up blood
• Have any shortness of breath or difficulty breathing
• Do not have any bowel movement for 3 days or longer
• Have nausea, vomiting, or diarrhea
• Have any questions or concerns

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Support Services

This section contains a list of support services that may help you get ready for your surgery and recover safely.

Write down your questions and be sure to ask your healthcare provider.

MSK support services

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, including requesting a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

Chaplaincy Service
212-639-5982
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

Counseling Center
646-888-0200
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Food Pantry Program
646-888-8055
The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org.

Patient and Caregiver Education
www.mskcc.org/pe
Visit the Patient and Caregiver Education website to search our virtual library. There, you can find written educational resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may find it comforting to speak with someone who has been through a treatment similar to yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. These conversations are confidential. They may take place in person or over the phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nursing Office
212-639-6892
You may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can have an impact on your sexual health. MSK’s Sexual Health Programs can help you take action and address sexual health issues before, during, or after your treatment.

• Our Female Sexual Medicine and Women’s Health Program helps women who are dealing with cancer-related sexual health challenges, including premature menopause and fertility issues. For more information, or to make an appointment, call 646-888-5076.
• Our Male Sexual and Reproductive Medicine Program helps men who are dealing with cancer-related sexual health challenges, including erectile dysfunction. For more information, or to make an appointment, call 646-888-6024.

Social Work
212-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

Virtual Programs
www.mskcc.org/vp
MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.

For more online information, visit the Cancer Types section of www.mskcc.org.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25^th & 26^th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

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Educational Resources

This section contains the educational resources that were referred to throughout this guide. These resources will help you get ready for your surgery and recover safely after surgery.

Write down your questions and be sure to ask your healthcare provider.

For information about lymphedema, you can also read the New York State Department of Health’s resource Understanding Lymphedema.

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Gary Willen, MD, MBA: Gynecologist

If, for whatever reason, a hysterectomy looms in your future, there are many things you can do ahead of time to ease the process. While surgery of any kind is no one’s idea of fun, with a little forethought and planning, you can ensure that everything goes as smoothly as possible.

When it comes to surgery, there’s very rarely any good news. In your case, however, it’s more than likely that you’re undergoing a hysterectomy to seek relief from heavy bleeding, pain, or some other medical problem. Now, add the fact that Dr. Gary Willen of Tahoe Women’s Care is highly-experienced in the latest robotic surgical technology, which affords women in Carson City, Nevada, greatly-reduced downtime and risk. All of a sudden, your hysterectomy may seem like a fair trade for a future of good health.

To prepare yourself for your hysterectomy, we’ve gathered a few tips that will help you better weather your surgery and your recovery.

Load up on fitness

Since you won’t be able to engage in much activity for a few weeks after your surgery, put some fitness in the bank. Add a few workouts to your routine so that you’re fighting fit for your surgery, and you won’t feel guilty about a little inactivity during your recovery.

Besides, losing a few pounds, if you’re overweight, or improving your cardiovascular health before any surgery is a good idea.

As long as we’re talking about fitness, you’d do well to add a hefty dose of Kegel exercises to your daily routine. Kegel exercises strengthen your pelvic floor muscles, and once we remove your uterus, you’ll need those muscles more than ever to keep your other organs in place.

Talk to your partner

Physically, you won’t be able to participate in sexual intercourse for six weeks after your procedure. Mentally, you may need more time than that. Talk to your partner ahead of time to make sure the lines of communication are open during every step of this journey.

Understand the consequences

There are different variations of hysterectomies, and your doctor determines if other organs are removed in addition to your uterus. If your ovaries are removed at the same time — called an oophorectomy — your body goes into menopause, since your ovaries won’t be producing reproductive hormones anymore.

The effect this hormonal change will have on you is hard to predict. Some women sail through menopause while others are plagued by side effects like hot flashes and painful sex for years.

Feel free to ask us anything you’d like about menopause so that you can be prepared for the road ahead. We don’t want you to assume that it’s going to be a bumpy journey, but it’s always good to have an idea of the potential impact. As well, we can fill you in on all of the wonderful new treatments for menopause, so please know it’s not a life sentence.

Household help

When it comes to your hysterectomy, we’re able to use the latest surgical techniques, including both laporscopy and the da Vinci® robotic system. This means we only need to make very small incisions to do the work, rather than using the traditional method of cutting across your abdominal muscles. As a result, your postoperative downtime shrinks from four to six weeks to only one to two weeks.

That said, it’s still surgery, and though the incisions may be small, you’ll still need to take it easy for a while afterward. To help you get through this time, make plans beforehand for any chores and tasks that you might need help with.

For example, enlist friends and family to do some of the heavy lifting around the house for the first couple of weeks, from mowing the lawn to vacuuming. The more you can get covered ahead of time, the better able you’ll be to get down to the business of healing.

Follow instructions

As the date of your surgery approaches, we’ll give you a list of preoperative instructions. We ask that you follow these carefully to make sure the procedure is as routine as possible. Cheating on the eating restrictions, for example, may leave you feeling very ill after the anesthesia. And you don’t want to be vomiting with abdominal incisions.

We understand that a hysterectomy is a big decision, and we’re here to help you every step of the way. Please call us with any questions you may have before your procedure. Your comfort and success are important to us.

Gynecologic Surgery – Preparation & Post-Operative Instructions and Precautions – Health Care Services

Preparation for surgery

Preoperative bowel preparation

Day of the procedure

Postoperative instructions for most gynecologic surgeries

Precautions

Follow-up

Preparation for surgery

• Make an appointment, usually with your primary care doctor, for a history and physical (H&P) examination. Regulations require that this exam take place within 30 days of your surgery, or your surgery will be delayed or canceled.
• If you take medication daily, please check with your prescribing physician for instructions on whether to stop or continue to take them the day of surgery. Medication on the day of surgery can be taken with a sip of water that morning.
• Do not take any aspirin or over-the-counter products that contain aspirin 1 week prior to surgery. You may take Tylenol only.
• If your procedure requires a bowel prep, you may have solid food up until you start the prep. Once started, you may only have clear liquids up until 6 hours before your surgery. If you do not require a bowel prep, have nothing to eat after midnight; you may have clear liquids up until 6 hours before your procedure. See bowel preparation instructions.

Preoperative bowel preparation

Your surgery requires a bowel prep to cleanse your bowel of all solid material. Follow the instructions below. Proper bowel preparation will reduce the risk of injury to the bowel during surgery.

A few days prior to surgery

• You will need to purchase 2 bottles of Magnesium Citrate (10 oz. each) and 2 Bisacodyl tablets (5 mg each tablet) from your local grocery store or pharmacy.

One day prior to surgery

• Your bowel prep begins the day before your surgery. You can have solid foods the day before, but once you’ve started the bowel prep you can only have clear liquids.
• We also recommend that if you do eat solid foods before your prep that you eat lightly. Examples: Toast, yogurt, soup.
• OPTION 1 (noon & 4 p.m.) — If you will be home the day before your surgery, start bowel prep:
  • At noon — Drink one bottle of Magnesium Citrate. This can be swallowed alone or mixed with a clear liquid of your choice. Continue to drink at least 8 oz. of clear liquid each hour.
  • At 4 p.m. — Drink the second bottle of Magnesium Citrate (10 oz.) AND take 2 Bisacodyl tablets. Continue to drink at least 8 oz. of clear liquid each hour until retiring for sleep.
• OPTION 2 (4 p.m. & 8 p.m.) — If you are unable to be home the day before your surgery, start bowel prep:
  • At 4 p.m. — Drink one bottle of Magnesium Citrate. This can be swallowed alone or mixed with a clear liquid of your choice. Continue to drink at least 8 oz. of clear liquid each hour.
  • At 8 p.m. — Drink the second bottle of Magnesium Citrate (10 oz.) AND take 2 Bisacodyl tablets. Continue to drink at least 8 oz. of clear liquids each hour until retiring for sleep.
• We would like you to have at least 10 8-oz. glasses of clear liquid from the time you start the bowel prep until you go to sleep.
• You may drink clear liquids up until 6 hours prior to your scheduled surgery time.
• You will notice an increase in watery bowel movements throughout the day. If this does not occur by the completion of the second dose of Magnesium Citrate, you may take a Fleet Enema or Milk of Magnesia to completely clear your bowels.
• Because you are drinking an increase in clear liquids during the bowel prep experience, you may notice that your urine is a light clear yellow color.
• Note: The later you start your bowel prep, the later you’ll be awake with bowel movements.

Clear liquid diet

These items are allowed during your bowel prep up until 6 hours before surgery:

• Water
• Clear broths (chicken or beef)
• Juices (apple or cider)
• White grape juice
• Clear soda
• Tea (no milk, creamer, or honey)
• Coffee (no milk or creamer)
• Jell-O (without fruit/no red Jell-O)
• Popsicles (without fruit/cream)
• Italian ice (no red)
• Clear Gatorade
• Spices and seasonings such as salt, pepper, sugar, and sugar substitutes may be used.

These items are not allowed:

• Milk
• Cream
• Milkshakes
• Orange juice
• Tomato juice
• Creamy soup or any soup other than clear broth
• Solid foods

Day of the procedure

• Do not shave or mark your skin anywhere near your surgical site.
• Do not wear makeup.
• All jewelry, including body piercings, must be removed prior to surgery. Leave all jewelry at home.
• Wear loose and comfortable clothing.
• Please arrive on time. Every effort is made to ensure your surgery begins at the scheduled time; however, your surgery may be delayed as a result of a hospital emergency or because of commonly encountered variations in the length of certain procedures due to unanticipated findings.
• All patients are required to have an escort home after surgery.

If you are going home the same day

• If your surgery involves anesthesia or sedation, you must be accompanied by a responsible person when you leave the hospital. You cannot drive yourself home.
• You should have an adult stay with you for 12-24 hours following your surgery.

Questions

• If you have questions about your surgery, contact our office during office hours.
• If you have other questions, contact the Abbott Northwestern surgical information line at 612-863-3138, Monday through Friday from noon to 6 p.m. A registered nurse will be available to answer your questions.
• Visit Preparing for Your Surgery for more information about Abbott Northwestern and your surgery.

Postoperative instructions for most gynecologic surgeries

The recommendations that follow are intended as a general guide to your first weeks at home. However, the most important thing is to use good common sense in planning your activities. If it hurts, don’t do it; and don’t do anything to the point of exhaustion.

• After minimally invasive procedures, laparoscopy, hysteroscopy, vaginal surgeries, and robotic procedures, you should be up and moving about freely soon after the surgery. Gradually increase your activities.
• You are allowed to climb stairs, but try not to become too tired.
• Avoid heavy lifting. Avoid strenuous exercise or sports for 2 weeks.
• Do not drive until you can do so without discomfort and without using pain medicine. This can take from 3 to 7 days.
• You may shower and wash your hair. Soapy water can run over the incisions. Do not soak the incisions in a tub immediately following surgery.
• No intercourse, douching, or tampons for at least 2 weeks. Longer restrictions may apply to vaginal surgeries.
• It can be normal to have a slight vaginal discharge, which may be bloody. Use sanitary pads not tampons.
• If you experience bleeding heavier than a period, call the office.
• You may eat and drink as tolerated. Go easy at first, with clear liquids, soup or broth, and crackers, before progressing to solids.
• Increase fiber and fluids if you get constipated. If needed, a stool softener (Surfak, Colace, or a generic equivalent) maybe purchased and taken by mouth as directed. It is common for narcotic pain medicines to cause constipation. If no bowel movement has occurred for 2-3 days, you may use Miralax, Milk of Magnesia, or Senokot. Do not use Correctol or Ex-Lax.

Precautions

• Contact the office if you experience fever of 100.4 or higher, chills, vomiting, pain unrelieved by using pain pills, vaginal bleeding heavier than a period, or foul-smelling discharge.
• Contact the office if you experience any urinary frequency, urgency, or burning that doesn’t respond to increasing fluids, cranberry juice, and nonprescription bladder medicine such as AZO.
• Contact the office if you have any chest pain, shortness of breath, pain in the calves or legs, or redness, drainage, or separation of the incisions.

Follow-up

• If an appointment has not been scheduled for you, call the office and tell them the date of your surgery and which procedure you had, and they will schedule the follow-up visit. A pelvic examination is often done at that visit.

preop-laparoscopic-hysterectomy – VBGYN.com

Preparations

for Laparoscopic Hysterectomy

                                                                                                                             Print-Friendly PDF – click here

Preoperative Instructions / Recovery Info:   This document is intended to help you to be prepared for your surgery with Dr. Lackore.  It is intended to reduce any fear, counteract any misinformation, and to simply be helpful. As you read this, please highlight and underline any areas of concern, and write your questions on the sides of the pages so that you can be sure to ask them during your surgery-planning visit. Bring this material with you to every pre-operative visit and to the hospital so that you can read and refer to it after your surgery because it also contains your discharge orders. Your spouse, partner, or friend who will be your main caregiver should also read this entire document to be most helpful during and after your hospitalization.

Choosing a date for your surgery – Recovery from a laparoscopic hysterectomy is about two weeks. For open laparotomy incision surgery of any type, the recovery is six weeks. We build our office and surgical schedules around our commitment to your surgery date. Choose your date to allow for your recovery and so that you will not have any reason to cancel your surgery at the last minute. Last-minute cancellations waste time and resources because we cannot simply substitute another patient at the last minute. So please, please check with your family and work before you choose your date, and try not to change it.

All surgeries are performed at:

Sentara Virginia Beach General Hospital 
1060 First Colonial Road 
Virginia Beach, VA 23454
757-395-8000 

Remember that I have cross coverage with other Gynecologic Surgeons and if you phone outside office hours you may be managed by one of these Physicians at Sentara Leigh Medical Center.

Insurance – Make sure that we have all your up-to-date insurance information so that we can obtain authorization for your surgery. We do this as a courtesy, so you will know your portion of the probable charges.

Contacts – Please make sure we have your local and your cell phone numbers so you can be contacted by the operating rooms if needed for any last-minute change in the surgery schedule.

Final Pre-operative Visit:
• Final Explanation: I will formally review your findings and will explain the risks, benefits, and alternatives of your specific surgical plan and answer all your questions.
• Consent Form: You will be asked to sign a consent form for your surgery. Remember that these consents are written to assure that you and I both have a clear understanding of your proposed procedure. They are not contracts, so you can always change your mind.
• Questions: Ask all your questions, and know that there is no pressure to sign anything without your complete understanding and agreement.
• Items to take to Hospital: You will be given a copy of the consent forms, and your hospital admitting orders for blood work, EKG and Chest X-Ray, if required. Please remember to give all of these documents to the nurses when you check-in at the hospital.

Allergies and Current medications: Please make a list of allergies to medications and a list of all of your current medications with doses (mg) and frequencies (daily, twice daily, etc) Include herbal, naturopathic, and over-the-counter drugs.

Read carefully:
1. Stop taking all Aspirin, Motrin, Nuprin, Advil, Aleve, or Aspirin-like substances 3 days before surgery. Use only Tylenol or Vicodin (acetaminophen) if you need pain relief before your operation.
2. Stop all herbal remedies and nutritional supplements, Meridia, Fastin, Ionamin, Adipex, and any amphetamines 7 days before your surgery.
3. If you are taking Plavix, Pradaxa and Coumadin Make a plan with your prescribing provider to stop taking them 7 days before your surgery and discuss “bridge anticoagulation with Lovenox or Heparin with the prescriber, and tell Dr. Lackore the “bridge plan”.
4. You must stop taking Mardil, Parnate, Eldepryl, Marplan Clorgyline, Brofaromine, Moclobemide, and Tolozatone at least 14 days before your surgery.

Take all your medications (except as above) exactly as prescribed, each night and day before your surgery. The morning of your surgery, take all your medications with just a sip of water.

Pre Operative testing: If you have had any blood work in the last few months, let us know, so we can avoid unnecessary blood-draws. Sometimes it is still necessary to draw your blood to establish recent baseline values prior to surgery and to cross-match for possible transfusion. All patients with heart or lung problems need a recent Chest X-Ray and EKG. These tests may be ordered ahead of time or we may ask you to have them done after your final pre-operative visit. Please remain flexible so that you can possibly stop by the hospital for these tests when requested.

Blood Transfusions: About 1% of women having laparoscopic surgery and 5% of women having open incisional surgery need some type of blood transfusion. The risk of receiving hepatitis or HIV from the transfusion of banked blood is about 1 in 300,000, rare. There is a significant charge to process each unit of self-donated blood. Thus, donating your own blood for laparoscopic surgery will not be worth your trouble. Also, if you receive blood during your hospitalization, please arrange for a few friends or family members to donate for you after your surgery to replace the precious gift of blood that you received.

Preparing and packing for your hospital stay:  Wear comfortable clothes that you can wear over your incisions during the drive home. Sweatsuits are a great choice. Do not wear or bring jewelry to the hospital. There is really no need for pajamas as the hospital provides covering for you. Bring your toothbrush and necessary cosmetics, a few light sanitary pads, and any particular health aids. Do not wear any eye make-up, as it may enter your eye fluid during your anesthesia and cause severe irritation. Wear glasses, not contacts, and be reassured that you can wear glasses, partial teeth, and hearing aids until the very last minute, taking them off in the operating room just before you go to sleep, and find them with you in the recovery room ready to put back on/in as soon as you wake up. While you are welcome to shave your legs if you prefer, PLEASE DO NOT shave the surgical site for us. We will shave only what is essential for the incisions in the operating room. Shaving the surgical site before this time actually increases wound infection rates.

The Hospital Pre-Op Nurse is available to answer your questions about registration and Pre-surgery process:
Sentara Virginia Beach General: (757) 395-8169.

Power of Attorney: If you are single, widowed, or in an unregistered domestic partnership, bring a copy of your durable medical power of attorney, or plan to sign one upon admission to the hospital. This will make certain that health decisions are made for you by the right person, if, for any reason, you cannot make your own decisions. If you are married your spouse is already legally your next-of-kin.

Bowel Preparation for Surgery: The entire length of your intestines must be emptied prior to surgery to make the surgery safer and the recovery easier. Empty bowels also make more room for me to operate. Please purchase the bowel prep below (No Prescription needed):

Take 4 Dulcolax oral laxative tablets at 2 pm. Next, Put 8.3 ounces of Miralax in 64 total ounces of Gatorade or Crystal Light or Vegetable/Chicken Broth and starting at 6 pm drink one cup every 15 minutes until all taken.

Also Purchase:
• Items to comfort your bottom!: 1 roll of very soft toilet paper, or Huggies brand non-scented moist towelettes for wiping, or A&D Ointment (to schmear over your anus (or all three!)).
• Acetaminophen 650 and Aleve 220-mg gel caps, 30-tablets, for preventing pain after you go home. Even if this did not work for your arthritis…together they work well for surgical pain. Buy it.
• Optional: Milk of Magnesia to relieve any constipation after you go home. Tell me if you have chronic constipation or irritable bowel, as it will happen after your surgery as well.
• Optional: 6 containers of natural yogurt (Dannon, Yoplait, etc) or Acidophilus in any form for regulating your bowel after you go home.
• One week of healthy, easy to prepare foods to come home to, as you won’t be driving for 10-14 days.
• Note: if you receive any advice from the anesthesiologist about when your last sip of water can be—follow the advice of the anesthesiologist. Otherwise, follow these instructions.

TWO DAYS BEFORE SURGERY: Eat regular food today. Pack your bag. Clean your house. You will be a new and healthier person when you come home!

ONE DAY BEFORE SURGERY
DAY OF BOWEL PREP:
1. Eat low or no-fiber food (plenty of meat, fish, dairy, eggs: no fibers such as fruits, grains, breads, nuts, or legumes just for today) for breakfast and lunch. You won’t be eating dinner. You will not be hungry during or after the bowel prep.
2. Start bowel prep, much earlier if you have chronic constipation. You will develop painless almost clear diarrhea, and then it will become brown again. This can happen quickly, or it could take several hours. Whenever your stool fluid becomes nearly perfectly clear, without any formed solid material, (tiny flecks fine) you may stop the bowel prep drinks, and go to step 3.
3. After you develop nearly clear rectal outflow, continue drinking any clear fluid of your choice such as tea, soft drink, or even more Gatorade/Broth until your urine is pale, dilute, and nearly clear before going to bed. This hydration is a very important preparation for your comfort the next morning. Don’t worry that your rectal outflow becomes cloudy brown again because it will. That’s fine.
4. Call my office 757-481-3366 if you have any problems or questions about the bowel preparation or medications. Call if you cannot follow the above instructions, as I may need to modify them for you, or postpone your surgery.
5. Finish cleaning your home. This is a time for a real cleansing! Finish packing!
6. After bowel prep: Do not eat anything. Nothing by mouth at all after midnight. (The anesthesiologist may tell you that you can have some clear liquid breakfast on the day of your surgery if your procedure is much later in the day. You may only have clear liquids, but carefully stop eating or drinking precisely according to the anesthesiologist’s instructions.) For your safety, your surgery will be canceled for another day if you have not followed these instructions correctly.

THE DAY OF SURGERY:
1. Take a nice shower. Apply no makeup, no jewelry. Bring contact or glasses case, dental fixture cases, and CPAP machine if you are on one. Pack overnight bag. No need for your jammies—we got ‘em.
2. Meds: Take only your daily prescription medications with a sip of water.
3. Diet: Do NOT eat or drink anything unless instructed specifically to do so. Do not chew gum or suck mints. No water, except sips with prescription meds.
4. Go to the hospital on time. Remain available by local phone or cell phone (make sure we have both of your numbers) in case your surgery time is changed. If the front door is locked very early in the morning, go to the side door on the right of the hospital.
5. Call Dr. Lackore at 757-481-3366 if you feel severely weak from not eating. Arrangements might be made for you to go early to the preoperative area 757-395-8169 to get your intravenous fluids started. This will relieve your weakness.

Hospital Check-in: Bring your surgical folder containing your consents and orders with you and give the nurses all of these when you check in to the hospital at the admitting desk. Bring your written list of medications, exact dose, and frequency that you take it, and give to the admitting nurse. At the admitting desk, you will be required to show your insurance card and you will be asked to pay for your portion of the cost of the hospital stay. Keep the receipts and all printed information that you will receive during the check-in and pre-op processes in your surgical folder.

Pre-operation Procedures: A nurse will review the forms that you completed at my office, and will ask you questions to complete new forms. Once the paperwork is complete, the nurse will give you your hospital gown. You may also receive antibiotics, preventive pain medications, and a blood-thinning shot to your abdominal wall skin, called Lovenox or Heparin. If you have any questions about what is happening to you, don’t hesitate to ask these nurses. They always want to relieve any anxiety that you might have by answering all of your questions.

The Anesthesiologist:  A Board-certified anesthesiologist will oversee your anesthesia during the entire case. She/he will meet you in the pre-operative area after you have checked in to discuss your anesthesia plan. Be sure to tell the anesthesiologist if you tend to get easily nauseous because today there are medications that can be added to your IV to significantly reduce the chance of nausea after surgery. The anesthesiologist will start your IV and will give you medication that will help you to relax (quite nicely!) prior to surgery. All of the abdominal cases, by laparoscope or by open incision, require “general” anesthesia; that is to say, you will sleep painlessly through the surgery and remember nothing.

Pre-operation waiting time:  While all efforts are made to have you in pre-op for only a short period of time, an operation preceding yours, or an Emergency Room patient, could delay your start time—up to a couple of hours in some cases. A family member or friend is allowed to stay with you in the pre-op area. Bring a cribbage game or cards to pass the time. If you are alone, bring a good book or a magazine. If you find that you are simply too, too nervous, ask the nurse to request an anti-anxiety shot from the anesthesiologist.

Going to the operating room for Surgery: The person who accompanies you can stay with you right up until you are taken into surgery. I will give her/him an idea of how long the surgery will last. It is a good idea for that person to get something to eat right after you go in so that she/he will be in the waiting room when you are done. The person waiting for you should be told that it is not unusual for surgery to run way past the estimated time period and not to panic if this occurs. The surgery might not have even started until hours after you were taken from the pre-operative area into the operating rooms. No one will notify her/him if surgery is running late, so even if two hours have passed, tell this person to try not to worry. Once you arrive in the OR, the anesthesiologist will give you the medications to fall asleep.

The assistant surgeons: There is almost always an assistant who helps me with the surgery, but I will perform your surgery. In addition, other fully trained medical doctors with other specialty expertise may be consulted to help in your care. You will receive a bill from any of these doctors who participate in your care. This is standard.

Observers and industry reps in the OR: I perform advanced laparoscopic procedures and use state-of-the-art equipment. On occasion, I request that registered equipment company representatives attend the case to provide me with a recently improved version of his usual equipment. There is no experimentation going on. (That would be unethical without your fully informed consent.) No one sees your face, your privates, or your name. This is strictly controlled by our OR Staff.

RECOVERY FROM SURGERY: You will be taken to the Recovery Room after your surgery, and you will wake up slowly. You will not have any sense of the amount of time that has passed since you closed your eyes, so it can be a bit confusing. You will have a tube in your bladder to drain the urine so you won’t have to get out of bed at first. You may feel an urge to urinate but be assured that your bladder is being emptied for these first 24 hours through the tube. When you wake up, the nurse in the Recovery Room should ask you how bad your pain is on a scale of 1 to 10 with 10 being the worst pain imaginable. Be honest when asked, because that determines the pain medication that you will be given. This is when I dictate the operation and go out to tell your family about the findings. After this is a good opportunity for your family members to eat because it will be approximately ninety minutes before you will be taken to your hospital room where they can be reunited with you.

Once settled in your room, you will probably experience a little bewilderment that you got through it all! You will also probably be surprised that you are not having much pain. There will be an IV in your arm to keep you hydrated and for pain medication. You may have compression devices on your legs that will inflate periodically to prevent blood clots. There will be a fingertip sensor-clip that measures your oxygen levels. You might feel “trapped,” but you can sit up when you feel like it, get out of bed to sit in a chair, or (with close assistance) walk around in the hallways. Hold a pillow to your stomach to help you get a good cough and clear your throat and lungs frequently. Stretch and move in bed. Walking helps you to be mentally alert and in charge of yourself. Ask the nurses to help you move around. More walking is better! Unlimited walking is best! It will help relieve gas pains and shoulder pains.

The recovery is entirely humane. Everyone experiences pain differently. Whatever your pain threshold, expect to experience some discomfort after your surgery, but not too much. Report to your nurse what the level of pain is from 1 to 10: 1 is very minimal pain, and 10 is unbearable pain. There is prevention and medication for each level of pain. For many women, just understanding the cause of the discomfort can help.

Three different MAIN causes of pain, with different ways to be managed:
1. Incision discomfort. This is dull and constant and will actually subside significantly over the first 12 hours, becoming more of an ache. In order to both prevent and treat the pain, you will receive intravenous medications followed later by oral medications.   Your incisional pain is prevented by long-acting local numbing medicines as well as by an intravenous medication including Toradol and if needed narcotics.  For any “breakthrough” pain that the Toradol does not prevent, you will receive a morphine-like substance called Dilaudid in your IV. You can use the Dilaudid until you are taking things by mouth when you will begin using the Percocet. If you are not having significant incisional pain, try to minimize the use of Dilaudid and Percocet as these drugs will slow the bowels from pumping and can delay and prolong the cramping phase. – these medications are given by nursing staff about every 6 hours until you begin eating. Thereafter you receive medications orally to continue to prevent the pain. When you go home you may take Aleve (with food)  and Tylenol to prevent the pain for the first three days.  The incisional pain from laparoscopic surgery is minimal after a few hours, and many patients use none of their prescribed Percocet at home. If you have a vertical open laparotomy incision, you will wake up with a binder (like a girdle) compressing your abdomen. Keep this binder centered over your incision to keep comfortable pressure on it. Use the binder at home only if you still want to, but keep it on in the hospital. Your incision should cause less pain every day, and not require Vicodin after a few days.

2. Intestinal cramps. After surgery, your bowels quit pumping. About 12-36 hours after surgery, it is normal to go through a 2-4 hour cramping phase as the gut resumes pumping. Some people experience no cramps, and only a very few will have severe cramping. We will give you Simethicone (Gas-X), which can help ease the crampy pains, but the key to alleviating this pain is to walk in the hallways as soon as possible to stimulate your bowels to resume normal function rapidly. Nothing you eat or drink will affect the “crampy phase” and there is no cure for it other than a “tincture of time” and walking. Neither Dilaudid nor Vicodin should be used for this pain. You can try over-the-counter Gas-X at home as well if the gas pains continue to bother.

3. Shoulder pain: can result from the gas that was used to inflate your abdominal cavity if laparoscopic surgery was performed. This gas is deflated from the abdomen after the surgery, but a small amount still remains
and may cause you to have a sense of pain in your right shoulder (and sometimes in your left shoulder). It is mild, constant, and tolerable and usually starts the morning after the surgery. There is nothing wrong with your shoulder, however. This pain can take several hours to a few days to completely resolve. Moving around in bed into different positions and getting out of bed to walk can relieve this pain sooner, and Aleve can help.

Other Discomforts:
Sore throat:  You may notice that your throat is sore or that you are hoarse or have laryngitis after the surgery. This is because a tube was placed to help you breathe during the surgery and was removed before you woke up. If bothersome, ask for some throat spray for relief.

Your Lungs: Since the breathing tube in your lungs induces mucus secretion, you will have a cough when you wake up. Hold your pillow over your incision(s) for comfort while you cough. Use the breathing device (inspirometer) frequently to help to re-expand and open your lungs to their normal volume; otherwise, a fever may develop. The nurses check your oxygen levels frequently and may ask you to wear a little tube near the outside of your nose to add some extra oxygen to your blood.

The day after surgery: The tubes come out and you move even more!!!! The intravenous line, the bladder catheter, and any leg devices are removed. You may shower and pat your incisions dry. The injections of pain medicines are replaced by oral medications: Ibuprofen and Percocet. Percocet is for breakthrough pain. Once you are at home, take two Aleve (with food) every 8 hours for 4 days after surgery to prevent pain, maximize your mobility, and minimize the need for constipating Percocet. If your pain is greater than level 3 out of 10, take one Percocet at first, and see if you need the after 45 minutes.

Your Bowels: The most important factor in your bowels resuming normal function is walking. Get out of bed as soon as the nurses let you and walk in the room and later in the hallways to hasten the recovery of your intestinal function. You may experience a painful cramp every time you empty your bowels for about two to even four weeks after the surgery, especially if you already have some irritable bowel syndrome (IBS) or just crampy bowels in general. This will get completely back to normal once the normal post-operative inflammation from the surgery has resolved, by one month (really!). Try to remember this fact when you have cramping after meals two to four weeks after your surgery—it is normal! And temporary!   If you have had open incisional surgery, your intestines will take about 5 days to resume their normal function. You will go through a phase of belching and bloating (intestines not pumping much), then gas pains (intestines pump in an uncoordinated fashion), and finally passage of gas (intestines coordinated) when you will finally feel normal. This is sometimes the most trying part of recovery, but everyone resumes their normal function.

Your Abdomen: Some women worry about how the space occupied by their uterus will be filled. The intestines and the colon move about in the abdominal cavity sliding over each other every minute as they pump. Removal of a normal or enlarged uterus/ovaries simply makes more room for the intestines to slide around on each other and for you to have a slightly flatter stomach. The lower abdominal wall will be swollen or even severely bruised after your surgery, but this will mostly resolve within two weeks. You may notice that your upper body is swollen and puffy after the surgery. This is due in part to the surgery being done with your body in a head-down tilt, and in part to fluid shifts from the surgery. All of your upper body swelling will resolve within a few days. Some women get huge black and blue marks in their lower abdomen or upper legs after going home. This is because some blood can ooze deep beneath the skin after the surgery, and cause a large bruise. It will resolve.

Your incisions: Your incisions should stop hurting in a few days after your surgery. You may shower, swim, bathe or soak in a hot tub any time after your surgery, once all incisions are dry. If any of your incisions develop oozing after you go home, cover it to protect your clothes with non-sterile dressings such as paper towels or band-aids. It is fine to still shower with dressing on, then re-apply new dry dressing afterward. Many will notice bruising under the incisions after the surgery – these will completely resolve, but can look quite fierce in the meantime. If you have vertical open laparotomy incision, you may shower, swim, bathe or soak in a hot tub once the incision is dry and closed. Even long vertical midline incisions generally stop hurting in less than one week. If you have any wound packing or dressing, leave the dressing on while you shower (but no bath or hot tub) and then put on a new dry dressing after you get out. If you had clips or staples for your wound closure, relax: they don’t hurt when they are removed!

Your Bladder: Once the catheter (the tube that drains the bladder) is painlessly removed when you are walking or the morning after your surgery, some women notice a feeling in their bladder as it empties in its new configuration. This “odd” feeling is normal and disappears usually within two weeks after the surgery. Some women have trouble sensing when their bladders are full at first, but this resolves also within the first two weeks. Try to empty your bladder every two to four hours to begin to familiarize yourself with your renewed bladder function.   Call the nursing staff if you find that you cannot empty your bladder within four hours after the catheter is removed. Some women need an extra day of bladder rest before their bladders work well again and may need to have the catheter re-inserted for a brief period of time 12-24 hours.

In general, you will spend one night in the hospital if you had a laparoscopic hysterectomy, about 2 days if you had an open horizontal incision, and about 4-8 nights in the hospital if you had an open vertical midline incision.

Discharge to Home:  Walk, Eat, Pee, Gas. Plan to go home after you are eating, emptying your bladder, passing gas, and walking well. You should have no nausea.
1. Diet: Resume eating regular food and drink plenty of fluids. If your bowels are not yet regular, take some prune juice or Milk of Magnesia to facilitate normal function.
2. Exert yourself. Walk for 20 minutes three times daily outside your house to regain energy and relieve crampy GI pain. Increase your energy by walking whenever you can. Stairs are fine!!! Recovery occurs as you regain your energy over time. It is fine to push yourself and walk as much as you can to facilitate your recovery. Raise your energy level by stretching, floor exercises, and walking frequently in the hospital and at home. There is no amount of walking or stairs that harms your incisions or your deeper surgery.
3. To prevent incisional and surgical pain: Take Acetaminophen 650mg and Aleve 440 mg (with food) every 6 hours for three days regardless of your pain level. This really works for surgical pain and reduces the need for the Percocet (which constipates and slows GI function and makes you listless). You will have a prescription for some Percocet pills in case you have any breakthrough pain. Do not Take Percocet for crampy GI gas pain—just go walking for that pain. If you do find that you need to take a Percocet, omit the next acetaminophen dose, as Percocet contains acetaminophen. Surgical pain is virtually absent within a few days after surgery and by four days you should not need any medication for pain. Call Dr. Lackore if you need pain medications after one week.
4. If you suffer from constipation: do not push at home!!! Take your usual stool softener. For gas pains or constipation: Take Milk of Magnesia as directed on the bottle.
5. If your incision becomes newly tender, swollen or oozes green or smelly fluid –  cover it, and call our office so we can reassure you or ask you to come in for exam. Leave sealant glue on the incisions (but shower as usual, and pat incisions dry). You may peel the glue off your incision any time after 10 days.

Hormone therapy:  If your ovaries were removed, or if you are already on hormone replacement, hormones can be started on the day after surgery, and you may go home on them. Make sure you have your prescription for home use of hormones. If you are already menopausal and not using hormones, it will not be necessary for you to start taking them, as you will likely only notice a difference for a short while. If you were started on hormones in the hospital, adjustments to the dose will be assessed at your post-operative meeting. If the dose of estrogen you are taking is too much, you may develop tender breasts. Too low a dose of estrogen can result in insomnia, hot flashes and depression. Call if you have these symptoms before your visit. About 10% of women require changes of dose, route or type of hormone a few times until it is just right for you.

Return to sexuality: The surgery in your abdomen does not involve removal of any of the organs of sexual activity or enjoyment. The female orgasm takes place in the muscles surrounding the vaginal opening, not any deeper, even though the orgasm feels deep within (It’s not!). The uterus and cervix are not any part of your orgasm and their removal does not impact on the ease of achieving orgasm, quantity of contractions, or quality of your orgasm. Good research has been done on women comparing their sexual function before, and at 3, 6, 9, and 12 months after hysterectomy, revealing a slight improvement in sexual function for most women, but overall, no detriment. Some women will notice differences if their hormones are not kept tuned afterward.  Dr. Lackore is adept at finding the right hormone replacement regimen, as needed, to keep you feeling your normal best.  Sexual enjoyment should be exactly the same.  Let us know if it is not. You may return immediately to sexual activity on the outside of your vagina in any / every way that pleases you. This is a great time to be creative with your sexuality and add to your repertoire of techniques for pleasure and orgasm.  PLEASE DO NOT RESUME VAGINAL PENETRATION UNTIL 10 WEEKS HAVE PASSED FROM SURGERY. When you resume penetration BE CAREFUL / BE GENTLE for another month.

Return to exercise:  Just do it. APPLIES TO EVERYONE. Surgery causes more exhaustion than pain after the first day or so. The challenge is to get back to your usual exercising self as soon as possible. You will nap plenty in your early recovery, and nap less as your energy returns to normal. Once you get out of bed, you are encouraged to begin walking vigorously as much and as often as tolerated immediately, both in the hospital and definitely after your discharge. You may go up or down any amount of steps, any number of floors, and are encouraged to do so frequently in your recovery. You may lift any weight you feel comfortable lifting when you go home. You may resume all of your floor stretches, exercises, and Yoga immediately. Do not begin or resume power weight lifting (as with dumbbells and barbells) until one week after laparoscopic surgery and two weeks after standard open abdominal laparotomy. Vigorous recovery and activity are encouraged, and you can nap in between.

Vaginal Bleeding: You might experience a two-day period of bright red bleeding around the 14-28th day after your surgery. The stitches at the top of the vagina dissolve at this time, allowing the end of the vagina to “settle” into its new position. The bleeding can be quite red, but not bigger than a period, and typically resolves without treatment. (Imagine taking off your bra after a long day, your breasts simply settle into their natural position!) In 6 women the bleeding has required an emergency trip back to the office or hospital for cautery or suture because it was profuse. If you think the bleeding is heavier than a period, call my answering service so we can be on alert, and possibly plan to meet you for treatment.  If the bleeding is dramatic (rare but possible), you must go to your nearest hospital emergency room and have them call my answering service at (757) 455-3584

Vaginal discharge: The inner end of the vagina from which the cervix and uterus above were removed has been sewn shut. Even though the outside skin incisions heal promptly and rather perfectly, the inner vaginal incision does not. It really takes about 6 weeks for the upper vagina to close. It is normal to have some tan to brown to frankly bloody vaginal discharge for the entire first six weeks. This discharge will resolve completely once the upper end of the vagina has completely healed. The upper end of the vagina will nearly always have some excessive growth of scar tissue called “granulation tissue.” This is treated with a Silver Nitrate medicated Q-tip at your 6-week post-op visit. The granulation tissue may take a few monthly treatments with medicated Q-tips before the upper-end seals completely and you have your normal minimal opalescent white vaginal fluid.

Disability Leave after Surgery: The general rule is that a FULL OPEN SURGERY with a large incision entails a 6-week period to resume normal, full workloads, including heavy lifting. A laparoscopic hysterectomy, with the 3 or 4 tiny incisions, entails a 2-week disability leave. Laparoscopic removal of ovaries entails a 1-week disability. Dr. Lackore cannot ethically extend the disability unless you have a clear-cut reason or complication from the surgery.

About complications: Your consent form mentioned that there could be unexpected effects of the surgery. While 96% of surgeries go perfectly well, many factors can affect the experience. Some of these factors are a result of unforeseen situations from your anatomy or the condition being treated. No two people are built the same. The reasons for your surgery, (pain, bleeding, endometriosis, adhesions, ovarian cysts) have countless physical presentations. Unexpected findings can require a change in approach, or even result in a second surgery. Nearby organs can be involved in dense scar tissue and severe distortion of the anatomy and can be injured on purpose or incidental to your primary procedure. Excess bleeding or internal bleeding after the surgery occurs in about 2% of women. Injury to the bladder, ureter, or bowel occurs in 2.5%. Overall about 4% of patients need some additional operation to get their complete recovery.

While Dr.Lackore takes every effort to prevent and avoid these complications, overall they occur in about 4% of women. Unfortunately, when a complication happens to you, it is easy to forget that you are part of a small 4%, as it definitely is 100% of you! Even if you have to have another operation, you will get back to your normal health and life. Rest assured that with surgical experience since 1980, Dr.Lackore has seen and managed many types of clinical presentation and surgical outcomes. Your surgical and medical care will be consistently managed and expertly provided by Dr.Lackore and his associates (other experienced on-call Physicians) every day of your hospitalization and recovery.

DO NOT DRIVE until two weeks after laparoscopic procedures and three weeks after open incision procedures. This is not because you can’t physically accomplish the task of driving, because most can. But what you cannot do is reliably jam on the brakes in an emergency without hurting yourself or another person in the early phase of healing after surgery.

Your post-operative care:  We will see you at a followup visit to check your recovery and make sure that you are healing well and that your organs are resuming their normal function. At this visit, we will discuss the results of the microscopic analysis of all tissues removed. We will fax a note with all the surgical documents to your referring doctor and to any other local treatment doctors required for your further care.  Even if you are from afar, call us for any complications.

Your informed consent: Overall, the benefits of the surgery have to outweigh the 4% risks of surgery. But when your body has a problem that is highly likely to be correctable by surgery, then a small amount of risk is very reasonable to undertake. The alternative is to not operate, or to try medical or other therapies, and accept responsibility for the results. When you sign up for surgery, you are also accepting the surgical results, a high likelihood of correcting the problem, and a very low likelihood of complication.  It is this understanding that constitutes your informed consent to surgery.

And…. if you appreciated your surgical experience and the care you received from PLEASE go online and leave us feedback at Healthgrades.com

A PERSONAL NOTE: I have performed Operative laparoscopic procedures since the mid-1980s and Laparoscopic Hysterectomy since around 2006. For the cases I accept, I offer what I believe to be the very highest quality of care. I will not operate on a problem that is not likely to be correctible. I do not do certain procedures that I believe are irresponsible or not indicated. I will refer you to any surgeon whom your situation would be better managed by.  My commitment to your health is absolute. I urge you to partner with me in that endeavor by reading all my information, asking all your questions, living a healthy lifestyle, and following through on our care plans. I will give you my best. Please visit my website www.vbGYN.com for more useful information.

Preparing for Surgery – HealthyWomen

Overview

What Is It?

Facing surgery can be a frightening experience fraught with questions, doubts and uncertainties. However, most surgeries are elective, meaning that you decide if surgery is the best option for you and elect to have the procedure.

Millions of Americans undergo surgery every year, most of them women. Many women will face a recommendation for surgery that involves their reproductive system, typically called gynecologic surgery. For example, hysterectomy—surgery that removes the uterus and sometimes other parts of the reproductive tract—is the second most common gynecologic surgery after cesarean section.

Facing surgery can be a frightening experience fraught with questions, doubts and uncertainties. However, most surgeries are elective, meaning that you decide if surgery is the best option for you and elect to have the procedure. This decision process often gives you needed time to prepare, which is an important step. Research suggests that women who prepare mentally and physically for surgery have fewer complications, less pain and recover more quickly than those who don’t prepare.

Following the invention of anesthesia in the mid-19th century, operations were developed for conditions ranging from appendicitis to uterine fibroids. Enthusiasm for gynecologic surgery was especially intense, and the first hysterectomy was performed in 1843 in Manchester, England.

Today, the trend in gynecologic surgery is toward less invasive techniques that don’t require surgeons to cut into the abdomen with large incisions. Doctors are even trying incisionless surgery—a new technique where internal organs are removed through body orifices such as the mouth or the vagina. Also, new, faster-acting anesthetics have been developed that have fewer side effects than traditional anesthetic agents.

Settings for surgery have changed, too. Not long ago, having surgery meant being admitted to the hospital a day ahead and discharged a week later. Today, more than half of all surgeries, including many gynecological procedures, are done on an outpatient basis. Outpatient surgery refers to operations that do not require an overnight hospital stay. Instead, the surgery is performed at an ambulatory surgery center or a health care professional’s office, and you return home in less than 24 hours. Now there is also a choice between hospitals’ ambulatory surgery centers and free-standing ambulatory surgery centers, which are becoming more popular and can often be found in the suburbs, even in shopping malls. They are physically separate from—and sometimes even distant from—a hospital.

Generally, outpatient, or ambulatory, surgery is appropriate for healthy individuals and for simple procedures that can be done in 60 to 90 minutes and don’t require a person to be closely monitored afterward. Outpatient surgery offers several advantages over surgery that requires hospitalization, such as:

• a lower risk of infection after surgery
• recovery at home
• fewer delays and shorter waiting times
• lower cost
• less disruption of your schedule

However, if a large incision has to be made or if the risk of complication is high, same-day surgery or having surgery performed at a free-standing surgical center may not be an option. Outpatient surgery is not for everyone. Women with chronic conditions such as diabetes, heart disease or high blood pressure (hypertension), or who are otherwise at risk for complications that could require hospitalization, might not be eligible.

Same-day surgery also puts more responsibility on the patient to manage pain medications, keep incisions clean and follow through with postoperative care on their own. A woman who has small children to care for at home may be unwilling or unable to take on the added responsibility and may not be a good candidate for same-day surgery. If you face a recommendation for surgery, be sure to consider which type of setting will work best for you.

Preparing Emotionally

Surgery also has an emotional impact. A woman who has heard, perhaps incorrectly, that a hysterectomy will ruin her sex life or leave her tired for months, for example, may become depressed, fearful or angry with her body. For some women, the anticipation of being hospitalized and separated from family members makes coping difficult. Even simple procedures done in a doctor’s office can provoke a strong reaction. Advances such as same-day surgery may make surgery more convenient, but they haven’t necessarily made it less stressful. Regardless of what kind of surgery you have, stress is involved. Hormones released in response to stress can cause symptoms ranging from headaches to high blood pressure. Stress hormones can also weaken the immune system and disrupt the body’s ability to manage pain and infection.

Some experts advocate preparing for surgery through a series of relaxation techniques: deep breathing, positive thinking and visualization—imagining or mentally seeing—a positive outcome from surgery and a quick recovery period, for example.

Preparing Physically

While emotional preparation is a necessary, often-overlooked step, preparing physically is also important for a successful surgical outcome. In the weeks before your surgery, you should:

• Stop smoking and avoid excessive alcohol.
• Eat a well-balanced diet including plenty of foods rich in vitamin C, which may help promote tissue healing.
• Avoid aspirin or other aspirin-like medications that interfere with blood clotting for five to seven days before your surgery, but be sure and discuss it with your health care provider before stopping any medication.
• Exercise regularly to build energy and maintain strength.
• Ready your home, including preparing food and rearranging furniture if necessary.
• If necessary, arrange for someone to take care of your children while you are in the hospital.
• Arrange for help at home after discharge, if you will need some time to recover.

If you decide to have surgery, discuss the following with your health care professional:

• Determine when elective surgery can be scheduled, taking into consideration your job and family commitments. Sometimes it is not possible to know the exact time of the surgery until the business day before the actual date.
• Learn which routine laboratory tests may be needed, which may include x-rays, blood tests, urine tests and an electrocardiogram (EKG or ECG), a measurement of electrical impulses produced by the heart.
• Ask if you need to change the schedule and dosage of any medications you are taking.
• If you are diabetic, discuss how to manage or modify your insulin intake during the time before your surgery when you are not eating.
• Since there are often several ways to perform a specific procedure, ask your doctor to explain the surgery and how it is done and to explain if there is more than one way to do it. For example, if you have fibroids, you have an option to choose between a hysterectomy (removal of the entire uterus, which can be done in several ways), a myomectomy (removal of the fibroid tumor alone), a uterine artery embolization (cutting off blood supply to the uterus), plus a couple of other noninvasive ways to remove fibroids. Discuss the risks and benefits of each alternative.
• If you are preparing for elective surgery, you get to choose your surgeon and may want to do some homework about the surgeon: What are his/her qualifications? Board certifications? Sub-specialities? How many similar procedures has the surgeon performed? What is the success rate? Remember, however, that the most important reason to choose a surgeon is that you feel respected and listened to; you communicate well with the surgeon; and you are not intimidated by him or her.

Legal Considerations

Once you’ve decided on surgery, had the necessary tests done and prepared mentally and physically, you’ll be asked to sign a consent form. This may also be a good time to consider donating blood for your surgery, if you wish to, and drawing up advance directives. These instructions communicate your health care plans if you cannot speak for yourself in the future.

There are two kinds of advance directives: a living will and a health care proxy. States differ in the directives they recognize. Discuss your wishes with your health care professional and your lawyer, if you have one. State-specific directives are available from the National Hospice and Palliative Care Organization website at www.caringinfo.org, or you can obtain one from your local health department, state medical associations, a hospital admissions office or your primary care provider.

A health care professional is required to have a detailed discussion with you before your surgery so that you are fully informed when making the decision whether and how to have it. This is called obtaining your “informed consent” to have the procedure. The informed consent process should include discussion of the risks and benefits of the proposed surgery.

Consent forms differ from one health care professional to another and may include permission for additional procedures to be performed if needed. Ask to sign the consent form several days in advance to avoid being confronted with a list of risks immediately before surgery, which can create anxiety. Do not sign the consent form until you understand and feel comfortable about what is being done. Don’t let this part of the process feel rushed. Ask questions if you need to.

Before surgery you may also be asked to sign a form allowing a blood transfusion to be performed, if necessary. Normally, blood donated to the Red Cross four to six weeks in advance of your surgery is shipped to the hospital a few days before your surgery. However, you can also donate your own, called an autologous blood donation. Or you can ask family members or friends with the same blood type to donate units of blood for you. You’ll need to inform your surgeon whom you have chosen to donate blood for your use.

If you’re considering autologous blood donation:

• Ask your surgeon if you are likely to need blood and if so, how much.
• Consider taking iron supplements to rebuild your blood supply before surgery.

Call the Red Cross and ask about fees and insurance coverage and about freezing your blood if your surgery is delayed.

Financial Considerations

Familiarize yourself with the extent of your medical benefit plan before your operation so you will know what portion of the costs will be your responsibility. Your physician’s office staff may be able to help you find out how much your medical benefit plan will cover. If your medical benefit plan will not pay all of the anticipated costs and you cannot afford the difference, then discuss this situation with your surgeon to see if you can work out an acceptable solution.

Some procedures and some health plans require pre-authorization before your operation. Become familiar with your insurance plan requirements to avoid unpleasant surprises after your surgery.

Understanding Pain

Knowing what to expect after surgery is as important as knowing what to expect beforehand. Pain is an inevitable part of surgery. Pain is the body’s way of sending a warning to the brain that it has been damaged and needs attention. Although a normal reaction to surgery, pain can interfere with recovery by:

• causing you to suppress coughs, which can lead to a build-up of fluid in the lungs and pneumonia
• slowing the return to normal digestion
• preventing you from getting out of bed, raising the risk of blood clots
• increasing stress, depression, and anxiety

There are several ways to relieve pain after surgery. Narcotics, such as morphine and codeine may be prescribed for severe pain following surgery via IV, pills or patches. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or other non-narcotic pain relievers may also be used, either as liquids or in pill form. Local anesthetic injections or anesthetic creams and patches may help prepare your body for a procedure or relieve pain afterward.

Depending on the type of surgery you are having, you may also be given pain relievers through patient-controlled intravenous analgesia (PCA), which is usually used in hospitals for acute pain following surgery. In PCA, the patient is connected to a machine called a PCA pump. When the patient pushes a control button, the machine delivers a dose of narcotic or other pain reliever through the veins. The doses are smaller than what would be given by injection, but because the drug goes directly into the bloodstream, relief can occur within seconds.

Ask the surgeon or anesthesiologist to discuss these options with you beforehand. Other nonmedical approaches to pain management can be very successful. These may include:

• relaxation techniques
• applying heat or ice to the surgical site
• massage and stretching exercises

When preparing for surgery, discuss with your health care professional what possible pains to expect after your procedure and how to best manage any possible symptoms.

Diagnosis

When your health care provider informs you that surgery is a recommended treatment option, there are a number of decisions for you to make. These include whether to have surgery at all, and if so, when to schedule it and whom to choose as your surgeon. Typically, several options are available before surgery and must be seriously considered. Generally, surgery should be considered only after more conservative measures have been exhausted. Though it may be tempting to take the last step first, because surgery may seem like the most definite solution, you need to remember that surgery may not be the only answer. Every procedure has risks, and no surgeon can guarantee a good outcome.

Because most conditions are not emergencies, alternatives to surgery are often good choices. One alternative may be watchful waiting to see if a condition improves or worsens on its own. For example, small fibroids that cause no symptoms may need no treatment at all. Fibroids shrink after menopause, so a woman who is close to menopause may try waiting to see if her symptoms subside once she stops menstruating. Fibroids and abnormal uterine bleeding may also be treated first with hormones or with minimally invasive surgery. By choosing to wait or investigating other options, women may be able to postpone surgery indefinitely.

Once the decision to have surgery has been made, a woman should have a clear idea of what is treatable by surgery and what is not. For some women, having too much detailed information about an impending operation is stressful. Still, a woman needs to be informed enough about the surgery to tell the surgeon what she wants done and what her wishes are in the event of unexpected findings.

Surgeries are designed to relieve symptoms, diagnose a condition or extend life. Having a good understanding of the procedure beforehand can make surgery less stressful and result in a better outcome. The informed woman should ask her health care professional what precisely an operation is meant to do, and if something is going to be removed, she should know why exactly.

If an operation can be done more than one way, a woman can weigh the benefits of having a less invasive procedure. A woman should ask the surgeon whether the procedure she is considering is one he or she does frequently or only on occasion. Often, a surgeon who is used to doing a procedure a certain way and has performed a lot of them has better results.

You should also discuss possible complications, such as infection, bleeding or reactions to anesthesia. Knowing what to expect after surgery allows you to feel more in control and better able to cope with recovery. Getting answers to certain questions can help. (See “Questions to Ask” section.)

Developing a good relationship with your health care team can help you feel more comfortable about your treatment and the outcome of your surgery. Some physicians are better communicators than others. Look for a physician who:

• is patient and approachable
• is forthcoming with information
• is a good listener
• is willing to address your concerns
• is competent and experienced
• has a team in place that shares these traits and is willing to help you if you ask

Getting a second medical opinion on any medical recommendation, if possible, can help make your options clearer to you. The advice of another health care professional can:

• verify your diagnosis
• ensure that all other forms of treatment have been explored
• satisfy health insurance requirements
• be a source of more information

A competent health care professional should not be insulted if you decide to get further advice. Sources for finding a medical expert to provide a second opinion include your primary health care provider—ask him or her to refer you to another surgeon; family or friends who have had success with a particular health care professional; and a local medical society or national association of specialists. Your health insurance coverage may require a second opinion and require you to choose from its list of providers.

Treatment

The steps you will take while preparing for any type of surgery are typically the same. Below, a number of practical issues are discussed, as well as information on surgeries that are common for women, primarily those related to your reproductive system.

What to bring to the hospital

• Ask the hospital for a list of the items they provide, such as toiletries (toothbrush, toothpaste, shampoo, etc.). If you prefer certain brands of toiletries, bring your own. Leave cash and jewelry at home (remove your rings). Bring an inexpensive watch, clock or clock/radio to help keep you oriented after surgery.
• Favorite magazines, books, crossword puzzles, etc., to spend relaxed time while your body resumes normal functioning. Bring eyeglasses, if required.
• Flowers, family photos, cards, etc., to make your room warmer and more cheerful.
• Music, audio books, and humorous or inspiring tapes or CDs because reading after surgery may at first be tiring or difficult with certain medications.
• Spiritual or religious art, medallions, beads, etc.
• Favorite foods and snacks, if allowed.
• List of phone numbers you might need.
• Notepad and pencil to have by your bed to jot down questions for your doctors or nurses.
• Your own pillow, quilt and pajamas, although these are optional.
• Something nice to smell, like mild fragrances to counteract the hospital atmosphere, can be very uplifting—for example, lavender, which is often used for relaxation, and Melissa, the “gladdening” herb, which has a fresh lemony scent. Putting a few drops of a high-quality essential oil on a cotton ball inside a small paper cup can be very pleasant when placed by your bedside, without bothering a roommate.
• Consider bringing a pair of earplugs or eye-mask to promote restful sleep.

The Presurgical Visit

The presurgical visit is generally scheduled the day before surgery. An anesthesiologist will examine you and review your medical history to determine what type of anesthesia is safe for you. You will be examined and questions will be asked about your health. Blood and urine samples will be taken. You may undergo an electrocardiogram, or EKG, which provides an electrical recording of the heart. If you have had a blood or urine test or EKG in the past 30 days, let your physician know—this may eliminate the need for these tests during the presurgical visit.

Preoperative Preparation

Just before surgery, preoperative preparation—or preop prep—takes place. The steps vary, but this is what you can expect:

• An identity bracelet will be placed around your wrist.
• A health care professional will review your medical history and will perform a brief physical exam.
• The area of your body undergoing the operation will be cleaned and may be shaved.
• You may be given a laxative or an enema to empty your bowels. You may be asked to douche or to empty your bladder.
• You’ll be asked to remove any dentures, hearing aids, contact lenses or eyeglasses, nail polish, wigs, hairpins, combs and jewelry.
• You’ll be asked to remove all your clothes and will be given a hospital gown and perhaps a cap.
• You may be given medication to help you relax. You may also be given other medications that your doctor has ordered.
• A needle may be placed into a vein in your arm or wrist. This needle is attached to a tube that will supply your body with fluids, medication or blood during and after the surgery. This is called an intravenous (IV) line.
• A tube called a catheter may be placed in your bladder to drain urine. This is often done after you have been given anesthesia. This way it is not felt.

Common Surgical Procedures

There are several reasons why gynecologic surgery may be recommended. Examples include symptoms caused by abnormal uterine bleeding, fibroids, pelvic pain from endometriosis (a disorder that occurs when some of the tissue that forms the lining of the uterus grows in other parts of the body) or other conditions, and uterine prolapse (when the uterus is no longer supported by muscles and ligaments, and drops into the vagina). All are common reasons why women seek surgical treatment from their health care professionals.

If you have one of these conditions, here are some of the procedures your health care professional may recommend:

• Laparoscopy and hysteroscopy. These minimally invasive techniques are used to diagnose and treat many conditions. The laparoscope is inserted through a small incision just below the navel so the surgeon can view and treat conditions in the pelvis. Sometimes other small incisions may be needed. General anesthesia is often used during laparoscopy. The hysteroscope is inserted through the vagina and cervix, giving the surgeon access to the uterus.

  Both procedures are performed with long, thin telescope-like instruments equipped with a light and camera so the surgeon can view the area being treated on a video monitor. Complications are not common but may include bleeding, injury to other organs or reactions to the anesthesia. You may also feel bloated and gassy the next day because often the abdomen has to be inflated with gas to make it easier to more easily maneuver the tools. In the hands of a skilled surgeon, minimally invasive surgeries offer several advantages to abdominal surgery: smaller incisions, less pain, smaller risk of bleeding, shorter recovery and less visible scars.

  Laparoscopy may be used for diagnosing endometriosis, pelvic pain and infertility. It can also be used for surgery on the fallopian tubes and to treat adhesions (painful scar tissue that may develop internally as a result of prior surgery).

  Hysteroscopy can be done in a health care professional’s office or operating room under local, regional or general anesthesia depending on whether other procedures, including laparoscopy, are done at the same time. Hysteroscopy may be used, among other reasons, to identify causes of abnormal bleeding or repeated miscarriages, to take a biopsy or to diagnose infertility.

• Myolysis. This laparoscopic procedure uses an electric current or laser to destroy fibroids and shrink the blood vessels that feed them. A similar procedure called cryomyolysis freezes fibroids with liquid nitrogen. Safety, effectiveness and risk of fibroid recurrence with these procedures are yet to be determined.
• Myomectomy. This surgical alternative to hysterectomy treats fibroids by cutting the growths out of the uterus and removing them through an incision in the abdomen. The surgery may also be done through the vagina with the use of a hysteroscope, or laparoscopically through a small incision in the lower abdomen. General anesthesia is usually used. The benefit of a myomectomy is that fertility is preserved because the uterus and cervix are left intact.

  This procedure is frequently more complicated than hysterectomy, and the risks of a myomectomy should not be underplayed. Myomectomy takes as long and often longer than a hysterectomy, and it may involve greater blood loss and a greater need for transfusion than hysterectomy.

  Myomectomy may also involve a more difficult postoperative course than hysterectomy, and there is the risk of damage to ureters and other structures, as with hysterectomy. Scarring of the uterus following myomectomy may also affect fertility. And the procedure doesn’t prevent further fibroids from growing. In fact, they often grow back and may require more surgery.

• D&C. This common surgical procedure, also known as dilatation and curettage, involves scraping the internal lining of the uterus to diagnose and treat abnormal uterine bleeding. It can also be performed to determine the cause of severe menstrual pain or gain information about why you are unable to get pregnant. This elective procedure is also commonly performed after a miscarriage to empty the uterus of remaining tissue associated with the pregnancy. D&C is sometimes done to remedy a condition called endometrial hyperplasia, in which the uterine lining has become too thick. Occasionally, a woman may experience bleeding after menopause; if vaginal bleeding occurs after a cessation of at least six months, then a D&C may be recommended.

  The procedure can be done on an inpatient or outpatient basis and involves dilating the cervix and inserting a thin, spoon-shaped instrument (a curette) to remove a sample of the internal lining of the uterus for testing or to remove the portion of the lining that is causing excessive bleeding. Following the D&C, you will be given oral medication for any postoperative pain, such as severe cramps. Most pain disappears within 24 hours. You may also be given an antibiotic to prevent infection.

• Endometrial ablation. Endometrial ablation involves using heat, electricity, laser, freezing or other methods to destroy the lining of the uterus. These procedures are recommended only for women who have completed their families because they affect fertility. However, following treatment, you must use contraception. Although endometrial ablation destroys the uterine lining, there is a small chance that pregnancy could occur, which could be dangerous to both mother and fetus. Overall, endometrial ablation procedures have a good success rate at reducing heavy bleeding, and some women stop having menstrual periods altogether.

  Some endometrial ablation procedures are performed with the help of a hysteroscope or a resectoscope, a device similar to a hysteroscope that has a built-in wire to deliver electrical current to remove endometrial tissue. And some endometrial ablation procedures use ultrasound to guide the instrument into the uterus.

  Depending on the type of endometrial ablation performed, it may be done as an outpatient surgery or as part of a hospital stay, and it may be performed under local or general anesthesia. The length of surgery and recovery time will vary depending on the type of ablation used.

• Hysterectomy. This common procedure removes the uterus and possibly other parts of the reproductive tract, such as the cervix, fallopian tubes and ovaries. If your ovaries are removed during the surgery, the procedure is called a bilateral salpingo-oophorectomy. A hysterectomy may be performed through the abdomen (abdominal hysterectomy), through the vagina (vaginal hysterectomy) or through the vagina with assistance from viewing instruments placed in the abdominal cavity (laparoscopically assisted vaginal hysterectomy [LAVH]). The most common complications are infection, injury to the bladder or bowel and bleeding.

  The setting and type of anesthesia used for hysterectomy can depend on the type of hysterectomy that is recommended. Typically there is a one- to two-day stay in the hospital and a two- to six-week recovery period. Side effects from hysterectomy include: difficulty emptying the bladder or bowels, urinary tract infections, abdominal pain and fatigue.

How Anesthesia Works

One of the most common fears people have about any type of surgery concerns anesthesia. Anesthesia refers to the drugs and gases used during an operation to relieve pain. These drugs work by artificially putting you to sleep and by blocking messages to the brain. As a result, all or part of the body becomes insensitive to pain and feeling for as long a time as needed.

Anesthesia can be given by either an anesthesiologist (a doctor who specializes in anesthesia) or by a nurse anesthetist working under the supervision of a physician. For minor surgeries done in a health care provider’s office, local anesthesia can also be given by the health care professional performing the procedure.

During surgery requiring anesthesia, the anesthesiologist adjusts the level of the drugs to heighten or lessen their effect. He or she also continually monitors a patient’s breathing, heart rate, blood pressure, temperature and other vital signs, and performs blood transfusions, if necessary.

Before any operation, you should ask who will be administering and monitoring the anesthesia. Because it is difficult for a surgeon to operate and monitor a person’s anesthetic at the same time, it is best if another person monitors the anesthetic. Minor procedures must be carefully monitored as well, because even sedatives can depress breathing.

The type of anesthesia used during surgery depends on a woman’s age and physical condition; on the nature and length of the procedure; and on any personal history or family history of adverse reactions to drugs. Some operations can be done with more than one type of anesthesia. In some cases, a health care professional may steer you toward one type of anesthesia based on your medical history and the type of surgery.

The four types are: conscious sedation, local anesthesia, regional anesthesia and general anesthesia. Their effects range from a short-lived numbness to temporary paralysis or unconsciousness, depending on the blend of products used and how they are administered.

• Conscious sedation puts you to sleep using sleeping pills, but not deeply enough to cause unconsciousness. It is often used in office-based gynecological procedures, such as new methods of sterilization, and may be used during colonoscopies.
• Local anesthesia is injected directly into a tissue to numb it. It is used for minor surgeries and may be coupled with a mild sedative. There are few, if any, side effects.
• Regional anesthesia blocks sensation in a region of the body, such as from the waist down. The two main types are spinal and epidural. Both are injected near the spinal cord. An epidural is administered through a thin plastic tube or catheter and can be given continuously during surgery. After surgery the catheter can be left in to provide postoperative pain relief. Spinal anesthesia acts faster and produces more numbness than an epidural, but it cannot be given continuously. Spinal anesthesia is often associated with headaches as it wears off.
• General anesthesia includes a group of agents that block pain, relax the muscles and produce unconsciousness. It can also shut down memory function. Typically, general anesthesia agents are given via inhalation or intravenously. In some cases, the anesthesiologist may also give a pre-medication orally or through an injection anywhere from a few minutes to a few hours before the surgery to induce relaxation and drowsiness. Temporary side effects of general anesthesia may include nausea, vomiting, muscle pain or shivering.

Many gynecologic surgeries are performed using an epidural injection—the type of anesthesia commonly used during childbirth. Epidurals are becoming increasingly popular because they can keep a person comfortable without causing grogginess or affecting a person’s consciousness.

An epidural works by putting anesthetic drugs in the epidural space just outside the spinal cord, which affects the large nerves entering and leaving the spinal cord. These nerves are responsible for transmitting information to the spinal cord and brain about touch, temperature and pain. If too large a dose of the medications is given or if the needle is inadvertently placed inside the spinal sac, the anesthetic could affect nerves higher up in the chest that control breathing and heart rate. An epidural can also cause blood pressure to fall. The administration of an epidural requires a skilled anesthesiologist.

Some procedures demand a particular method of anesthesia, leaving you without a real choice. You may, however, be able to request that the smallest possible amount of a drug be administered, which may reduce side effects. Before receiving any anesthesia, you should discuss the options with your surgeon or anesthesiologist.

The anesthesiologist typically will discuss your surgical procedure and anesthesia-related issues before your scheduled surgery. Use this meeting to express any fears or concerns you have about anesthesia. You should also ask the following questions:

• What types of anesthesia are appropriate for this type of surgery?
• What effects can I expect after the operation?

For safer surgery, it’s important to share as much information as possible about yourself and your health history with the anesthesiologist including:

• previous adverse reactions to anesthesia in yourself and in other family members
• any allergies you have
• if you smoke
• which medications, including herbal supplements, you’ve recently taken
• if you think you might be pregnant

Prevention

While there is not really a way to prevent necessary gynecologic surgery, you should carefully consider alternatives to elective surgery. The most common alternatives to hysterectomy as a treatment for fibroids, endometriosis and abnormal uterine bleeding, for example, are watchful waiting and hormonal therapies.

For example, birth control pills may be used successfully to treat abnormal bleeding or pain caused by endometriosis.

If you decide surgery is your best option, ask your surgeon:

• Is there a minimally invasive approach to this type of surgery?
• What are the risks and benefits associated with this choice?
• How many times have you performed this procedure?
• How long will I be hospitalized and approximately how long will it take for me to recover?
• How can I prepare before and after the surgery?
• Where can I learn more about the surgery?

Facts to Know

1. Millions of Americans undergo surgery every year, many of them women. Many women will face a recommendation for surgery that involves their reproductive system, typically called gynecologic surgery.
2. Today, more than half of all surgeries, including many gynecological procedures, are done on an outpatient basis. Outpatient surgery refers to operations that do not require an overnight hospital stay.
3. Generally, outpatient or ambulatory surgery is appropriate for simple procedures that can be done in 60 to 90 minutes and don’t require a person to be closely monitored afterward.
4. Outpatient surgery may not be appropriate if a large incision has to be made or if the risk of complications is high. Women with chronic conditions such as diabetes, heart disease or high blood pressure, or who are otherwise at risk for complications that could require hospitalization, also might not be eligible.
5. Same-day surgery puts more responsibility on you to complete the necessary preoperative tests, manage pain medications, keep incisions clean and follow through with postoperative care on your own.
6. In the weeks before your surgery, you should stop smoking and avoid excessive alcohol; eat a well-balanced diet; avoid aspirin or other aspirin-like medications that interfere with blood clotting for five to seven days prior; exercise regularly to build energy and maintain strength; and ready your home, including preparing food and rearranging furniture if necessary.
7. Advance directives are instructions that communicate your health care plans if you cannot speak for yourself in the future. There are two main kinds of advance directives: a living will and a health care proxy.
8. You can donate your own blood prior to surgery, in case you need a transfusion during surgery. This is called an autologous blood donation. Call the Red Cross and ask about fees and insurance coverage and about freezing your blood if your surgery is delayed.
9. Although a normal reaction to surgery, pain can interfere with recovery by: causing you to suppress coughs, which can lead to fluid in the lungs and pneumonia; slowing the return to normal digestion; preventing you from getting out of bed, raising the risk of blood clots; and increasing stress, depression and anxiety.
10. There are several ways to relieve pain after surgery. Narcotics, such as morphine, codeine, hydromorphone (Dilaudid) and meperidine (Demerol), may be prescribed for severe pain following surgery. Acetaminophen, prescription and nonprescription nonsteroidal anti-inflammatory drugs, such as ibuprofen, and similar medications, may also be used, either as liquids or pills. Local anesthetic injections or anesthetic creams may help prepare your body for a procedure or relieve pain afterward. Other nonmedical approaches to pain management may include relaxation, applying heat or ice to the surgical site and massage and stretching exercises.

Questions to Ask

Review the following Questions to Ask about preparing for surgery so you’re prepared to discuss this important health issue with your health care professional.

1. How will the surgery improve my health or quality of life?
2. How long can I safely delay the surgery?
3. Where will the operation be done?
4. What presurgical tests are necessary?
5. What type of anesthesia will be used?
6. Who will be in the operating room during surgery?
7. Where will the incision be and will I have a visible scar?
8. Will more surgery be necessary?
9. Will I have bleeding or discharge after surgery?
10. What can I expect during recovery?
11. When can I resume my normal activities?
12. What, if any, limits will I have after surgery?

Key Q&A

1. If surgery is recommended, should I get a second opinion?
   Yes! Getting a second medical opinion on any medical recommendation, if possible, can help make your options clearer to you. The advice of another health care professional can verify your diagnosis; ensure that all other forms of treatment have been explored; satisfy health insurance requirements; and be a source of more information.

   A competent health care provider should not be insulted if you decide to get further advice. Sources for finding a medical expert to provide a second opinion include your primary health care professional—ask him or her to refer you to another surgeon; family or friends who have had success with a particular provider; and a local medical society or national association of specialists. Your health insurance coverage may require a second opinion and require you to choose from its list of providers.

2. How long will the surgery take? How long will it take for me to recover?
   While that answer depends on the type of surgery, the current trend in gynecologic surgery is toward less invasive techniques that don’t require surgeons to cut into the abdomen with large incisions, and therefore have shorter recovery times. Also, new, faster-acting anesthetics have been developed that have fewer side effects than traditional anesthetic agents.

   Settings for surgery have changed, too. Not long ago, having surgery meant being admitted to the hospital a day ahead and discharged a week later. Today, more than half of all surgeries, including many gynecological procedures, are done on an outpatient basis. Outpatient surgery refers to operations that do not require an overnight hospital stay. Instead, the surgery is performed at a hospital ambulatory surgery center, a free-standing ambulatory surgery center or a doctor’s office, and you return home in less than 24 hours.

3. For whom is outpatient surgery not appropriate?
   Women with chronic conditions such as diabetes, heart disease or high blood pressure, or who are otherwise at risk for complications that could require hospitalization, might not be eligible. Outpatient surgery may also not be appropriate if a large incision has to be made or if the risk of complications is high.

   Same-day surgery also puts more responsibility on the patient to complete the necessary preoperative tests, manage pain medications, keep incisions clean and follow through with postoperative care on their own. You may not be a good candidate for outpatient surgery if you have small children to care for at home and are unable to take on the added responsibility.

4. Should I do anything in particular to physically prepare for surgery?
   In the weeks before your surgery, you should stop smoking and avoid excessive alcohol and eat a well-balanced diet including plenty of foods rich in vitamin C, which may help promote tissue healing; exercise regularly to build energy and maintain strength; and ready your home as necessary. If your doctor tells you to stop taking aspirin before the operation, avoid it for at least five days prior. (Do not stop taking aspirin unless you’re instructed to do so, however.)
5. Should I prepare emotionally for surgery as well?
   Yes! Some experts advocate preparing for surgery through a series of relaxation therapies: deep breathing, positive thinking and visualization—imagining or mentally seeing a positive outcome from surgery and a quick recovery period, for example.

   According to a study published in the British journal Lancet, women who listened to a tape of positive suggestions during surgery spent significantly less time in hospital after surgery, had a fever for a shorter time and were generally rated by nurses as having made a better than expected recovery. Organizing a support group of family and friends can also help because you can do a lot emotionally and spiritually to speed your own healing through thoughts, experts suggest.

6. What other ways should I prepare?
   Once you’ve decided on surgery, had the necessary tests done and prepared mentally and physically, you’ll be asked to sign a consent form. Now may also be a good time to consider donating blood for your surgery and drawing up advance directives.

   Advance directives are instructions that communicate your health care plans if you cannot speak for yourself in the future. There are two kinds of advance directives: a living will and a health care proxy. States differ in the directives they recognize. Discuss your wishes with your physician and your lawyer.Talk to your health care provider about the options.

7. Will I have pain?
   Most likely. Pain is an inevitable part of the surgery and recovery process. Pain is the body’s way of sending a warning to the brain that it a certain body part has been damaged or injured and needs attention.
8. How can I reduce the pain?
   There are several ways to relieve pain after surgery. Narcotics, such as morphine and codeine, may be prescribed for severe pain following surgery. Acetaminophen, nonsteroidal anti-inflammatory drugs such as ibuprofen, and similar medications, may also be used, either as liquids or pills. Local anesthetic injections or anesthetic creams may help prepare your body for a procedure or relieve pain afterward.

   Ask the surgeon or anesthesiologist to discuss medication options with you beforehand. Other nonmedical approaches to pain management can be very successful. These may include relaxation, applying heat or ice to the surgical site and massage and stretching exercises. When preparing for surgery, discuss with your health care professional what possible pain to expect after your procedure and how to best manage any symptoms.

Organizations and Support

For information and support on Preparing for Surgery, please see the recommended organizations, books and Spanish-language resources listed below.

American Academy of Orthopaedic Surgeons (AAOS)
Website: http://www.aaos.org
Address: 6300 North River Road
Rosemont, IL 60018
Phone: 847-823-7186

American Brain Tumor Association
Website: http://www.abta.org
Address: 2720 River Road
Des Plaines, IL 60018
Hotline: 1-800-886-2282
Phone: 847-827-9910
Email: [email protected]

American College of Obstetricians and Gynecologists (ACOG)
Website: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: [email protected]

American College of Surgeons
Website: http://www.facs.org
Address: 633 N. Saint Clair Street
Chicago, IL 60611
Hotline: 1-800-621-4111
Phone: 312-202-5000
Email: [email protected]

American Society for Aesthetic Plastic Surgery
Website: http://www.surgery.org
Address: Central Office
11081 Winners Circle
Los Alamitos, CA 90720
Hotline: 1-888-ASAPS-11 (1-888-272-7711)
Email: [email protected]

American Society for Dermatologic Surgery
Website: http://www.asds.net
Address: 5550 Meadowbrook Dr., Suite 120
Rolling Meadows, IL 60008
Phone: 847-956-0900

American Society of Plastic Surgeons
Website: http://www.plasticsurgery.org
Address: 444 East Algonquin Road
Arlington Heights, IL 60005
Phone: 847-228-9900

Association for Professionals in Infection Control and Epidemiology, Inc.
Website: http://www.apic.org
Address: 1275 K Street NW, Suite 1000
Washington, DC 20005
Phone: 202-789-1890
Email: [email protected]

Center for Medical Consumers
Website: http://www.medicalconsumers.org
Address: Center for Medical Consumers
239 Thompson Street
New York, NY 10012
Phone: 212-674-7105
Email: [email protected]

Books

Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques
by Peggy Huddleston

The Surgery Coach: Mind-Body Preparation for Faster, Better Recovery
by Joseph Casey

Spanish-language resources

Agency for Healthcare Research and Quality: Having Surgery? What You Need to Know
Website: https://www.ahrq.gov/topics/informacion-en-espanol/index.html
Address: Agency for Healthcare Research and Quality
Office of Communications and Knowledge Transfer
540 Gaither Road, Suite 2000
Rockville, MD 20850
Phone: 301-427-1364

Medline Plus: Surgery
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Robotic Hysterectomy | Johns Hopkins Medicine

Hysterectomy is the surgical removal of a woman’s uterus. This surgery can be done through small incisions using a thin, lighted scope with a camera on the end (a laparoscope). This is called a laparoscopic hysterectomy.

In robotic-assisted laparoscopic hysterectomy, the surgeon uses a computer to control the surgical instruments. The computer station is in the operating room. The surgeon is able to control the robot’s movements steadily and precisely. This lets him or her get into tiny spaces more easily and have a better view of the operation than with conventional laparoscopic surgery. This procedure continues to be researched to improve the technique.

Why might I need a robotic hysterectomy?

Your surgeon may recommend this surgery if you have a problem with your uterus that has not responded to other treatments. Here are some common reasons why a hysterectomy is recommended:

• Non-cancerous fibroid tumors

• Cancerous tumors

• Uterine prolapse (your uterus has slipped down into your vagina)

• Endometriosis (cells from the lining of your uterus grow outside your uterus, causing pain and bleeding)

• Other causes of long-term abnormal uterine bleeding

• Chronic pelvic pain

Some reasons why robotic-assisted laparoscopic hysterectomy may be recommended:

• You will have smaller incisions than in an open type of hysterectomy.

• You may have less pain and a shorter hospital stay after surgery.

• Your recovery may be easier.

• Your risk for complications like bleeding or infection may be less.

What are the risks of a robotic hysterectomy?

Robotic-assisted laparoscopic hysterectomy is a safe procedure, but all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery. You will also want to discuss these risks and benefits with your surgeon. Some potential risks of hysterectomy done by any technique include:

• Reaction to the anesthesia

• Infection

• Bleeding

• Damage to other organs inside the abdomen

• Blood clots that form in your legs and may travel to your lungs

An additional risk of robotic surgery:

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I prepare for a robotic hysterectomy?

Sometime before the day of your surgery you will need a physical exam. Your surgeon may also order tests, such as blood tests, a chest X-ray, or an electrocardiogram (ECG) to check on your general health. Be sure to tell your surgeon about any medications you take at home, including herbal supplements and other over-the-counter medications. You may be told to stop taking aspirin or other medications that thins your blood and may increase bleeding.

Other points to go over:

• Tell your healthcare provider if you or someone in your family has any history of reaction to general anesthesia.

• If you smoke, you may have to stop smoking well before surgery.

• On the day and night before surgery you will be given instructions on when to stop eating and drinking. If you are having general anesthesia, it is common to have nothing to eat or drink after midnight or for at least 8 hours before surgery.

• Ask your surgeon if you should take your regular medications with a small sip of water on the morning of the procedure.

What happens during a robotic hysterectomy?

This surgery is usually done under general anesthesia.  So, you will be asleep during surgery. Before the procedure:

• You will have an intravenous line (IV) started so you can receive fluids and medications to make you relaxed and sleepy.

• If you are having general anesthesia, medication may be given through the IV to put you to sleep.

• A tube may be inserted in your throat to give you anesthesia and help you breathe while you are asleep.

• You may be given antibiotics before surgery.

• You may have a catheter tube placed into your bladder to drain urine.

• You may have special stockings placed on your legs to help prevent blood clots.

Surgery time may range from 3 to 4 hours.

This is what may happen during the surgery:

1. Three or 4 small incisions are made near your belly button.

2. Gas may be pumped into your belly to inflate it and give your surgeon a better view and more room to work.

3. The laparoscope is inserted into your abdomen. Other surgical instruments are inserted through the other incisions.

4. Your surgeon attaches the laparoscope and the instruments to the robotic arms of the computer.

5. Your surgeon moves to the control area to remotely control the surgery.

6. Your uterus is cut into small pieces that can be removed through the small incisions.

7. During laparoscopic-assisted vaginal hysterectomy your uterus may be taken out through your vagina.

8. Depending on the reasons for your hysterectomy, the whole uterus may be removed or just the part above the cervix. The tubes and ovaries attached to the uterus may also be removed.

9. After surgery, the incisions are closed with 1 or 2 stitches and covered with small dressings.

What happens after a robotic hysterectomy?

After surgery, you will be taken to the recovery room to be watched as you recover from the anesthesia. Most people stay in the hospital for a few days. During your hospital stay this is what may happen:

• Expect some pain after this procedure. You may be given pain medicine through your IV.

• Your IV will be removed once you can drink fluids and your bowels are starting to pass gas.

• You will be given additional pain medicine by mouth or by injection as needed.

• Once your IV is removed and you are passing gas, you can start a normal diet.

• Your bladder catheter will be removed in 1 or 2 days.

• You may have bleeding from your vagina that requires the use of pads.

• You will be encouraged to get up and walk as soon as you are able. This helps prevent blood clots from forming in your legs.

• You may be given medicine that also helps prevent blood clots.

• Caregivers will help you with your bathroom and wound care.

Once you go home, it’s important to follow all of your surgeon’s instructions and keep your follow-up appointments. Take any medications as directed. Some pain during early recovery is normal. Ask your surgeon what medications to take for pain.

Here is what you can expect during recovery at home:

• You should be able to gradually return to your normal diet.

• Your incision areas should be kept dry for a few days. Follow your surgeon’s instructions on bathing and dressing care. You may need to go back to have your stitches removed.

• Keep walking. You should gradually be able to resume normal activities in a few days.

• Avoid heavy lifting for a few weeks. Ask your surgeon when you can return to specific activities.

• You may continue to have light bleeding from your vagina for several days.

• You may be instructed not to put anything into your vagina for up to 6 weeks.

• Complete recovery may take anywhere from a few weeks to a few months.

Tell your surgeon about any of the following during recovery:

• Increasing pain or pain that is not relieved by medication

• Any drainage, bleeding, redness, or swelling from your incision areas

• Fever

• Heavy vaginal bleeding

• Pain or swelling in your legs

• Chest pain or shortness of breath

In addition to the physical symptoms of recovery, you may have emotional symptoms after this surgery. After hysterectomy you will no longer be able to get pregnant and your periods will stop. Some women experience sadness related to these losses.

If you have had your ovaries removed as part of your surgery, you may notice symptoms of menopause, such as hot flashes and vaginal dryness. Some women may benefit from hormone therapy after hysterectomy. Discuss this with your doctor.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• The risks and benefits of the test or procedure

• When and where you are to have the test or procedure and who will do it

• When and how will you get the results

• How much will you have to pay for the test or procedure

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Preparing for Surgery Gynecology (operations)

First of all, Before the operation, a consultation with the operating gynecologist is needed, who will determine the treatment plan and the type of operation required.

In addition, before carrying out any operation, it is necessary to pass a certain list of analyzes:

• blood group and Rh factor (indefinitely, with the seals of the designated clinic).

Studies, the results of which are relevant within 1 month after delivery:

• blood for antibodies to HIV,
• blood RPR + IgG, IgM to Tr. pallidum (syphilis),
• blood on HbsAg,
• blood HcV,
• clinical blood test with leukocyte count, platelet count, ESR,
• biochemical blood test: blood glucose, total protein, urea, creatinine, total bilirubin, direct bilirubin, AsAt, AlAt, total cholesterol, levels of potassium, sodium, chlorine,
• coagulogram: fibrinogen, APTT, INR, thrombin time, PTI,
• general urinalysis,
• Microscopic examination of a vaginal smear (up to 14 days).

Studies, the results of which are relevant within 1 year after passing:

• Cytological examination of the cervical epithelium (liquid cytology).

In addition to analyzes, it is also necessary to undergo a number of examinations:

• ECG (electrocardiogram) – the result is valid within 3 months after delivery;
• X-ray examination of the chest organs or fluorography (FLG) – the result is relevant within 1 year after delivery.

For your convenience, all this can be done in our clinic. But we also accept opinions from other medical institutions, including government ones.

Not later than 3 months before the operation, it is necessary to consult the following specialists of the Fomin Clinic:

• therapist,
• anesthesiologist (at the consultation, the doctor will not only answer all your questions and resolve doubts, but also determine the degree of anesthetic risk).

Vaginal extirpation of the uterus (vaginal hysterectomy)

Home »Information for patients» Vaginal extirpation of the uterus (vaginal hysterectomy)

Vaginal extirpation of the uterus (vaginal hysterectomy) – an operation to remove the body of the uterus through the vagina with the possibility of simultaneous plastic surgery on the walls of the vagina and the muscles of the pelvic floor.Pelvic floor muscle plastic surgery is a reconstructive surgery to restore the pelvic floor muscles when they are torn or cut, most often during childbirth (episiotomy or perineotomy). Basically, plastic surgery of the pelvic floor muscles concerns the muscles that lift the anus (levators). When performing plastic surgery of the vaginal walls and levatoroplasty, it is possible not only to restore the lowered walls of the vagina, but also to correct the opening and capacity of the vagina.

Pelvic (genital) prolapse is a more common condition that requires surgery through the vagina and sometimes removal of the uterus through the vagina.

Pelvic (genital) prolapse is a disease that includes structural and functional failure of the muscular and ligamentous apparatus of the uterus and vagina, leading to prolapse and then prolapse of the vagina and uterus beyond the genital gap.

Sometimes the prolapse of the vaginal walls and prolapse of the uterus is collectively called a genital hernia.

Dysfunction of the pelvic floor organs and prolapse of the uterus and vagina are mainly caused by the weakness of the vaginal wall and ligamentous apparatus of the pelvic organs as a result of damage to the connective tissue, that is, with normal ligaments, there is a normal structure and function of the pelvic organs.When the anterior wall of the vagina is pushed down, one usually speaks of “cystocele”, implying that the bladder is located behind the wall of the vagina. When the posterior wall of the vagina is lowered, doctors speak of “rectocele”, implying that the rectum is located behind the wall of the vagina. Isolated forms of prolapse of the vaginal walls are very rare, more often there is a combination of a myofascial defect of the rectovaginal septum with prolapse of the vaginal walls and failure of the pelvic floor muscles. Of all patients with prolapse or prolapse of the genitals, almost 70% have pelvic dysfunction (difficulty urinating or urinary incontinence, a tendency to constipation or frequent urge to defecate).Pelvic prolapse with dysfunction of the pelvic organs leads to social and sexual maladjustment, reduces the quality of life of patients of not only premenopausal, but also reproductive age.

In connection with an increase in obstetric injuries, as well as an increase in the life expectancy of women, the frequency of this pathology in the structure of gynecological diseases is 27-32%.

Slow progression of the disease begins at reproductive age, periodically accelerating as a result of childbirth or heavy physical exertion.

The trigger mechanism in the development of pelvic prolapse is an increase in intra-abdominal pressure in combination with a weakness of the musculo-fascial frame of the pelvic floor.

There are 4 factors for the development of prolapse of the walls of the vagina and uterus:

1. Systemic connective tissue dysplasia.
2. Post-traumatic changes in the musculo-fascial apparatus of the pelvic floor (tears and incisions of the perineum during childbirth).
3. Chronic diseases, accompanied by a sharp increase in intra-abdominal pressure and a violation of the hemodynamics of the pelvic organs.
4. Decreased synthesis of female sex hormones.

Under the influence of one or several factors, the failure of the muscular and ligamentous apparatus of the pelvic floor is primarily formed. With a short-term increase in intra-abdominal pressure (cough in chronic obstructive disease) and prolonged (hard physical labor, carrying heavy objects), the bladder and / or rectum is squeezed out of the genital gap. Due to the presence of a common ligamentous apparatus between the bladder, rectum, uterus and the walls of the vagina, when squeezed out of the abdominal cavity, the walls of the vagina also prolapse.

The prolapse of the vaginal walls and prolapse of the uterus is the end product of all factors and mechanisms that is observed at the final stage of the disease.

There is also the concept of “apical prolapse” – prolapse and prolapse of the dome of the vagina after the transferred removal of the body of the uterus with the cervix. The cervix with its ligamentous apparatus is an important element of the pelvic floor, which, after removing the body of the uterus, prevents the vaginal walls from descending.

It is also worth noting that when communicating with patients, connective tissue dysplasia can be suspected in the presence of the following diseases and conditions:

• vegetative-vascular dystonia;
• violation of heart rhythm and intracardiac conduction;
• asthenic physique
• muscle hypotension;
• flat feet;
• varicose veins of the lower extremities;
• scoliosis;
• joint hypermobility and tendency to dislocation;
• myopia;
• hernia;
• dolichosigma.

Clinically, there are 4 degrees of vaginal prolapse and uterine prolapse:

1st degree – the cervix is ​​lowered no more than half the length of the vagina; while there is a mild prolapse of the anterior and posterior walls of the vagina.

2nd degree – the walls of the vagina and the cervix are lowered to the genital slit.

3rd degree – the cervix and vaginal walls are located outside the genital slit; the body of the uterus is lowered, located above the genital slit.

4th degree – the body of the uterus and the walls of the vagina are outside the genital slit.

The main complaints of patients with pelvic prolapse is a feeling of discomfort in the lower abdomen and in the perineal region, somewhat disappearing in the supine position and after a night’s rest. By the end of the working day, as well as when lifting weights, the discomfort increases. In the presence of prolapse of the uterus, over time, patients adapt to adjust the uterus on their own to perform the act of urination and relieve discomfort.

Pain syndrome of such patients is rarely worried. Sharp pains in the lower abdomen with prolapse of the uterus are noted by the patient only with acute urinary retention, which requires urgent catheterization of the patient followed by urgent surgical treatment.

Patients with prolapse of the vaginal walls and prolapse of the uterus very often suffer from recurrent inflammatory diseases – vaginitis and cervicitis. The treatment carried out always has a short-term and incomplete effect, since when the genital gap is gaping, there is contact with underwear and skin, which always leads to constant infection and mechanical trauma.

In elderly patients with impaired microcirculation in tissues, insufficient amount of female sex hormones, flabby and thinned mucous membranes, areas of ulceration are formed, in places of friction with the skin and linen (decubital ulcer).

Not unimportant complaints are pain during sexual activity or inability to perform it. During sexual activity, due to the prolapse of the walls of the vagina and the weakness of the pelvic floor muscles, there is no tight fit of the male genital organ, which leads to sexual dissatisfaction of the sexual partners. Some women, after intercourse, notice unpleasant vaginal sounds caused by the release of air.

Descent of the anterior vaginal wall in combination with urethrocele leads to a violation of the act of urination.

With a mild cystocele, mainly urinary incontinence or frequent urination in small portions is present. With complete or incomplete prolapse of the uterus, there is difficulty urinating, which requires self-repositioning of the genitals or giving the body a certain position for the act of urination.

To diagnose stress urinary incontinence, a cough test is required during a bimanual examination (involuntary leakage of urine is noted when coughing on the gynecological chair).

Violation of urodynamics contributes to infection of the upper urinary tract with the possible formation of urolithiasis.

Descent of the posterior wall of the vagina (rectocele) is also accompanied by either stool and gas retention, or incontinence.

Diagnosis of prolapse of the vaginal walls is simple and is carried out during a gynecological examination in a chair in the supine position. Usually I ask the patient to push, and the severity of the prolapse is easily diagnosed.

As a preparation for surgical treatment, I recommend using sanitary preparations (in the form of vaginal suppositories or ointment tampons), it is also possible to use estrogens locally for a short period (suppositories or Ovestin cream).

Surgical treatment is aimed not only at eliminating anatomical and cosmetic defects, but also at restoring the normal function of the bladder and rectum.

Determination of the scope of surgical treatment for prolapse of the vaginal walls and prolapse of the uterus is selected strictly individually for each patient, depending on the degree of prolapse and violation of adjacent organs.

In case of proven connective tissue dysplasia, the use of one’s own tissues in reconstructive plastic surgeries leads to a relapse in 37-45% of cases.In such cases, it is advisable to use additionally modern synthetic nets.

Indications for vaginal extirpation of the uterus:

1. Complete prolapse of the uterus in combination with incompetence of the pelvic floor muscles.
2. Incomplete prolapse of the uterus in combination with uterine fibroids, uterine endometriosis, ovarian cysts.
3. Complete prolapse of the uterus in combination with acute urinary retention.

List of basic examinations to be performed before vaginal extirpation:

1. Complete blood count (shelf life 14 days).
2. Biochemical blood test: blood glucose, AST, ALT, urea, creatinine, total and direct bilirubin, total protein, serum iron (shelf life 14 days).
3. Coagulogram, hemostasiogram – assessment of the blood coagulation system: VSC, prothrombin index, APTT, fibrinogen, antithrombin III (shelf life 14 days).
4. Hospital complex (blood for syphilis, HIV, hepatitis B and C) (shelf life – 3 months).
5. Blood group and Rh factor (if you plan to undergo surgery in another medical institution) – only a form with seals is accepted (expiration date – for life).
6. General urine analysis (shelf life 14 days).
7. Smears from the cervix for oncocytology (shelf life 6 months). This analysis is taken strictly in the absence of bloody discharge from the genital tract.
8. Smears from the cervix and vaginal mucosa for flora and purity (shelf life 14 days). This analysis is taken strictly in the absence of bloody discharge from the genital tract.
9. Electrocardiogram (shelf life 10 days).
10. Chest x-ray or fluorography (shelf life 12 months).
11. Ultrasound of the kidneys and bladder (shelf life 1 month).
12. Ultrasound of the abdominal cavity (shelf life 1 month).
13. Consultation with a therapist (expiry date 14 days).

Performed strictly after receiving all examination results in order to conclude that there are no contraindications for surgical treatment.

Preoperative preparation before vaginal extirpation of the uterus

1. Vaginal extirpation of the uterus is performed outside the days of menstruation or the absence of bloody discharge from the genital tract, preferably immediately after the end of menstruation (when performing surgical treatment against the background of menstruation, there is increased tissue bleeding).
2. It is not necessary to shave the pubic area and labia at home. Hygienic treatment of the perineum is performed on the day of surgery in a hospital setting to minimize the risk of inflammation of the hair follicles and excessive trauma to the skin. In preparation for vaginal extirpation of the uterus, hygienic preparation of the perineum and the walls of the vagina is carried out strictly by medical personnel. The perineum should be free of hair and inflammation. It is optimal to shave the hair on the day of the operation by medical personnel with the obligatory treatment of the area with an antiseptic solution (chlorhexidine, miramistin).
3. In the presence of allergic reactions, it is necessary to take anti-allergic drugs and do not cancel them on the day of surgery. Be sure to warn about the presence of allergies not only to drugs.
4. The day before vaginal extirpation of the uterus, alcohol, antiplatelet and anticoagulant drugs should be discontinued. Blood pressure medications, cardiovascular medications, and hormones should not be taken. The intake of certain groups of antihypertensive and antidiabetic drugs can be changed during the period of hospitalization in agreement with the attending physician and anesthesiologist.
5. A special diet and bowel preparation are required prior to vaginal extirpation of the uterus.

2-3 days before surgery, I recommend a slag-free diet (exclude unpeeled vegetables and fruits, coarse bread, fatty meats, fish and poultry, cabbage). Depending on the volume of surgical treatment, it is necessary to do 1-2 cleansing enemas before the operation: in the evening before and in the morning on the day of the operation. If you are admitted to a hospital on the day of the operation, you can prepare the intestines at home with Flit.

Recommended products to be taken before surgery:

1. White bread, refined cereal flour products, crackers.
2. White rice.
3. Vegetables without skin or seeds, preferably steamed.
4. Fruit without skin or seeds.
5. Milk and yoghurts in limited quantities.
6. Boiled lean beef, poultry, fish.
7. Broths.
8. Jelly, honey, syrup.
9. Eggs.
10. Low-fat cottage cheese.

You can drink without restrictions until the last 8 hours before the operation.

If you are admitted on the day of the operation, you must arrive at the clinic strictly on an empty stomach. Do not eat or drink 8 hours before surgery.

When taking vital medications, it is necessary to put them under the tongue and dissolve, or drink 1 sip of water.

In hot times of the day, if you have strong thirst, you can rinse your mouth with ordinary boiled water.

Surgical treatment is performed on an empty stomach. Most operations are performed under spinal or epidural anesthesia. Vaginal extirpation under endotracheal anesthesia is extremely rare.

If you have varicose veins of the lower extremities, I recommend wearing compression hosiery.

Hospital compression anti-embolic hosiery is a modern and quite effective means of preventing the formation of blood clots and their blockage of deep veins of the lower extremities and pulmonary artery during the perioperative period.

Surgical intervention is a provoking factor for the blood coagulation system towards hypercoagulation, and the forced motionless position during and after the operation slows down the movement of blood in the veins. Together, this increases the likelihood of thrombosis. The use of stockings reduces the likelihood of thrombosis several times; therefore, it is mandatory for most surgical interventions not only of a gynecological profile. For the same reason, during the operation, I use, if necessary, a special hardware compression system Kendell (Switzerland), which stimulates blood flow in the legs, imitating walking.I will also ask you to activate yourself as early as possible after the operation: turn in bed, perform flexion and extension movements, get up as early as possible (as soon as possible). Together, this significantly reduces the risk of thrombosis and thromboembolism.

The use of hospital knitwear provides a narrowing of the lumen of the veins, normalization of the valves of the veins of the lower extremities, acceleration of venous blood flow towards the heart due to graduated pressure (compression) of 18-21 mm Hg.st. on the soft tissues and walls of the veins of the legs. Graduated compression is a physiologically distributed pressure across the leg, maximum in the ankle area and gradually decreasing towards the thigh, which is set when making knitwear.

Each manufacturer has its own table for the selection of hospital compression hosiery. Someone uses the ratio of height and weight, someone uses the circumference of the lower leg and thigh. It is necessary to take the following measurements (preferably in the morning, when there is no swelling of the lower extremities):

1. Ankle circumference.
2. Shin circumference.
3. Mid-thigh circumference.
4. Thigh circumference 5 m below the crotch.
5. Height.
6. Weight.
7. Leg length from floor to knee / to mid-thigh.

Having them at hand, you can choose exactly the size you need. And the accuracy of fitting is very important, since the compression of hospital stockings is not evenly distributed, but graduated – 100% falls on the area above the ankles, 70% on the shin area and 40% on the thigh area.

I do not welcome the use of compression bandages due to the inconvenience of use by patients and the inconsistent level of compression.

Manufacturers of stockings take care of the antimicrobial and antiallergenic properties of their products, using a special porous knitting structure, impregnating the threads with antimicrobial compounds, avoiding the use of latex. Such stockings are held by the silicone tape in the upper part (as in ordinary women’s stockings), and the degree of compression is constant.

Important: the generated compression must be 15-23 mm. rt. Art. (manufacturers call this prophylactic compression or compression of the 1st class), it is desirable that the sock is open and the size of the stockings is correctly selected.

If you still have varicose veins of the lower extremities, then I strongly recommend that you consult with a phlebologist (vascular surgeon) for a more detailed degree of compression. Compression level # 1 may not be enough for you.

Now, having made all the measurements, you can go to the pharmacy or orthopedic salon.

Manufacturer’s table

I do not recommend bringing with you sanitary pads that you use during your period.For about 14 days after vaginal extirpation of the uterus, I recommend using sterile gauze wipes with antibacterial and wound-healing ointments.

Contraindications to vaginal extirpation of the uterus:

1. Disorder of the blood coagulation system.
2. Acute inflammatory diseases in the genital area.
3. Diseases of any organs and systems in the stage of decompensation.
4. Presence of oncological diseases of the genitourinary sphere.
5. Sexually transmitted diseases.
6. Pronounced adhesive process in the small pelvis.
7. Large benign tumors of the ovaries and uterus (relative contraindication).
8. Decubital ulcer.

Performing vaginal extirpation of the uterus

The essence of the method of vaginal extirpation of the uterus is to make incisions in the vaginal mucosa, followed by transection of the ligamentous apparatus of the uterus, ligation of the uterine arteries, removal of the uterine body with the cervix, excision of excess mucosa with suturing of the underlying muscle-fascial elements and restoration of the integrity of the vaginal mucosa.The suture line on the muscle and fascial tissue can be additionally reinforced with a synthetic mesh to prevent recurrence. If it is necessary to correct the stress component of urinary incontinence, sling techniques are used. Surgical treatment is performed through an incision on the anterior wall of the vagina after vaginal extirpation of the uterus with a synthetic mesh prosthesis placed under the urethra. Vaginal extirpation of the uterus is almost always associated with posterior plastic surgery of the vagina and levatoroplasty – the muscle bundles of the levators are isolated and stitched together.If the patient has complete or incomplete prolapse of the uterus and the realized reproductive function, plastic of the vagina and levatoroplasty is performed after removal of the body of the uterus with the cervix. If the patient wants to leave the uterus, the uterus is fixed with a promontorium using synthetic mesh materials using laparoscopy (laparoscopic promontofixation). When performing surgical treatment, only absorbable suture material is used. The suture absorption process takes about 14-28 days.The duration of the operation is about 60-90 minutes. In the early postoperative period, I recommend often applying ice to the perineal area in order to reduce pain, edema, and prevent hematomas. The length of hospital stay is 3 days.

Postoperative rehabilitation period

The recovery period after vaginal extirpation of the uterus takes about 28 days.

In the first 3 days after vaginal extirpation of the uterus, it is recommended to spend in a hospital with the exception of the sitting position.After vaginal extirpation of the uterus in the first 5-7 days, the use of painkillers, anti-inflammatory, antibacterial drugs and vaginal suppositories is required. During the first 5 days after surgical treatment, physiotherapeutic treatment – magnetotherapy – is performed on the perineal wound.

In the postoperative period, I pay special attention to the prevention of blood clots in the vessels – I use highly effective drugs in combination with early activation and the use of compression hospital hosiery.

Particular attention should be paid to the treatment of postoperative wounds with antiseptic solutions (miramistin or aqueous chlorhexidine) after each urination and the use of sterile gauze napkins using Methyluracil and Levomekol ointments in thick layers in order to accelerate the healing process and exclude wound infection. Rehabilitation and wound healing suppositories must be inserted into the vagina for 14 days after the operation. In the early postoperative period, I pay special attention to the exclusion of bladder overflow – I recommend urinating even without urge every 2-3 hours.The act of emptying the intestines occurs on the 3rd day and the feces should be semi-liquid. The regulation of the intestines is carried out using a special diet that prevents constipation, as well as the addition of vegetable oils to the diet. When performing sling operations on the 1st day, a urinary catheter is inserted into the bladder. For 28 days, physical activity and sex life are excluded. It is advisable to exclude taking baths, baths, saunas, swimming pools, open reservoirs after vaginal extirpation of the uterus for 28 days.Hygiene procedures can only be carried out under the shower. Approximately 4-5 times in 28 days after vaginal extirpation of the uterus, I invite you for a postoperative examination and postoperative wound treatment. The final time for examination and consultation, I invite you on the 28th day of the postoperative period in order to assess the processes of wound healing and remove restrictions. Removal of postoperative sutures after vaginal extirpation of the uterus is not required. When resuming sexual activity, it is recommended to use water-based lubricants, like “Montavit-gel”.

In the early postoperative period after vaginal extirpation of the uterus in combination with vaginal plastic and levatoroplasty, during the first 10 days, there may be scant bleeding from the genital tract, pulling or aching pains in the perineal region of a non-intense nature, an increase in body temperature up to 37 ° C in the evening hours … All of the above is the normal course of the early postoperative period. The reason for going to the doctor is a deviation from the above symptoms or acute urinary retention during sling operations, which indicates the development of postoperative complications.

90,000 Vaginal extirpation of the uterus in Moscow. Cost of vaginal hysterectomy at Family Doctor

The recovery period after vaginal extirpation of the uterus lasts about a month.

The first three days must be spent in a hospital under the supervision of a doctor. During this period, scanty spotting of their genital tract is possible (up to 10 days), pulling pains in the lower abdomen, a slight increase in body temperature.

Getting out of bed is allowed immediately after coming out of anesthesia. Early activation and the use of compression hosiery prevents complications associated with thrombosis.

To relieve postoperative pain and prevent inflammation, the doctor will prescribe pain medications, antibiotics, anti-inflammatory drugs. To improve the healing of sutures and prevent their suppuration, vaginal antibacterial drugs are used.

During the first week after surgery, which includes plastic surgery of the vagina and perineal muscles, it is forbidden to sit down.It is recommended to empty the bladder every 2-3 hours, even if there is no urge to urinate. In order to regulate stool and prevent constipation, a special diet is prescribed.

To treat the surgical wound of the perineum, antiseptic solutions, wound healing and anti-inflammatory ointments are used. Similar drugs are prescribed vaginally in suppositories. The duration of therapy is 14 days and can be supplemented with physiotherapy procedures.

After discharge from the hospital, treatment continues on an outpatient basis.

Within a month after the operation, it is necessary to exclude:

• physical exercise;

• lifting weights over 3 kg;

• sexual intercourse;

• visiting baths, saunas, swimming pools, swimming in open reservoirs, taking baths.

90,000 Amputation of the cervix (Hysterectomy) in Moscow at an affordable price in the clinic of JSC Medicina

Any disease that is diagnosed in women requires immediate treatment.But therapy does not always stop at taking medications.

In cases where there are no other ways to save a woman from complex gynecological diseases and pathologies, the cervix is ​​amputated. This is an operation that is performed with the aim of completely removing a part of an organ. But there are several methods of doing it. It all depends on the patient’s clinical history.

Hysterectomy is an operation to remove the uterus or a specific part of it.Otherwise it can be called extirpation of the uterus without appendages or total hysterectomy.

Types of hysterectomy

There are two main methods of performing the operation:

• Laparoscopic hysterectomy. It can be done through three small punctures in the anterior lower abdominal wall;
• laparotomy. Conducted through open access.

Indications for cervical amputation surgery are:

• myoma, which is caused by rapid growth;
• prolapse or prolapse of the uterus;
• mutation of cells of a malignant nature;

• uterine bleeding;
• endometriosis of the common type;
• Chronic pain localized in the pelvic region.

Let’s take a closer look at the main types of hysterectomy.

Supravaginal uterine amputation or subtotal hysterectomy

This type of surgery involves removing the uterus while preserving the cervix. It is characterized by fast recovery and is the most gentle. Hysterectomy of the uterus is performed laparoscopic or laparotomy.

Indications:

• uterine adenomyosis;
• internal bleeding;
• myoma.

Benefits:

• there are no risks of proliferation of fibromatous nodes;
• the possibility of prolapse of the pelvic organs is excluded;
• accelerated recovery process.

Total hysterectomy

This implies the removal of the uterus with the cervix. During the operation, the vaginal stump is sutured after removing the uterus. The operation is performed laparoscopically.

Radical hysterectomy

Most often indicated for cervical cancer.But other indications are also possible. The operation is prescribed exclusively by the supervising doctor. The cervix and the uterus are amputated. The appendages and nearby lymph nodes are also removed.

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Leading specialist obstetrician-gynecologist, gynecologist-surgeon

Gavrilov

Mikhail Vladimirovich

Experience 17 years

Leading specialist obstetrician-gynecologist, gynecologist-surgeon.Candidate of Medical Sciences. First medical category. Associate Professor of the Department of Obstetrics and Gynecology, Faculty of Medicine, Russian National Research Medical University named after N.I. Pirogov.

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Precinct gynecologist

Lukyanova

Yana Sergeevna

Obstetrician-gynecologist, endosurgeon Member of the European Society of Gynecological Endoscopy Member of the European Society of Human Reproduction and Embryology

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Gynecologist

Temisheva

Yakha Akhmedovna

Experience 44 years

Obstetrician-gynecologist of the highest category, candidate of medical sciences, member of the Association of Gynecologists-Endoscopists of the Russian Federation, member of the Endometriosis Association, member of the Society for Reproductive Medicine and Surgery, member of the European Society of Gynecology

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For any questions, you should contact your gynecologist.He will prescribe not only all the necessary diagnostic methods, but also select a more optimal method of treatment. In some cases, the operation is optional. But in a situation where other methods do not help, this method is the only way out.

Hysterectomy in Moscow is performed using modern equipment. By contacting JSC “Medicine” (the clinic of Academician Roitberg), you can be sure of the excellent results of the operation performed.

You can make an appointment with a gynecologist through the feedback form available on our website, or by phone +7 (495) 775-73-60.We are located in the central district of Moscow at the address: 2nd Tverskoy-Yamskaya lane, 10, Mayakovskaya metro station. You can find out the current cost of a hysterectomy from the staff of the call center of our clinic.

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Hysterectomy and types of operations in the clinic of JSC “Medicine” (Clinic of Academician Roitberg)

All methods of removing the uterus, cervix and appendages are used at JSC “Medicine” (the clinic of Academician Roitberg).It all depends on the patient’s clinical record. Doctors carry out a complete diagnosis of pathologies. Only then is the optimal treatment method selected. If none of the methods helps, then the removal of an organ or part of it is prescribed. But the main condition is the competent preparation of the woman for the operation.

You can study reviews on cervical amputation in our clinic and make sure of the high professionalism of our doctors.

Preparation for hysterectomy of the uterus

The success of surgical treatment largely depends on the quality of the preparatory consequences.Certain recommendations are given by a specialist who prescribes the operation. He also determines the scope of examinations. This is the main stage in preparation.

It is necessary:

• take a blood test to determine the blood group, Rh factor, hemoglobin and glucose levels, clotting activity indicators and assess the infectious status. This is also done in order to determine the number of leukocytes in the blood;
• to be examined by a therapist;
• visit an anesthesiologist;
• to conduct an extended colposcopy;
• to do electrocardiography and fluorography;
• to conduct a cytological study of material from the affected area of ​​the organ;
• Carry out hysteroscopy.

Postoperative period. Recovery. Consequences of the operation.

The consequences of cervical amputation can manifest themselves slightly or with a stronger character. It all depends on the individual characteristics of the organism, the type of operation performed. If laparoscopic surgery is performed, then recovery is faster and more efficient. The woman stays in the hospital for 2 days (no more).

The period of complete rehabilitation after a hysterectomy can be from 1.5 to 2 months.When recovering from amputation of the cervix, it is forbidden to lift heavy objects (weighing more than 4 kg), swim in pools and open bodies of water, and have sex. It is recommended to wear a bandage. Pregnancy after cervical amputation is unacceptable.

Removal of the uterus when lowering in Almaty

Removal of the uterus: indications, methods, rehabilitation

Modern medicine rarely resorts to surgical treatment of diseases, if there is a chance to carry out conservative treatment.However, Hysterectomy is one of the few operations that has been debated for many decades, and a definite conclusion has not yet been worked out. The fact is that the removal of the uterus implies an irreversible loss of fertility, which is unacceptable for a woman who is not beyond fertile age. Therefore, today doctors prescribe such an intervention with great care and only in situations where it is impossible to do with another type of treatment.

Indications for

removal of the uterus

Like any other operation, removal of the uterus is prescribed only in desperate situations.These include:

• tumors. An attempt at conservative therapy in the treatment of neoplasms (both benign and malignant) often fails, and then the surgeon gets down to business;
• adenomyosis. A systemic disease with a rapid course and the vastness of the pathological process requires surgery as the only correct method of treatment, however, hormonal therapy is prescribed in parallel;
• bleeding. In situations where gentle ways to stop uterine bleeding do not lead to the expected effect, they resort to surgery, which saves the patient’s life;
• offset, dropout, dropout.In case of impossibility of minimally invasive or non-invasive treatment, the removal operation remains the only correct solution to normalize a woman’s life.

In most cases, surgery is prescribed for women whose fertile age is over. In this situation, the removal of an organ is even welcomed by some specialists, since in the future it helps to avoid some problems. In addition, such a radical method of treating a particular disease allows you to solve the problem in the most effective, albeit time-consuming, way.Conversely, in young women, this intervention is used as rarely as possible. Doctors are trying to preserve the woman’s ability to bear and give birth to a child.

How is it done

removal of the uterus

Surgeons have developed a number of techniques that allow an intervention to be carried out with minimal consequences and risk for the patient. Depending on the observed clinical picture, doctors resort to one or another technique.

1. Laparoscopy.It can be performed both totally, where access to the operated organ is made through several incisions, and locally. In the second case, one small incision is used. Single-port laparoscopy is more gentle for the patient, but less convenient for the surgeon.
2. Vaginal laparoscopy. Unlike traditional laparoscopy, vaginal laparoscopy involves the use of the vagina as one of the ports for surgical intervention and for direct extraction of the uterus.
3. Abdominal. In this case, the surgeon performs all manipulations through a horizontal or vertical incision in the lower part of the peritoneum, in some cases the incision is made in the suprapubic region. Abdominal surgery is performed in a number of cases when there is a malignant tumor of the organ, multiple adhesions, or the uterus itself is large.
4. Vaginal. If the size of the removed organ is small, then access to it is through the vagina.The outer covers are not truncated.
5. Robotic. Surgical robots such as Da Vinci allow for minimal postoperative scars. Despite the separation of this technique in a separate form, in its principle, it does not differ in any way from total or one-port laparoscopy.

An important aspect of the operation is the visual examination of the organ after the incisions have been made. Often, the volume of the intervention performed can be assessed by the surgeon only after the start of the manipulation.And here, many patients have a chance to preserve the uterus at least partially. Fibroids can be cited as a striking example, when the doctor decides to remove only local pathologies and, in part, adjacent tissues. But sometimes, and vice versa, it is necessary to remove some other organs – appendages, ovaries.

Preparing for

Hysterectomy

Since surgery is a complex procedure, removal of the uterus requires preparation in a hospital setting.This is necessary to eliminate the risks associated with the operation itself and to minimize the risks of complications after it. Preparation is carried out in several stages:

• a conversation with a doctor. Anamnesis. Study of the patient’s medical history;
• examination by a gynecologist;
• collection of biological material for laboratory research. Here, both general clinical and specific studies are carried out, including a pregnancy test, the presence of infections in the genitourinary system, determination of the blood group and coagulogram;
• ECG and chest x-ray.It is necessary to assess the general condition of the body, as well as to identify possible heart diseases;
• Ultrasound of the pelvic organs and abdominal cavity. Sometimes MRI or CT is used;
• conversation with the anesthesiologist.

The doctor who will be directly involved in the removal of the uterus will tell you exactly where the incisions will be made, what technique will be used for the intervention and will tell you about the expected results. He will also inform the patient about the possible risks.

The doctor of our medical center will answer any questions from the patient and calm him down. Traditionally, women worry about such things as the length of surgery and hospital stay, anesthesia before, during and after surgery, what is the rehabilitation course, whether a diet is needed, and so on. The patient has every right to ask any questions about the intervention and its consequences, and our doctor will give a complete and comprehensive answer to each of them.

Risks associated with hysterectomy

There is almost always a risk of complications, but with high-quality preparation of the patient for the intervention, they are minimized.Removal of the uterus can cause the following complications:

• Inflammatory processes on the skin with localization in the area of ​​intervention. It may be slight redness, swelling. Rarely and only if the regimen is not followed – purulent discharge, seam divergence. Local therapy quickly enough copes with these complications;
• hematomas in the suture area. Associated with soft tissue injury. No therapy required;
• thromboembolism.Requires the mandatory intervention of a specialist, since in the future it can lead to serious problems up to hypoxia and pneumonia and death;
• peritonitis. Mandatory treatment is required, since it can lead to sepsis;

90,013 bleeding. You may need specialized treatment, blood transfusion;

• Difficulty urinating, including soreness. Associated with injury to the mucous membrane of the ureters. Treatment is symptomatic.

Postoperative period

Immediately after the operation, the woman is transferred to the ward, where she is kept for 5-10 days, depending on the method of intervention. During this time, the patient experiences pain of varying intensity, which requires the use of pain medications. As time goes on, the intensity of pain decreases, which is associated with the gradual healing of the wound (external and internal).
The patient is recommended an active way of behavior – getting out of bed early at the latest – one day after the operation.This is necessary for the “acceleration of blood”, stimulation of the digestive tract. The wearing of compression stockings is strictly indicated, as they minimize the risk of thrombophlebitis. A sparing diet is indicated for a period until the first independent bowel movement, after which the woman is transferred to a common table.
Also, general postoperative treatment is performed – antibiotics, anticoagulants and intravenous infusion of saline.

After discharge from the hospital, the second postoperative period begins.Removal of the uterus leads to serious injury, so the usual life will be restored only over time. An active life position will speed up the process – a course of physiotherapy exercises, leisurely walks in the fresh air. The beginning of the course is determined by the attending physician based on data on the patient’s body recovery. Wearing a bandage is highly recommended, including for women with developed abs.
Great importance is attached to the diet. The daily diet should exclude fatty, fried, spicy and salty.It is imperative to ensure not only that the female body receives a sufficient amount of proteins, fats and carbohydrates every day, but also that the calorie content of food is consistent with age, body weight and lifestyle. It is worth consuming more fiber and vitamins. Liquid food is preferred. From drinks – fruit drinks and natural juices, clean water, tea. You will have to say goodbye to coffee for up to 2 months. It is worth excluding tobacco smoking, alcohol.
In the late postoperative period, you cannot take hot baths, visit the sauna or bath.It is also worth refraining from swimming in a pool or pond for the first month after discharge from the hospital.
Sexual life is prohibited for the duration of the entire rehabilitation course. The decision about the possibility of resuming sexual life is made only by the doctor and only after the spotting has completely disappeared (which persist for 1-1.5 months). It is also forbidden to lift weights over 3 kg on a hand, to do heavy work. Usually, the return to full life occurs after 2 months.

Removal of the uterus requires postoperative recovery, for the entire period the woman is given a sick leave.

90,000 Preparing for Gynecological Surgery without Stress – American Approach.

For a woman, the upcoming gynecological operation is a disaster. The stress that arises and accompanies the patient after realizing the need for surgery can hardly be overestimated. These are fears about the outcome of the operation, the desire to preserve the reproductive organs in full, the fear of anesthesia, financial costs, etc.e. But an important aspect in this cycle of thoughts and events is preparation for the operation. In general, I would divide the entire process associated with surgical treatment into 3 parts. Preparation for the operation, the operation itself and rehabilitation after it. But everything is in order. In the traditions of our domestic medicine, of course, not everything is bad. The first thorough examination is the cornerstone of preparation. There is an Order of the Ministry of Health of the Russian Federation No. 572, which regulates the examination. Passing numerous tests (sometimes an excessively long list) allows you to comprehensively assess the work of all organs and systems before the operation and correct those concomitant diseases that may worsen or affect the results of the operation.But as it happens in Russia, first analyzes, then consultation of a therapist, and sometimes narrow specialists. That in the United States (the most advanced world power in terms of providing medical care) – the cornerstone is a survey and anamnesis, that is, the history of life and disease, the identification of risk factors (including smoking cigarettes), and then the decision on the appointment of tests. On the recommendation of the American College of Obstetricians and Gynecologists, before surgery, it is mandatory to take a smear for cytology from the cervix, examination of the mammary glands, exclude pregnancy in women under 50, and take aspirate from the uterine cavity in women over 45.In young women (up to 45 years old) in the absence of risk factors and concomitant diseases, no tests are taken when referring to low-invasive procedures with a low degree of risk (hysteroscopy, cervical surgery, biopsy, diagnostic laparoscopy). Testing and additional examinations begin if a complex operation is planned or if there are serious diseases or risk factors. It is obligatory, as in Russia, to consult an anesthesiologist before surgery. Of course, we cannot copy this side of preoperative preparation from American medicine and therefore we examine women before any operation according to the order.But we are quite capable of changing other aspects, for example, bowel preparation. In America, and in Europe, the preparation of the intestine-enemas, cleansing with laxatives (Fortrans, Fleet) are not carried out. Suffice it to have a light diet on the eve of the operation and drink plenty of water (at least 2 liters). This approach saves women from organizational difficulties – to give an enema or drink 2 liters of laxative solution! In addition, bowel cleansing is a guaranteed dysbiosis after surgery, dehydration and electrolyte imbalance.Now how much, what and until what time can you drink after the operation? Programs of fast recovery-fast-track- allow the intake of clear liquids – mostly water without gas – no later than 2-3 hours before the operation (within reasonable limits, of course, no more than half a glass).