How to Prepare for a Hysterectomy

This is my last box of tampons. One month from today, I am saying good bye to my uterus.

Ironically, my mom had a hysterectomy at 36. Her mom had a hysterectomy at 36.

I’ll be 36 in July.

I guess you could say genetics are weird. Also, I have had a heck of six months physically (so many surgeries! I still need to write about my butt surgeries. If you don’t know what I am talking about, go to Instagram.)

The most common response I have gotten from people who I have told I am having a hysterectomy is, “are you okay?” I guess that’s how you define okay. I have endometriosis, incredibly painful cysts and my periods are horrible. My bleeding is out of control every month (thankfully, it doesn’t last for more than 10 days, unlike some friends I know who have had bleeding go for weeks). The cysts cause me pain every day. In the fall, I saw a pelvic pain specialist who said, “we could just deal with the cysts for right now, but in about a year, you will likely need a hysterectomy, so I would advise doing the whole thing now.” With my family history, it seemed like the best option.

Then, all the stuff happened with my butt and we decided to wait on the hysterectomy. Finally, things are resolved on my back side, so we can fix this bigger issue. I will keep my ovaries, so won’t have to take hormones after the surgery.

I am really optimistic that this is going to be a huge, positive life change for me and my family. I deal with menstrual migraines, so those won’t happen anymore. I also won’t have the constant pain and awful cycles. After the recovery, I am going to be like a new person!

If you have had a hysterectomy, can you leave comments with what to expect in the recovery? Any advice you have to share, I will welcome. I am feeling a bit overwhelmed. I have two trips in the next month, a full-time job and you know, all the things. I will be out of work for six weeks.

For more on pelvic pain, here’s a video I did with my surgeon (perks of working for the hospital you will have your surgery at!). Also, that is a REALLY flattering thumbnail, lol.

Preparing for: Abdominal Hysterectomy | Medika Life

Our Preparing for series allows a patient to prepare themselves for a procedure properly. We answer questions about how long the procedure will last, what’s involved, what to expect, and even advice on packing your bag. While your surgeon preps, we’ll make sure you’re ready.

What is an Abdominal Hysterectomy?

A hysterectomy is a surgery to remove the uterus. Gynecologists perform hysterectomies for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse, and gynecologic cancer.

During a hysterectomy, a surgeon removes the uterus. Gynecologists often recommend removing the fallopian tubes (bilateral salpingectomy) to reduce the risk of ovarian cancer. Some women will also need the removal of the ovaries (oophorectomy). Removal of the ovaries triggers hormonal changes. After a hysterectomy, a woman can longer get pregnant.

Gynecologists perform hysterectomies through a variety of techniques. The patient’s uterus size, body type, and prior surgical history help determine the surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy
3. Laparoscopic hysterectomy
4. Laparoscopic-assisted vaginal hysterectomy
5. Robotic hysterectomy

What are the advantages of abdominal hysterectomy?

In an abdominal hysterectomy, the uterus is removed through an incision in the lower abdomen. The abdominal incision gives a large clear view of the pelvis and allows us to work through adhesions from prior surgeries or endometriosis most carefully. It can be performed even if the uterus is huge.

However, abdominal hysterectomy is associated with a greater risk of complications than a vaginal hysterectomy or laparoscopic hysterectomy.

Wound infections, bleeding, blood clots, and nerve and tissue damage are more common. Abdominal hysterectomy also requires a more extended hospital stay and a longer recovery time.

Some patients may not be candidates for minimally invasive approaches because of uterine size or prior surgical history. Your doctor will determine which surgical approach is most suitable for you.

Is a hysterectomy safe?

Hysterectomy is a very safe surgical procedure, and complications are rare. However, as with any surgery, problems can occur, such as:

• Fever and infection
• Heavy bleeding during or after surgery
• Injury to the urinary tract or nearby organs
• Blood clots in the leg that can travel to the lungs
• Breathing or heart problems related to anesthesia
• Death

Some problems are discovered immediately, and some may not show until days, weeks, or even years after surgery. These problems include the formation of a blood clot, infection, or bowel blockage. Complications are generally more common after an abdominal hysterectomy and in women with certain underlying medical conditions.

Beautiful woman taking a selfie photo in hospital ward portrait. Social media addict concept

How long will I be in the hospital?

Most women will need to stay 1–2 nights after an abdominal hysterectomy. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Can my family visit me?

A trusted family member should drive you to and from the hospital. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary with the ongoing COVID-19 pandemic.

Does my procedure require an anesthetic?

An abdominal hysterectomy requires general anesthesia, meaning patients will temporarily be put to sleep. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

Why do I need a preoperative clinic visit?

Most surgeries will involve a preoperative visit with your surgeon to review the procedure’s risks and benefits and answer your questions regarding the upcoming surgery. Because hysterectomies will eliminate the possibility of child-bearing, your doctor will confirm that you do not want children in the future.

It is essential to provide your doctor with an updated list of all medications, vitamins, and dietary supplements before surgery. The surgical team will review your medications. Together we can plan when to take the last dose when to resume medications. Medication management is particularly important for patients taking aspirin, blood pressure medicines, and diabetes medicines. Your doctor should review all medication and food allergies. We remind patients to avoid alcohol 24 hours before the surgery.

If any blood work or preoperative testing is required, it will be scheduled and confirmed. If appropriate, share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon before your surgery. Some patients may need to supply a surgical clearance letter from their primary care physician.

Finally, the doctor will give instructions regarding your diet before the surgery.

Try to avoid wearing jewelry, make-up, nail polish/acrylic nails on the day of surgery. If you wear contacts, glasses or dentures, please bring a case.

You should also confirm the date, time, and location of the surgery.

What happens after I check-in at the hospital?

After arrival at the hospital, the staff will guide you to the pre-operative holding area to change into a surgical gown and store your belongings. You will meet the nursing team who will provide care during your surgery. They will review your medical history. The surgical consent form is reviewed, signed, or updated with any changes. An IV will be placed at this time. You may be given special stockings to help prevent a blood clot.

The anesthesia team will also interview you and answer questions. Typically your surgeon will review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure. Then the anesthesiologist will give medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and apply an antibacterial fluid to your abdomen and vagina. After you are asleep, a tube called a catheter will be placed in your bladder to drain urine. The team then performs a “surgical time-out.” A surgical safety check-list is read aloud, requiring all surgical team members to be present and attentive.
The gynecologist begins by making an incision in the lower abdomen. It is typically horizontal, but sometimes a vertical incision is needed if there is a large uterus or large mass.

Once the uterus and ovaries are visualized, we place a metal retractor to maintain a clear view of the pelvis. This step helps us safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon works carefully from the outer edges inward. First, we dissect the broad ligament, the thin layer of connective tissue covering the female organs. If the plan is to remove the ovaries, we start with this step. Otherwise, we begin by separating the tubes from the surrounding tissues until the uterus is reached. 

The surgeon then separates the uterus from the surrounding connective tissue by moving downward toward the cervix. At this point, the surgeons detach the bladder from the uterus. After the bladder is safely out of the way, the surgeon will focus on the uterine arteries.

These two blood vessels are the main blood supply to the uterus and travel over the ureters, the tubes which connect the kidney to the bladder. Once the uterine arteries are controlled, the surgeon then safely gradually separates the uterus from the body. Depending on the anatomy, bleeding, or scar tissue, the surgeon may decide not to removal the cervix. 

The uterus and tubes (and sometimes ovaries) are sent to the pathology lab for microscopic analysis. The surgeon examines all of the surgical sites for bleeding.

The surgeon then sews the edges of the vagina closed to form the vaginal cuff. If the cervix has not been removed, it is carefully inspected for bleeding.
Afterward, the abdomen and pelvis are washed in a warm saltwater (saline) solution. Then, the layers of the abdominal wall and skin are carefully closed.
Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake up the patient and then transfer her to the recovery room.

What happens in the RECOVERY ROOM?

Once the operation is over, you will be moved into the recovery area. This area is equipped to monitor patients after surgery.

Many patients feel groggy, confused, and chilly when they wake up after an operation. You may have muscle aches or a sore throat shortly after surgery. These problems should not last long. You can ask for medicine to relieve them. You will remain in the recovery room until you are stable. Afterward, you will be moved to a hospital room for the rest of your stay.

As soon as possible, your nurses will have you move around as much as you can. You may be encouraged to get out of bed and walk around more quickly after your operation. Walking helps reduce the risk of blood clots. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal.

What preparations should I make for aftercare at home?

You should speak with your physician regarding the resumption of exercise and sexual activity. Your doctor will also review wound care instructions. Sexual activity is typically restricted for 6–8 weeks to allow the vagina to heal. Do not insert anything into your vagina — no sex, tampons, or douching — until cleared by your doctor.

Most women can return to basic activities in one to two weeks. Generally, we recommend patients stick to light activity only for the first 4–6 weeks. Light exercise helps your body heal and prevents some postoperative complications. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. Avoid strenuous exercise and heavy lifting.

You may resume a regular diet on the day of surgery. It may help prepare some meals and do your grocery store shopping and laundry before surgery.

You will be given instructions to help control postoperative pain during healing. Some pain is expected for the first few weeks after the surgery. You may also have light bleeding and vaginal discharge for a few weeks. Sanitary pads can be used after the surgery. Constipation is common after hysterectomies. Try a stool softener and fiber supplement. Some women have temporary problems with emptying the bladder after a hysterectomy. Some women have an emotional response to hysterectomy. You may feel depressed that you are no longer able to carry a pregnancy, or you may be relieved that your former symptoms are gone.

Your doctor will schedule a postoperative examination 4–6 weeks after the procedure.

After recovery, we recommend continuing your annual routine gynecologic exams. Depending on your age and reason for the hysterectomy, you may still need pelvic exams and pap tests.

DANGER SIGNALS

Call your doctor or report to the ER if you experience:

• Pain not controlled with prescribed medication
• Fever > 101
• Severe nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas or have a bowel movement

This article was contributed by MacArthur Medical Center’s Dr. Reshma Patel

COPYRIGHT NOTICE: This Patient Information Leaflet has been produced exclusively for Medika and may not be reproduced in part or otherwise without the written consent of Medika Life.

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Surviving a Hysterectomy – Part 1 — QENDO

Before Surgery

A hysterectomy is the surgical removal of the uterus. It’s a significant gynaecological surgery that can occur for a number of reasons. You can find out more about hysterectomy here.

Like any surgery or medical procedure, there are lots of questions running through your mind and it can be easy to turn to Dr Google to find stories from other women about their experience. QENDO is here to help! We’ve had one of our very own share their experience and provide in detail how to prepare as well as what happens next.

So, you’ve had your consults and your surgery is booked in. This post covers what to do before your hysterectomy, starting about a week before you do your pre-surgical bowel prep.

1. Inform yourself

• Ask lots of questions of your doctor about your surgery—what is the plan? Will your ovaries be removed or remain? Don’t be afraid to ask what you need to make yourself comfortable with what is coming.

• Talk to a counsellor or loved ones about what you are about to do. Ensure you work through any issues, concerns or feelings you have so that nothing is left unresolved.

• Get a pelvic floor assessment by a pelvic physio prior to your surgery so that you understand what impacts surgery may have on your pelvic floor and how you can manage it post surgery.

2. Get your house in order

3. Pack your hospital bag

• Pack some things to keep you occupied in hospital. Pack some wipes, dry shampoo and any of your other favourites that you can use to stay fresh. The length of your hospital stay will vary depending on the type of surgery you will have.

• Pack your own pillow—while not compulsory, this is a great way to stay comfortable and bring a piece of home with you.

• Pack clothes and shoes that are easy to get on and off. Don’t forget some warm socks, as it can get cold in hospital.

• If you’re a light sleeper, you may also like to pack ear plugs and an eye mask to block out the constant noise and light.  

4. Think about the logistics

• Organise someone to pick you up from hospital. Confirm them ahead of time so you’re not worrying about this from your hospital bed.

• The drive home means bumps and other movement that may cause pain and discomfort. Have a soft pillow ready for the car trip to tuck between your stomach and the seat belt. This helps you stabilise yourself when you can’t use your muscles to do it.

5. Bowel prep

• Be well hydrated before you start any bowel prep. Start drinking more water in the week/s beforehand.

• Eat cleanly, including more fresh fruit and vegetables, the week before you begin your bowel prep.

• Consider having less solid food and more liquid-type foods and less fibre the closer you get to beginning your bowel prep.  

• If you’re on a clear fluid diet before you officially begin your bowel prep, ensure you alternate between sweet and savoury flavours.

• Get your bowel moving and as healthy as you can—the better your bowels move beforehand the less you have to clean out during the prep process.

• The ‘drink’ you have to consume to get things going is pretty horrible but you just have to stick it out. Focus on getting it down as quickly as possible to limit how much you taste—try drinking through a straw, pinching your nose etc.

• Have some flushable wet wipes at the ready to help soothe a sore backside. The all-natural, aloe vera, unscented wipes tend to sting less. Ointment for anal skin irritation is also helpful.

• Just to be clear—stay close to the bathroom! Make sure your household know that the toilet is yours during bowel prep as you need unrestricted access as things happen quickly!

We hope this helps and would love to know if you have any tips on how to prepare for major surgery like a hysterectomy. If you’ve got tips, share them by commenting below! Stay tuned for part 2, for more tips about surviving hysterectomy. 

The materials available on or through the website www.qendo.org.au [‘QENDO’] are an information source only. Information provided by QENDO does not constitute medical advice and should not be relied upon to diagnose or treat any medical condition.To the maximum extent permitted by law, all contributors of QENDO make no statement, representation, or warranty about the quality, accuracy, context, completeness, availability or suitability for any purpose of, and you should not rely on, any materials available on or through the website qendo.org.au. QENDO disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs you or any other person might incur for any reason including as a result of the materials available on or through this website being in any way inaccurate, out of context, incomplete, unavailable, not up to date or unsuitable for any purpose.

Preparing for Hysterectomy? Physical Therapy Exercises that Promote Your Recovery

Preparing for hysterectomy with these Physiotherapy exercises helps you improve your recovery speed and reduce your risk of some common problems after hysterectomy.

1. Pelvic Floor Exercises (Kegels)

Hysterectomy may increase the risk of pelvic floor problems after surgery including prolapse and/or bladder control problems.

Starting your pelvic floor training before your surgery can help you strengthen your pelvic floor muscles. This prepares your pelvic floor to support your internal wound after you surgery.

2. Deep Breathing Exercises

Some women experience breathing difficulties and chest problems such as chest infection after hysterectomy.

Abdominal hysterectomy has a greater risk of postoperative chest problems than vaginal hysterectomy owing to the difficulty deep breathing and coughing with an abdominal wound.

Practice the correct deep breathing exercise technique before your surgery and learn to breathe into your abdomen. Knowing this technique allows you to start your breathing exercises immediately after your hysterectomy and during your early recovery.

3. Circulation Exercises

Surgery and immobility increase the risk of DVT (deep venous thrombosis or clots in the deep veins of the leg). Preparing for hysterectomy surgery includes knowing basic circulation exercises to do during early recovery and when resting in bed.

You can usually expect to move out of bed into standing and walking from the day after your surgery to reduce your risk of DVT.

Circulation exercises are usually commenced after waking from surgery. Regular circulation exercises are encouraged during bed rest. These exercises include calf pumps (shown right) and heel slides throughout the day.

4. Core Abdominal Exercises

Abdominal exercises help you prepare for hysterectomy. Your deep abdominal muscles help support your abdominal wound, firm your lower tummy and improve support for your lower back and pelvis.

Deep abdominal exercises are gentle exercises directed at the deep innermost layer of your abdominal muscles. These exercises are not the same as traditional abdominal curl exercises.

Preparing for hysterectomy involves practicing the deep abdominal exercises similar to those demonstrated below in this core exercises video

These core abdominal exercises can often be continued during hysterectomy recovery.

5. General Fitness Exercises

Fitness naturally declines during hysterectomy recovery. 

Improving physical fitness before hysterectomy is a positive step towards reducing the risk of some post operative problems e.g. chest problems. Poor physical fitness increases the length of hospital stay for some patients.

Having a good baseline level of fitness helps you maintain better function and fitness compared with being unfit unfit.

Fitness exercise prior to hysterectomy may include regular:

• Walking
• Hiking
• Dancing
• Stationary bike
• Swimming
• Water walking

It’s important to do what you can comfortably manage when exercising prior to hysterectomy. Some women have abdominal discomfort while others may be anaemic. Do what feels right for your body according to your general health and wellbeing before your surgery.

6. Strength Exercises

Physical strength affects hysterectomy recovery including the ability to move and function well after surgery. Simple tasks such as getting in and out of bed can be very challenging after a hysterectomy.

Simple whole body strength exercises that can help you with your hysterectomy recovery include leg and buttock exercises such as bridging exercises or mini squats.

Strength exercises that help daily movement such as sit to stand using a firm chair can improve your ability to stay mobile with ease after surgery.

7. Body Weight Control Exercises

Losing weight prior to your surgery can reduce your risks and improve your outcomes if you’re overweight or obese.

Dietary management is essential for weight loss – it’s very difficult to lose weight through just exercise.

Appropriate weight management exercises for women who are overweight involves low impact exercises with the large muscles working continuously.

Low impact weight management exercises for women who are overweight include:

• Stationary bike
• Walking
• Water walking
• Elliptical machine

The amount of exercise you perform determines the success of your weight management program.

Small amounts of exercise (i.e. 10 minutes) can be repeated 2-3 times during the day if you’re unable to perform 30 minutes of continuous exercise. To lose weight you need to do at least 45 minutes of aerobic exercise on 5 days of the week. The more exercise you do, the more weight loss you can expect to achieve if you’re dieting.

8. Lower Back Exercises

Lower back problems are very common after hysterectomy.

Familiarising yourself with a good routine of lower back exercises is an important part of preparing for hysterectomy.

Appropriate lower back exercises for hysterectomy include:

• Modified lumbar rotations
• Pelvic tilts
• Heel slides

These lower back exercises are usually appropriate for most women to continue during after their hysterectomy recovery.

9. Correcting Your Bowel Emptying Technique

Constipation is one of the most common problems after a hysterectomy. If you’re prone to constipation take the time to practice good bowel emptying position and technique when preparing for hysterectomy. Using this method can help you avoid constipation and empty your bowels with minimal pain and without straining after surgery.

When emptying your bowels correctly adopt the correct bowel emptying position:

• Sit on the toilet seat with your feet apart
• Lean forward from your hips with your chest raised
• Support your upper body by resting your hands or forearms on your thighs

Practice using the brace and bulge technique demonstrated in this bowel movement video below.

10. Practice Getting In & Out of Bed Safely

Moving in and out of bed incorrectly after a hysterectomy can cause wound pain and strain.

Practice the correct technique for getting in and out of bed before your surgery. This technique makes moving after surgery safer and more comfortable.

Getting in and out of bed correctly involves:

• Rolling onto your side (log roll)
• Raising your body sideways into sitting

11. Practice Moving Within Bed Safely

Moving in bed is challenging especially during early hysterectomy recovery. Moving incorrectly for example sitting up forward increases the downward pressure on your internal wound.

Take the time to learn and practice moving in bed when preparing for your hysterectomy.

Moving correctly in bed involves:

• Sliding one heel at a time towards your buttocks
• Lifting your buttocks off the bed by pushing down through your feet and keeping your head resting on the pillow
• Moving your body around the bed using this technique rather than sitting forwards or using an overhead bar to move your body.

12. Knowing Your Hysterectomy Risk Factors

Knowing your risk factors helps you know how to direct your exercise preparation for hysterectomy.

These hysterectomy risk factors can be addressed with the exercises listed above:

• Circulation problems such as a history of DVT
• Chest problems including chronic coughing (e.g. chronic bronchitis or bronchiectasis  or chronic shortness of breath (e.g. obesity, heart problems)
• Spinal problems including lower back or neck pain
• Weak pelvic floor muscles
• Bladder or bowel control difficulties
• Chronic constipation and straining
• Obesity or overweight

Further Reading

» How to Prevent Prolapse After Hysterectomy

» How to Reduce Your Hysterectomy Recovery Time

» Hysterectomy Recovery Diet

Hysterectomy Recovery Exercises for Avoiding Post-Operative Complications (eBook)

with Pelvic Floor Physiotherapist
Michelle Kenway

Prepare for your hysterectomy with these Physical Therapy exercises and techniques that help you:

• Move well with minimal discomfort
• Exercise safely
• Reduce your risk of major complications and common side effects of hysterectomy.

Includes exercises for constipation, gas pain, lower back pain, moving in and out of bed and safe return to activity after hysterectomy.

Hysterectomy – How it’s performed

There are different types of hysterectomy. The operation you have will depend on the reason for surgery and how much of your womb and reproductive system can safely be left in place.

The main types of hysterectomy are described below.

Total hysterectomy

During a total hysterectomy, your womb and cervix (neck of the womb) is removed.

A total hysterectomy is usually the preferred option over a subtotal hysterectomy, as removing the cervix means there’s no risk of you developing cervical cancer at a later date.

Subtotal hysterectomy

A subtotal hysterectomy involves removing the main body of the womb and leaving the cervix in place.

This procedure is not performed very often. If the cervix is left in place, there’s still a risk of cervical cancer developing and regular cervical screening will still be needed.

Some women want to keep as much of their reproductive system as possible, including their cervix.

If you feel this way, talk to your surgeon about any risks associated with keeping your cervix.

Total hysterectomy with bilateral salpingo-oophorectomy

A total hysterectomy with bilateral salpingo-oophorectomy is a hysterectomy that also involves removing:

• the fallopian tubes (salpingectomy)
• the ovaries (oophorectomy)

The National Institute for Health and Care Excellence (NICE) recommends that the ovaries should only be removed if there’s a significant risk of further problems – for example, if there’s a family history of ovarian cancer.

Your surgeon can discuss the pros and cons of removing your ovaries with you.

Radical hysterectomy

A radical hysterectomy is usually carried out to remove and treat cancer when other treatments, such as chemotherapy and radiotherapy, are not suitable or have not worked.

During the procedure, the body of your womb and cervix is removed, along with:

• your fallopian tubes
• part of your vagina
• ovaries
• lymph glands
• fatty tissue

Performing a hysterectomy

There are 3 ways a hysterectomy can be performed.

These are:

• laparoscopic hysterectomy
• vaginal hysterectomy
• abdominal hysterectomy

Laparoscopic hysterectomy

Laparoscopic surgery is also known as keyhole surgery. It’s the preferred way to remove the organs and surrounding tissues of the reproductive system.

During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small cut (incision) in your tummy.

This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your womb, cervix and any other parts of your reproductive system.

Laparoscopic hysterectomies are usually carried out under general anaesthetic.

Vaginal hysterectomy

During a vaginal hysterectomy, the womb and cervix are removed through an incision that’s made in the top of the vagina.

Special surgical instruments are inserted into the vagina to detach the womb from the ligaments that hold it in place.

After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.

A vaginal hysterectomy can either be carried out using:

• general anaesthetic – where you’ll be unconscious during the procedure
• local anaesthetic – where you’ll be awake, but will not feel any pain
• spinal anaesthetic – where you’ll be numb from the waist down

A vaginal hysterectomy is usually preferred over an abdominal hysterectomy as it’s less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.

Abdominal hysterectomy

During an abdominal hysterectomy, an incision will be made in your tummy (abdomen). It’ll either be made horizontally along your bikini line, or vertically from your belly button to your bikini line.

A vertical incision will usually be used if there are large fibroids (non-cancerous growths) in your womb, or for some types of cancer.

After your womb has been removed, the incision is stitched up. The operation takes about an hour to perform and a general anaesthetic is used.

An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it’s not possible to remove it through your vagina.

It may also be recommended if your ovaries need to be removed.

Getting ready

If you need to have a hysterectomy, it’s important to be as fit and healthy as possible.

Good health before your operation will reduce your risk of developing complications and speed up your recovery.

As soon as you know you’re going to have a hysterectomy:

You may need to have a pre-assessment appointment a few days before your operation.

This may involve having some blood tests and a general health check to ensure you’re fit for surgery.

It’s also a good opportunity to discuss any concerns and to ask questions.

Find out more about how to prepare for surgery

Page last reviewed: 01 February 2019
Next review due: 01 February 2022

Hysterectomy Preparation — FemFusion Fitness

Recently, I received a fantastic question (see below):

“How can I prepare for a good recovery from a hysterectomy?”

Before diving into specifics, let’s define hysterectomy. A hysterectomy is the surgical removal of the uterus. Accompanying organs (including the fallopian tubes, ovaries, and/or cervix) may be removed at the same time. Hysterectomies are often performed to treat conditions such as fibroids, heavy menstrual bleeding, endometriosis (when uterine tissue grows outside of the lining of the uterus), adenomyosis (when endometrial tissue grows into the muscle wall of the uterus), uterine prolapse, and cancer. Hysterectomies are reserved for women for whom more conservative treatment options have not worked.

There are three primary approaches for hysterectomy surgery: abdominal, vaginal, and laparoscopic. Although these approaches are very different, all three require invasion of the tissues in the abdominal and pelvic regions. Specifically, the abdominal and laparoscopic approaches require incisions in the abdominal wall.

A hysterectomy is a major surgery, and as with ANY major surgery, there are risks involved. These risks include post-surgical infection, excessive bleeding, and/or complications associated with anesthesia. More specific to hysterectomy, post-surgical complications may also include urinary complaints, a possible decrease in sexual responsiveness if the cervix is removed, and an increased risk of vaginal vault prolapse. Vaginal vault prolapse occurs when the top of the vagina drops down as a result of a reduction in support structures (i.e. the uterus, fallopian tubes, and cervix).

Patients undergoing a hysterectomy will not be able to conceive after the surgery, and there may be some hormonal changes that can force early menopause or require hormone replacement therapy. The decision to have a hysterectomy is complex and often very emotional.

Please know that if you and your healthcare provider determine that a hysterectomy is the best course of treatment for your needs, you have not “failed,” you are not broken, and there is nothing to be ashamed of. Furthermore, there are multiple things you can do to prepare for a successful outcome!

Strengthening the muscles before any type of surgery helps the muscles heal more quickly. “Pre-hab,” or strengthening BEFORE surgery, may help maintain the integrity of the surgical stitching and will give you the strength and awareness to work these muscles more quickly and effectively post-surgery. From a mind-body perspective, pre-hab also MENTALLY PREPARES you by allowing you to focus on the upcoming surgery in a positive way; you can have peace of mind knowing that you are taking every step to prepare your body for optimal recovery.

There are three primary regions to focus on when it comes to pre-hab exercises for hysterectomy: The pelvic floor muscles, the gluteal (i.e. butt) muscles, and the deep abdominal muscles. Let’s start with the pelvic floor. As noted above, there is an increased risk of vaginal vault prolapse post-hysterectomy, so one of the best things you can do is to start preparing your pelvic floor muscles NOW (before surgery) to optimally support your internal organs LATER (after surgery).

Focus on the Pelvic Floor (Kegels)

To make your kegel sessions successful, there are three key points to remember: 1) be sure to relax fully after each contraction, 2) balance your pelvic floor strengthening (i.e. kegels) with targeted gluteal strengthening exercises to counteract the risk of over-tightening the pelvic floor, and 3) remember WHY you’re doing kegels… To learn how to quickly use the muscles when you really need ’em — for example, when you’re jumping on a trampoline, when you’re in the car and you REALLY HAVE TO PEE but there’s no rest area nearby, or when you’re coughing or sneezing. Of course kegels also strengthen and improve endurance of the pelvic floor, which will help support your pelvic organs after surgery.

Kegels can be done in any position, although supine (lying down on your back) is a great starter position since your pelvic floor muscles are not fighting gravity in this position. You can even place a pillow under your hips in order to use gravity to help assist you with your kegels. As you get stronger, move to more upright positions such as seated or standing.

Want help with kegels? Sign up to get the first three days of my Kegel Camp delivered to your inbox!

Hysterectomy | ACOG

Adhesions: Scars that can make tissue surfaces stick together.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Fibroids: Growths that form in the muscle of the uterus. Fibroids usually are noncancerous.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.

Hysterectomy: Surgery to remove the uterus.

Laparoscope: A thin, lighted telescope that is inserted through a small incision (cut) in the abdomen to view internal organs or to perform surgery.

Laparoscopy: A surgical procedure in which a thin, lighted telescope called a laparoscope is inserted through a small incision (cut) in the abdomen. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Oophorectomy: Surgery to remove an ovary.

Osteoporosis: A condition of thin bones that could allow them to break more easily.

Ovarian Cancer: Cancer that affects one or both of the ovaries.

Ovaries: The organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Risk-Reducing Bilateral Salpingo-oophorectomy: Surgery to remove both healthy fallopian tubes and both healthy ovaries. The surgery is done to reduce the risk of cancer.

Salpingectomy: Surgery to remove one or both of the fallopian tubes.

Salpingo-oophorectomy: Surgery to remove an ovary and fallopian tube.

Uterine Prolapse: A condition in which the uterus drops into or out of the vagina.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Laparoscopy of the uterus and fallopian tubes

The essence and advantages of laparoscopy of the pelvic organs

Laparoscopy is a minimally invasive method of surgical intervention that allows manipulations through several small (5-10 mm) incisions. With its help, practically without blood loss, doctors carry out surgical treatment of diseases of the pelvic organs, in particular the uterus, fallopian tubes and ovaries. Also, this technique is used for diagnostic purposes, for example, to identify the causes of infertility.

Benefits of laparoscopy

• Minimal damage to healthy tissue.
• Aesthetic appearance after surgery.
• Rapid recovery and return to the usual way of life.

Laparoscopy for diseases of the uterus

Laparoscopic operations on the uterus, depending on the indications, are carried out either to remove pathological neoplasms, or for hysterectomy (removal of the uterus).In oncological diseases, hysterectomy is often complemented by removal of the lymph nodes.

Indications for laparoscopy in diseases of the uterus

• Uterine fibroids, anomalies of the uterus, adenomyosis.
• Endometriosis.
• Prolapse (prolapse) of the pelvic organs.
• Precancerous condition or early stage cervical cancer.
• Chronic pelvic pain.
• Clarification of the diagnosis (diagnostic laparoscopy).

Laparoscopy for diseases of the fallopian tubes

Laparoscopy for diseases of the fallopian tubes is performed for the surgical treatment of pathologies, including ectopic pregnancy. Very often this method is used to determine the causes of infertility. In many cases, they can be eliminated immediately. Sometimes, with the help of laparoscopic instruments, surgeons perform tubal sterilization if the woman no longer plans to have children.

Indications for laparoscopy in diseases of the fallopian tubes

• Ectopic pregnancy.
• Adhesions in the pelvic region.
• Pathology of the fallopian tubes (inflammatory diseases).
• Hydrosalpinx.
• Acute inflammatory diseases of the uterine appendages (pyosalpinx, pyovar, purulent salpingitis, purulent tubovarial formations).
• Diagnostics and elimination of the causes of tubal and peritoneal infertility.

Contraindications to laparoscopy

There are not many contraindications to laparoscopy.Most often, this is acute blood loss in the abdominal cavity with hemodynamic instability, when not a minute can be lost. The main contraindications for laparoscopy are also considered:

• widespread oncological process;
• impossibility of removing the tumor without rupture in the abdominal cavity;

• severe cardiovascular diseases;
• acute infectious diseases during planned interventions (the operation is simply postponed until complete recovery).

Preparation for laparoscopy

General blood and urine tests must be done 14 days before the operation. Also, a study of the biochemical composition of blood and the quality of coagulability is carried out, testing for HIV, syphilis, hepatitis C and B, a smear for flora, ultrasound of the pelvic organs and an electrocardiogram.

3-4 days before the operation, it is necessary to exclude fatty, spicy and gas-forming food from the diet.

On the eve of laparoscopy, you should cleanse the intestines at home and stop taking food and drinks 6 hours before surgery.

Rehabilitation

Hospitalization after treatment of pathologies of the uterus and fallopian tubes usually takes 1 day, after hysterectomy – 2 days. At this time, the patient is in the hospital under the supervision of doctors. As a rule, after two or three days, the woman returns to her usual way of life. Full recovery occurs after about 2-3 weeks of the postoperative period.

Pregnancy planning after laparoscopy of the uterus and fallopian tubes

The timing of pregnancy planning may vary.It all depends on what pathology was the reason for the laparoscopy. If the ovulation process is not disturbed, and the ability to conceive is preserved, then pregnancy can occur after 1-2 monthly cycles.

In some cases, additional hormonal treatment may be required, for example, after removal of endometriosis. In this case, the optimal period for conception is determined by the attending physician based on the results of examinations. After myomectomy – from 6 to 12 months, and after removal of cysts – after 1-2 menstrual cycles.

In cases of ovarian-sparing hysterectomy, a woman can use her own eggs for subsequent artificial insemination. In this case, she needs to contact a fertility specialist.

Why do they trust us?

• We make decisions about the treatment of complex oncogynecological patients at consultations with the participation of international experts.
• We carry out preoperative examination as soon as possible on the basis of one medical center.
• We provide organ-preserving treatment for benign, borderline and some malignant gynecological diseases.
• We preserve reproductive function in young cancer patients.
• Personalized approach – each patient has the opportunity to contact the attending physician by e-mail, receive comments on the test results.
• Close cooperation with mammologists, the possibility of joint consultations.
• Hospitalization according to the fast track system – the fastest possible mobilization of patients after operations, the minimum length of stay in the hospital.

Hysterectomy of the uterus or extirpation (removal of the uterus) in Kiev. Operation indications and cost. :: ACMD

Extirpation or hysterectomy is a complete removal of the uterus. The operation is radical, therefore, it is prescribed only when absolutely necessary (in the case of oncological pathologies with an unfavorable prognosis and other diseases with a severe, aggressive course).It is important to carry out extirpation professionally, because any mistakes made lead to serious complications. Trust your health to the specialists of the ACMD clinic! Professionals with vast experience work here.

Indications for extirpation of the uterus

The goal of modern gynecology is to preserve the female reproductive system. Such complex operations as extirpation of the uterus are used less and less due to the development of medicine and the emergence of innovative highly effective methods of conservative treatment.Indications for complete removal of the uterus are:

• oncological pathologies of the uterine neck and body;
• multiple, large, fast-growing fibroids;
• fibrosis of organ tissues.

Types of uterine extirpation

According to the volume of surgery, there are 3 types of uterine extirpation:

• removal of the uterus without ovaries – carried out at stage 0 of oncology of the organ and cervical body, mainly in patients aged 40+;
• excision of the uterus together with the ovaries (pangysterectomy) – performed at stages 2-3 of uterine oncology, if the pathological process has affected the relevant organs;
• extended excision (extirpation of the organ itself, appendages, nearby tissue and regional lymph nodes) – is performed in the late stages of oncology.

Preparation for surgery

Extirpation of the uterus requires careful preparation. You must first undergo a full examination:

• to pass clinical blood tests, gynecological smears, coagulogram;
• to undergo chest x-ray and electrocardiogram;
• to do an ultrasound of the pelvic organs.

Immediately before the operation, you must refuse food for 8 hours. On the day of surgery, the intestines are cleansed with an enema, and a catheter is inserted into the bladder.Removal of the uterus is performed under general anesthesia and takes up to several hours, depending on the chosen extirpation technique.

Laparoscopic removal of the uterus

Laparoscopy is the basic technique for the removal of female reproductive organs. During the procedure, 3 small holes are made in the peritoneum through which special instruments are inserted. The surgeon controls his actions using a camera, the image from which is broadcast on the screen.

The procedure begins by closing off the vessels that are responsible for blood circulation in the uterus.Direct excision of the organ is performed transvaginally through the vagina.

Laparoscopic extirpation is indicated at:

• early stages of oncology;
• numerous fibroids that provoke pathological disorders in the tissues of the uterus;
• adenomyosis and external endometriosis;
• polyposis and atypical hyperplasia.

Contraindications to laparoscopic extirpation:

• enlargement of the uterus to volumes comparable to 16 weeks of gestation;
• organ prolapse;
• cysts in the ovaries;
• overweight;
• severe diseases of the heart, lungs, kidneys.

Laparoscopic extirpation is a gentle method with minimal involvement of the surrounding tissue. With such a surgical intervention, the likelihood of complications is minimized. Thanks to this, rehabilitation takes less time (from 1 to 3 weeks). There are no large scars or visible cosmetic defects after the surgery.

Laparotomic extirpation

The technique involves the removal of the reproductive organ by the transabdominal route. The doctor gains direct access to the uterus through an incision below the navel.Laparotomic extirpation is convenient in that it allows you to examine the pelvic organs in maximum detail and fully control the process of surgical intervention. Thanks to this, there is less likelihood of complications and relapses.

Indications for laparotomic surgery:

• the volume of the uterus is comparable to the 16th week of pregnancy;
• oppression of nearby organs;
• Rapid growth of benign and malignant tumors during menopause;
• Multiple submucous fibroids on legs, prone to torsion and spontaneous necrotic changes;
• death of myomatous nodes;
• Formation of multiple growing fibroids closer to the cervix.

Contraindications to laparotomy are:

• aggravated infectious diseases of the reproductive and abdominal organs;
• Serious cardiovascular and respiratory disorders;
• period after heart attacks, strokes.

Transvaginal extirpation of the uterus

This operation involves removing the uterus (cervix and body) through an incision in the vagina. Vaginal extirpation is recommended for:

• early oncological diseases;
• precancerous conditions;
• severe, advanced cervical erosion;
• complicated submucous fibroids;
• significant prolapse, partial and complete prolapse of the organ;
• recurrent polyposis;
• any contraindications to laparotomic removal.

Surgery is not performed if the patient has a history of celiac disease. Also contraindications to transvaginal extirpation are: pathological enlargement of the uterus, the development of adhesive sepsis after past operations.

Vaginal removal of the uterus is considered a low-traumatic method. According to research results, it is often possible to remove the uterus using a transvaginal method. This method is actively practiced abroad (about two thirds of all operations to remove the uterus are performed transvaginally).

The above methods of uterine extirpation are practiced in the AMC clinic by the best specialists in the field of surgical gynecology. Each patient receives an individual approach and friendly, qualified service. The doctors of the AMC clinic will help you find a way out of any situation and restore your health!

Call us by phone: (044) 393-09-33 or (044) 393-09-30 to get comprehensive information. You can also make an appointment with the doctor by clicking the button below ⬇️

About total abdominal hysterectomy and other gynecological operations

This guide will help you prepare for total abdominal hysterectomy and other gynecological procedures at Memorial Sloan Kettering (MSK).It will also help you understand what to expect as you recover.

Read this manual at least once before your surgery and use it as a reference as you prepare for the day of your surgery.

Take this guide with you to all visits to MSK, including the day of your surgery. You and your healthcare team will guide you through your treatment.

to come back to the beginning

Operation Information

In a total (complete) abdominal hysterectomy, your uterus and cervix will be removed.Such surgery may be prescribed for you in connection with cancer of the uterus, cervix or ovaries, uterine fibroids, endometriosis, profuse vaginal bleeding, or pelvic pain.
Your doctor will explain to you why this operation will be performed.

About your reproductive system

Your reproductive system includes your ovaries, fallopian tubes, uterus, cervix, and vagina (see Figure 1). The uterus is located in the lower part of your abdomen (belly) between your bladder and rectum. The lower, narrow end of the uterus is called the cervix. The ovaries and fallopian tubes are connected to the uterus.

After a hysterectomy, you will not be able to have a baby naturally. Menses (menses) will also stop. A hysterectomy does not lead to menopause, unless the ovaries are removed. If you have any questions about maintaining the ability to have biological children, ask your doctor to refer you to a fertility specialist.

Figure 1.Your reproductive system

About gynecological surgery

There are various types of operations that can be prescribed by the attending physician, depending on what the treatment will be directed to. You may be prescribed several types of surgery at the same time. Your doctor will discuss with you the nature of your scheduled gynecological surgery.

Total abdominal hysterectomy

The surgeon will make an incision (surgical incision) in the abdomen (abdomen).Through this incision, he will remove your uterus and cervix and then close the incision with stitches.

In addition, the surgeon may perform one, two, or all three of the procedures listed below. If they are performed, then simultaneously with hysterectomy.

Salpingo-oophorectomy

Depending on the nature of your surgery, you may have one or both ovaries removed and one or both fallopian tubes removed. This operation is called salpingo-oophorectomy.

If both ovaries are removed, you will have menopause, if this has not happened before.If you are running or have already entered menopause, you will not notice any changes. If you haven’t already, you may experience common symptoms including night sweats, hot flashes, and vaginal dryness. Talk to your doctor about how to deal with these symptoms.

Sentinel node markers and lymph node dissection

Lymph nodes are small bean-shaped structures found throughout the body. They produce and store blood cells that help fight infections.Signaling lymph nodes are those that are most likely to be affected if cancer is present and spread.

If your surgeon suspects you have cancer, you may have a sentinel lymph node mapping and removal of one of your lymph nodes in an operation called lymphadenectomy. Before performing these procedures, you will receive anesthesia (medication will be administered, under the influence of which you will fall asleep).

To mark the sentinel lymph node, your surgeon will inject you with a small amount of dye where the cancer may have spread.The surgeon will discuss with you the type of dye to be used. This dye will enter the signal nodes, staining them blue or green.
After locating the sentinel node (s), the surgeon will make a small incision. The sentinel node or nodes that are blue or green will be removed and examined for cancer cells.

Colon resection

Colon resection is an operation performed to treat cancer or remove diseased tissue near the colon.This removes the part of the colon affected by cancer. The healthy ends of the colon are sutured together again. The surgeon will explain which part of the colon will be removed (see Figure 2).

Figure 2. Parts of the colon

to come back to the beginning

Before operation

The information in this section will help you prepare for your surgery. Read this section after you have assigned your surgery and refer to it as the date of your surgery approaches.It contains important information about what you need to do before your surgery.

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

Preparing for surgery

You and your healthcare team will prepare for your surgery together. Help us make your transaction as safe as possible by telling us if any of the statements below match your situation, even if you’re not entirely sure.

• I am taking a blood thinner.These drugs include aspirin, heparin, warfarin (Jantoven ^® , Coumadin ^® ), clopidogrel (Plavix ^® ), enoxaparin (Lovenox ^® ), dabigatran (Pradaxa ^® ® (Eliquis) ) and rivaroxaban (Xarelto ^® ). There are other similar medications, so be sure to tell your healthcare provider about any medications you are taking.
• I take prescription drugs (prescribed by a healthcare professional), including patches and ointments.
• I take over-the-counter medicines (which I buy without a prescription), including patches and ointments.
• I take nutritional supplements such as herbs, vitamins, minerals, and natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter defibrillator (AICD), or other cardiac pacemaker.
• I have sleep apnea.
• I used to have problems with anesthesia (when a drug is administered that makes the patient fall asleep during the operation).
• I am allergic to some drugs or materials such as latex.
• I do not want to receive a blood transfusion.
• I drink alcohol.
• I smoke.
• I take soft drugs.

On alcohol use

The amount of alcohol you drink may affect your condition during and after surgery. It is very important to tell healthcare providers how much alcohol you are drinking. This will help us plan your treatment.

• If you stop drinking abruptly, it can cause seizures, alcoholic delirium and death.
  If we know that you are at risk for these complications, we can prescribe medications for you to avoid them.
• If you drink alcohol regularly, there is a risk of other complications during and after surgery. These include bleeding, infections, heart problems, and longer hospital care.

To prevent possible problems, before the operation, you can:

• Tell healthcare providers honestly how much alcohol you drink.
• After the appointment of the operation, try to stop drinking alcoholic beverages. If, after stopping alcoholic beverages, you experience headaches, nausea (vomiting sensation), increased anxiety, or have trouble sleeping, tell your healthcare provider right away.These are early signs of alcohol withdrawal that can be treated.
• Tell your healthcare provider if you are unable to stop drinking.
• Ask your healthcare provider questions about how drinking alcohol might affect your body in connection with surgery. As always, we will ensure the confidentiality of all of your medical information.

On smoking

During surgery, smokers may experience breathing problems.Quitting smoking even a few days before surgery will help prevent these problems. If you smoke, your healthcare provider will refer you to our Tobacco Treatment Program. You can also contact this program by calling 212-610-0507.

Sleep Apnea Information

Sleep apnea is a common breathing disorder that causes a person to stop breathing for a short period during sleep.The most common type is obstructive sleep apnea (OSA). In OSA, the airway is completely blocked during sleep. OSA can cause serious complications during and after surgery.

Let us know if you have sleep apnea attacks, or if you suspect you may have such attacks. If you are using a breathing apparatus (such as a CPAP machine) to prevent sleep apnea, take it with you on the day of surgery.

About Accelerated Recovery After Operation

Enhanced Recovery After Surgery (ERAS) is an assistance program that allows you to recover faster after surgery. It is very important to follow the instructions of the ERAS program before and after the operation.

Be sure to follow the steps below to prepare for surgery.

• Read these guidelines. These provide information on what to expect before, during, and after surgery. If you have any questions, write them down. You can ask your healthcare provider about them at your next visit or by phone.
• Get exercise and a healthy diet. This will help prepare the body for surgery.

To recover faster after surgery:

• Read the recovery plan for you. This is a paper copy of the educational material your healthcare provider will give you.This document describes the steps in the recovery process through which you will learn what to do and what to expect on each day of the recovery period.
• Start moving as soon as you can. The sooner you get out of bed and start walking, the sooner you can return to your normal life.

Within 30 days prior to surgery

Preoperative study

Before your surgery, you will be assigned a presurgical testing (PST).The date, time and location of the preoperative examination will be indicated in the reminder you will receive at the surgeon’s office.

On the day of your scheduled preoperative examination, you can take your food and medication as usual.

During your visit, you will meet a senior nurse / nurse who works with anesthesiologists (medical personnel with specialized training who will perform anesthesia during surgery). A senior nurse / nurse will review your medical record and your surgical history with you.You will need to undergo a number of tests, including an electrocardiogram (EKG) to check your heart rate, chest x-rays, blood tests, and other tests needed to plan your treatment. In addition, a trained nurse can refer you to other specialists.

The Nurse will also advise you on what medications you will need to take on the morning of your surgery.

You will be of great help to us if you take with you to the preoperative examination:

• A list of all medicines you take, including prescription and over-the-counter medicines, patches, and creams;
• Results of any tests you did outside of MSK, such as exercise ECG, echocardiogram, or carotid Doppler
• names and telephone numbers of medical staff treating you.

Complete the Health Care Proxy Form

If you have not yet completed the Health Care Proxy, we recommend that you do so now. If you have already completed this form, or have other advance directives, please take them with you to your next visit.

The Power of Attorney for Health Care Decisions is a legal document that specifies the person who will represent you in the event that you are unable to do so on your own.The person listed there will be your health care agent.

Talk to your healthcare provider if you are interested in completing a Health Care Proxy. You can also read the resources Advance Care Planning and How to Be a Care Representative for information about health care proxies, other advance directives, and acting as a care agent.

Perform breathing and coughing exercises

Take deep breaths and clear your throat before surgery. You will receive a stimulation spirometer to help expand your lungs. For more information, read the resource How to Use Your Incentive Spirometer. If you have any questions, talk to your nurse or pulmonary therapist.

Physical activity

Try to do aerobic exercise daily.Aerobic exercise is any exercise that increases your heart rate, such as walking, swimming, or cycling. In cold weather, take the stairs in your home, go to the mall or shop. Physical activity will help improve the condition of the body for the operation, as well as help facilitate and speed up the healing process.

Stick to a healthy diet

Aim to eat a well-balanced, healthy diet prior to surgery.If you need help with diet planning, ask your healthcare provider to refer you to a dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) antiseptic cleanser (such as Hibiclens®).

4% CHG solution is a skin cleanser that kills various microorganisms and prevents their appearance within 24 hours after use. Showering with this solution before surgery will reduce the risk of infection after surgery. You can purchase a 4% CHG antiseptic skin cleanser at your local pharmacy without a prescription.

Buy what you need to prepare your bowel as needed

Your surgeon may order you to clear your bowels before surgery. The nurse will tell you how to do this. For bowel preparation, you will need to buy the items listed below from your nearest pharmacy. You don’t need a recipe for this.

• 1 bottle (238 g) polyethylene glycol (MiraLAX ^® ).
• 1 bottle (64 oz. Or 1.9 L) clear liquid.

Your doctor can send prescriptions to your pharmacy for the following antibiotics:

• Metronidazole (Flagyl ^® , Metrogel ^® ) 500 mg tablets;
• Neomycin (Neo-Fradin ^® ) 500 mg tablets.

If you need them, be sure to get them at the pharmacy and also take them with you.

Also get enough clear drinks to drink on the day before surgery, if needed.For a list of clear liquids you can drink, see the Resource Zero Diet.

7 days before surgery

Follow your healthcare provider’s instructions when taking aspirin

If you are taking aspirin and any medicines containing aspirin, you may need to change your dose or not take them for 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless directed to do so. Read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for more information.
…

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 surgery. These medicines can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatments.

2 days before surgery

Stop taking nonsteroidal anti-inflammatory drugs [NSAIDs].

Stop taking NSAIDs such as ibuprofen (Advil ^® , Motrin ^® ) and naproxen (Aleve ^® ) 2 days before surgery. These medicines can cause bleeding. For more information, read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
…

1 day before surgery

Record the time at which the operation is scheduled

An admissions officer will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, you will receive a call the previous Friday. If no one contacts you by 19:00, please call 212-639-5014.

A staff member will tell you when you should come to the hospital for your surgery. You will also be reminded how to get to the ward.

You need to come to the address:

MSK Presurgical Center (PSC)
1275 York Avenue (between East 67 ^th and East 68 ^th Streets)
New York, NY 10065
elevator B, 6 floor

Follow a clear liquid diet as needed

You may need to follow a clear liquid diet the day before your surgery.The clear liquid diet is all about clear liquids. Examples are shown in the Healthy Diet Table. Following this diet:

• Do not eat any solid food.
• Aim to drink at least 1 glass (8 oz. Or 240 ml) of clear liquid every hour while awake.
• Drink a variety of clear liquids, not just water, coffee and tea.
• Do not drink sugar-free liquids unless you have diabetes.

Diabetes

If you have diabetes, talk with your healthcare provider about what you should do when you are on a clear liquid diet.

• If you are taking insulin or other diabetes medications, ask if you need to change the dosage.
• Ask if you should use sugar-free clear liquids.

Check your blood sugar frequently while you are following a clear liquid diet. If you have any questions, ask your healthcare provider.

Initiate bowel preparation as needed

You may also need to prepare your bowel so that you can empty it before your surgery.The nurse will tell you if this is necessary.

MiraLAX Bowel Cleanser will cause you to have frequent bowel movements (you will often go to the toilet in a big way), so stay close to the toilet the evening before surgery.

• Mix all 238 grams of MiraLAX with 64 ounces (1.9 L) of clear liquid until the MiraLAX powder is completely dissolved. When MiraLAX is dissolved, you can refrigerate the mixture if you wish.
• At 5:00 pm on the day before your surgery , start drinking MiraLAX Bowel Cleanser.Drink 1 glass (8 oz. [240 ml]) of the solution every 15 minutes until it runs out.
• When you finish drinking MiraLAX Colon Cleanser, drink 4-6 glasses of clear liquid. You can continue to drink clear liquids until midnight or until you go to bed, but you don’t have to.

Apply petroleum jelly (Vaseline ^® ) or A&D ^® ointment to the skin around the anus after each bowel movement. This will prevent irritation.

At 7:00 pm on the day before surgery , take your prescribed antibiotics as directed.

At 10:00 pm on the day before surgery , take your prescribed antibiotics as directed.

Shower with a 4% CHG antiseptic cleanser (such as Hibiclens®)

The evening before the day of surgery, shower with a 4% CHG antiseptic cleanser.

1. Wash hair with regular shampoo. Rinse your hair thoroughly.
2. Wash face and genital area with your usual soap. Rinse your body thoroughly with warm water.
3. Open the vial with 4% CHG solution. Pour a small amount into your hand or onto a clean washcloth.
4. Move away from the water jet. Massage the 4% CHG solution lightly into the body from neck to feet. Do not apply it to your face or genital area.
5. Return under tap water and rinse with 4% CHG solution.Use warm water.
6. After showering, dry yourself with a clean towel.
7. Do not apply any lotion, cream, deodorant, makeup, powder, perfume or cologne after a shower.

Sleep

Go to bed early and try to get a good night’s sleep.

Instructions for eating before surgery

Do not eat after midnight before your surgery. This also applies to candy and chewing gum.

Morning before surgery

Shower with a 4% CHG antiseptic cleanser (such as Hibiclens®)

Shower with 4% CHG antiseptic skin cleanser before leaving the hospital.Use the same product you used the night before.

Do not apply any lotion, cream, deodorant, makeup, powder, perfume or cologne after a shower.

Take medication as directed

If your healthcare provider tells you to take some medicines in the morning before your surgery, take only those medicines with a small sip of water. Depending on the medications, this may be all or some of the medications you usually take in the morning, or you may not need to take them at all.

Instructions for drinking drinks before surgery

Drink the ClearFast preop ^® that your healthcare professional has ordered two hours before your scheduled arrival time at the hospital. Don’t drink anything else, not even water.

Do not drink any liquid two hours before your scheduled arrival time at the hospital. This also applies to water.

Points to Remember

• Do not use any lotion, cream, deodorant, makeup, powder or perfume.
• Do not wear metal objects. Remove all jewelry, including body piercings. Equipment used during the operation may cause burns if it comes into contact with metal.
• Leave valuables at home, such as credit cards, jewelry, or a checkbook.
• Before going to the operating room, you will need to remove your hearing aid, dentures, dentures, wig, and religious paraphernalia.
• Wear comfortable, loose-fitting clothing.
• If you wear contact lenses, remove them and put on glasses.

What to take with you

• CPAP device for the prevention of sleep apnea attacks, if you have one.
• Stimulation spirometer, if you have one.
• Power of Attorney for Health Care Decisions, if completed.
• A briefcase for keeping your personal belongings such as glasses, hearing aids, dentures, dentures, wig, and religious paraphernalia, if you have one.
• These are recommendations. Using these guidelines, your healthcare team will guide you on how to take care of yourself after your surgery.

Where to park

MSK Garage is located at East 66 ^th Street between York Avenue and First Avenue. For parking prices, call 212-639-2338.

To enter the garage, turn East 66 ^th Street from York Avenue. The garage is located approximately a quarter block from York Avenue, on the right (north) side of the street.A pedestrian tunnel leads from the garage to the hospital.

There are other garages located at East 69 ^th Street between First Avenue and Second Avenue, East 67 ^th Street between York Avenue and First Avenue, and East 65 ^th Street between First Avenue and Second Avenue.

Upon arrival at the hospital

Change for operation

When it’s time to change before your surgery, you will be given a hospital gown, gown, and non-slip socks.

Nurse appointment

You will meet with the nurse before your surgery. Tell her / him the doses of all medications you took after midnight and when you took them (including all prescription and over-the-counter medications, patches, creams, and ointments).

A nurse may place an intravenous (IV) line into one of the veins, usually in the arm or hand. If the nurse does not give you an IV, your anesthesiologist will do it when you are in the operating room.

Meeting with anesthesiologist

You will also meet with your anesthesiologist before your surgery. This specialist:

• will review the medical record with you;
• will ask if you have had any problems with anesthesia in the past, including nausea or pain.
• will tell you about your comfort and safety during the operation;
• will tell you about the type of anesthesia you will receive;
• will answer your questions about anesthesia.

Prepare for Operation

You will go to the operating room yourself, or you will be taken there on a gurney.A representative of the operating team will help you lie down on the operating table. Special compression boots will be worn on the bottom of your feet. They will inflate or deflate smoothly to improve circulation in your legs.

When you are comfortable on the table, the anesthesiologist will administer anesthesia through an IV line and you will fall asleep. Your IV line will also give you fluids during and after your surgery.

When you fall asleep, a breathing tube will be inserted through your mouth into your windpipe to help you breathe.You will also receive a urinary catheter (Foley catheter ^® ) to drain urine from your bladder.

Surgical staples or stitches will be placed on your incision after surgery is complete. Steri-Strips ^TM (thin strips of adhesive) will be applied directly to the incision and a bandage will be applied over the top. The breathing tube is usually removed while you are still in the operating room.

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After operation

The information in this section will let you know what to expect after surgery, while you are in the hospital, and when you leave home.You will learn how to safely recover from surgery.

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

What to expect on the day of your procedure

After your surgery, you will wake up in the Post Anesthesia Care Unit (PACU).

You will receive oxygen through a thin tube under your nose called a nasal cannula. The nurse will monitor your body temperature, heart rate, blood pressure, and oxygen levels.

You may have a catheter inserted into your bladder to help you keep track of the amount of urine you are making. It must be removed before you leave the hospital or when you are transferred from the recovery room. In addition, compression boots will be worn to improve circulation.

You may also have abdominal drainage installed.
It will allow fluid to drain from the abdominal cavity.

The pain medicine will be given through an IV line, or you will take it as a pill.If you are in pain, tell your nurse.

After your stay in the recovery room, you may be discharged or transferred to an inpatient ward. Here a nurse will tell you how to recover from your surgery. Below are some guidelines to help make this process safer.

• You are advised to walk with the support of a nurse or physiotherapist. We will give you medicine to relieve your pain.Walking helps reduce the risk of blood clots and pneumonia. It also helps to stimulate and restore bowel function.
• Use a stimulating spirometer. This will help expand the lungs, which will prevent pneumonia from developing. For more information, read the resource How to Use Your Incentive Spirometer.

Frequently Asked Questions: Hospital Stay

Will I have pain after surgery?

Yes, you will experience pain after surgery, especially in the first few days.The doctor and nurse will regularly ask you about your pain. If necessary, you will be given medication to relieve pain. If pain persists, tell your doctor or nurse. Pain relief is imperative so that you can cough up, breathe deeply, use an incentive spirometer, and get out of bed and walk.

Will I be able to eat?

Most patients can return to their normal diet or eat, taking into account the individual tolerance of certain foods.You should start with foods that are soft and easily digestible, such as applesauce and chicken noodle soup. Eat small meals often and then move on to your regular meals.

If you suffer from bloating, gas, or cramps, limit your high fiber foods, including whole grain breads and cereals, nuts, seeds, lettuce, fresh fruit, broccoli, cabbage, and cauliflower.

If you also had a colon resection, you will be given clear fluids for the first few days after surgery.Then you will gradually move on to solid foods. For more information, see the answer to the question “Do I need to change my diet (diet) after surgery?” in this section.

Your doctor will give you dietary advice after surgery. Your dietitian will review these recommendations with you before you leave the hospital.

How long will I be in the hospital?

Depending on the type of surgery you had, you can stay in the hospital for 3-5 days. Before you are discharged, you must:

• to manage pain with pain medications;
• to get out of bed and walk on their own;
• independently urinate and give off gas;
• eat and drink independently.

Frequently Asked Questions: After Checkout

Will I feel pain when I get home?

The duration of the presence of pain and discomfort is different for each person. You may feel pain when you return home, and you may be taking pain medication.Follow the guidelines below.

• Take your medicines as directed and as needed.
• Call your doctor if the prescribed medication does not relieve pain.
• Do not drive or drink alcohol while you are taking prescription pain medication.
• As the incision heals, the pain will decrease and you will need less pain medication. Mild pain relievers such as acetaminophen (Tylenol ^® ) or ibuprofen (Advil ^® ) may help relieve pain and discomfort.However, taking large amounts of acetaminophen can damage the liver. Do not take more acetaminophen than what is listed on the bottle, or as directed by your doctor or nurse.
• Pain medications should help you get back to your normal routine. Take enough medication so you can exercise comfortably. Pain medications are most effective 30 to 45 minutes after you take them.
• Keep track of the time you take your pain medication. It is better to take the medicine when the pain first appears and not wait for it to intensify.

Pain medications can cause constipation (less bowel movements than usual).

How do I care for my incision?

Sutures, staples, or surgical glue will be applied to the incision (s). If you have braces, they are usually removed 10-14 days after surgery. You will need to return to the hospital to remove them.The procedure takes place in the doctor’s office and is not accompanied by pain.

Steri-Strips will be applied to keep your incision (s) closed. After about 14 days, they will begin to peel off and you can remove them. The incision (s) will remain closed.

You should check your incision (s) daily for signs of infection and do so until your doctor confirms that it has healed. Call your doctor right away if you develop any of the following signs of an infection in your wound:

• redness;
• edema;
• increased pain;
• increase in body temperature at the site of the incision;
• foul odor or purulent discharge from the incision;
• Temperature 101 ° F (38.3 ° C) or higher

Do not allow anyone to touch the incision (s) to prevent infection.Before touching your incision (s), wash your hands with soap and water or an alcohol-based hand sanitizer.

When can I shower?

Shower with Hibiclens until surgical staples are removed. Gently flush your incision (s) using Hibiclens. If you have Steri-Strips or surgical glue over your incision (s), do not rub or use a washcloth. This can irritate the incision (s) and prevent healing.

When taking a shower, do not let your incision (s) stay wet for too long. After you finish showering, gently blot your incision (s) with a clean towel. Allow them to air dry completely before dressing.

After the surgical braces are removed, your doctor or nurse will tell you if you can stop showering with Hibiclens. For 4 weeks after surgery, continue showering with soap such as Dove ^® or Ivory ^® at least once a day.

Do not take a bath or swim until your doctor tells you to.

What are the most common symptoms following a hysterectomy?

For 4-6 weeks after surgery, you may usually experience bruising in the form of spots or slight bleeding from the vagina. You should keep an eye on this using panty liners or panty liners. Do not use tampons or insert anything into your vagina for 8 weeks after surgery. If you experience heavy bleeding, such that blood seeps through the pad every 1 to 2 hours, call your doctor immediately.

In addition, there is usually some discomfort after the operation due to the air being pumped into the abdominal cavity (abdomen) during the operation. To cope with this, drink plenty of fluids and be sure to take the stool softening medications that are given to you.

When can I resume sexual activity?

Do not have vaginal sex for 8 weeks after surgery. Some patients need to wait more than 8 weeks, so talk to your doctor before resuming vaginal sex.

How can I prevent constipation?

After surgery, you may experience constipation (problems with passing stools). This is a common side effect of taking pain medication. Light exercise such as walking and drinking plenty of fluids can help reduce this side effect.

To prevent constipation, take a stool softener such as docusate sodium (Colace ^® ) 3 times daily and 2 senna (laxative) tablets before bed.Take a stool softener and laxative until you stop taking any pain relievers. Drink plenty of fluids. If you feel bloated, avoid foods that can cause gas, such as legumes, broccoli, onions, cabbage, and cauliflower.

How will bowel movements change after surgery?

If part of your colon is removed, the rest of your colon will adjust to these changes.Adaptation of the rest of the colon will begin shortly after surgery. During this adaptation period, you may experience the following symptoms:

• gases;
• colic;
• changes in bowel habits (eg frequent bowel movements).

If you experience pain around the anus caused by frequent bowel movements:

• Apply zinc oxide ointment (Desitin ^® ) to the skin around the anus.This will prevent irritation.
• Do not use harsh toilet paper. You can use alcohol-free wet wipes instead.
• Take the medicine as directed by your doctor.

Do I need to change my diet (diet) after surgery?

Parts of the colon can be removed without significantly affecting digestive function. However, as the rest of your colon adapts, your body may not absorb nutrients, fluids, vitamins, and minerals as well as it did before surgery.It is very important to drink enough fluids and make sure you are getting enough nutrients while you are recovering from surgery.

When is it safe for me to drive?

Do not drive a vehicle until you have received permission from your surgeon. This will happen some time after the first postoperative appointment. If you are still taking your prescribed pain medications, your surgeon may ask you to take your time to get behind the wheel.Pain medications can slow down your reflexes and reactions, making driving unsafe. In addition, the abdominal muscles are involved when braking, and therefore driving can be uncomfortable.

Will I be able to travel?

Yes, you can travel. If you are traveling by plane a few weeks after your surgery, be sure to get up every hour during the flight to get around. If possible, try to stretch your legs, drink plenty of fluids, and keep your feet elevated.

What exercises can I do?

Exercise will help you gain strength and improve your well-being. Hiking is great exercise. Gradually increase the walking distance.

Do not run (including jogging). Don’t do Pilates or yoga. Check with your doctor or nurse before proceeding to more vigorous exercise.

When can I lift weights?

Consult your doctor before lifting weights.In most cases, you should not lift anything heavier than 10 pounds (4.5 kg) for at least 6 weeks after your surgery. Ask your doctor how long you should refrain from lifting weights.

When can I return to work?

The timing of returning to work depends on what kind of job you have, what kind of surgery you have undergone, and how quickly your body recovers. In most cases, patients can return to work 4–6 weeks after surgery.

How can I deal with my feelings?

After an operation due to a serious illness, you may experience a new feeling of depression. Many people say that at some point they felt like crying, had to experience sadness, anxiety, nervousness, irritation and anger. You may find that you are unable to contain some of these feelings. If this happens, try to find emotional support.

The first step on this path is to share your feelings.Friends and loved ones can help you. A nurse, doctor, and social worker can give you comfort and support and advice. Be sure to tell these professionals about your emotional state and about the emotional state of your friends and loved ones. Numerous materials are available for patients and their families. Whether you are in the hospital or at home, nurses, doctors, and social workers are ready to help you, your friends, and loved ones cope with the emotional aspects of illness.

When will my first visit to the doctor after surgery take place?

Your first visit to the doctor will take place 2-4 weeks after your surgery.
The nurse will give you directions on how to make an appointment, including the phone number to call. During this appointment, your doctor will discuss the laboratory results with you in detail.

What if I have other questions?

If you have any questions or concerns, talk to your doctor or nurse.You can reach them Monday through Friday, 9:00 am to 5:00 pm.

After 5:00 pm and on weekends and holidays, call 212-639-2000 and ask the doctor who is on duty in your place.

When to contact your healthcare provider

Tell your healthcare provider if you have:

• temperature 101 ° F (38.3 ° C) or higher.
• pain that does not go away after taking pain medication;
• there is redness, swelling, or discharge from incisions;
• severe vaginal bleeding is observed;
• there is swelling or tenderness in the calves or thighs;
• coughing up blood is observed;
• shortness of breath or shortness of breath is observed;
• Absent stool for 3 days or longer
• nausea, vomiting, or diarrhea is observed;
• have any questions or concerns.

After 5:00 pm and on weekends and holidays, call 212-639-2000. Ask to speak to the doctor on call or call your surgeon.

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Support services

This section provides a list of support services that can help you prepare for and recover from surgery.

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

MSK Support Services

Admitting Office
212-639-7606
Call if you have questions about hospitalization, including requesting a single room.

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

Blood Donor Room
212-639-7643
Call for more information if you would like to become a blood or platelet donor.

Bobst International Center
888-675-7722
MSK accepts patients from all over the world. If you are from another country, call for help arranging your treatment.

Chaplaincy Service
212-639-5982
At MSK, chaplains are ready to listen, support family members, pray, reach out to local clergy or religious groups, or simply provide comfort and a helping hand.Anyone can apply for spiritual support, regardless of their formal religious affiliation. The Interfaith Chapel is located next to Memorial Hospital’s main lobby and is open 24 hours a day. If you have an emergency, call the hospital operator and ask to speak to the duty chaplain.

Counseling Center
646-888-0200
Counseling counseling helps many people.We provide counseling for individuals, couples, families and groups of individuals, and we provide medications to help you cope with anxiety or depression. To make an appointment, ask your healthcare provider for a referral or call the phone number above.

Food Pantry Program
646-888-8055
The Food Pantry Program provides food to low-income patients during cancer treatment. For more information, contact your healthcare provider or call the phone number above.

Integrative Medicine Service
646-888-0800
The Integrative Medicine Service offers a variety of services to complement traditional health care. These services include music therapy, mind / body therapy, dance and movement therapy, yoga and tactile therapy.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or contact library staff for more information on a particular type of cancer. Alternatively, you can check out the LibGuides section on the MSK library website at libguides.mskcc.org.

Patient and Caregiver Education
www.mskcc.org/pe
Visit the Patient and Caregiver Education website to find educational materials in our virtual library.You can find tutorials, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may be encouraged to talk to someone who has received treatment like yours. Through our Patient and Caregiver Peer Support Program, you can talk to a former MSK patient or caregiver.Such conversations are confidential. You can communicate in person or by 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 a health care power of attorney or concerns about caring for you.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about who MSK will share your information with during surgery.

Private Duty Nursing Office
212-639-6892
You can request the assistance of a Private Duty Nursing Office or Companions. Call for more information.

Resources for Life After Cancer [RLAC] Program
646-888-8106
At MSK, patient care does not end after active treatment is completed. The Resources for Life After Cancer (RLAC) program is designed for patients who have completed their treatment and for their families. This program offers a variety of services such as workshops, workshops, support groups, and post-treatment counseling.She also helps with health insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health. MSK’s Sexual Health Program can help you get started and address sexual health issues before, during, and after treatment.

• Our Sexual and Reproductive Medicine Program for Women helps women with cancer-related sexual health problems, including premature menopause and decreased fertility.For more information and to make an appointment, call 646-888-5076.
• Our Sexual and Reproductive Medicine Program for Men helps men with cancer-related sexual health problems, including erectile dysfunction. For more information and to make an appointment, call 646-888-6024.

Social Work
212-639-7020
Social workers help patients, their families and friends cope with the challenges of cancer.They provide one-on-one counseling and support groups during your treatment and can help you connect with your children and other family members. Our social workers can also refer you to local agencies and programs, and provide information on additional financial resources, if you are 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 Virtual Programs offer online training and support for patients and caregivers, even if you cannot come to MSK in person. Through interactive activities, you can learn more about your diagnosis and what to expect during treatment and how to prepare for the different stages of cancer treatment. Classes are held confidentially, free of charge and with the involvement of highly qualified medical professionals.If you would like to join the virtual training program, visit our website at www.mskcc.org/vp for more information.

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

External support services

Access-A-Ride Organization
web.mta.info/nyct/paratran/guide.htm
877-337-2017
MTA New York offers ridesharing and escort services for people with disabilities who are not can take the bus or metro.

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 Shelter of Hope ( Hope Lodge is a free stay for patients and their caregivers during cancer treatment.

Cancer and Careers Website
www.cancerandcareers.org
A resource for educational materials, tools and information on various activities for working people with cancer.

Cancer Organization Care
www.cancercare.org
800-813-4673
275 Seventh Avenue (between West 25 ^th Street and 26 ^th Street)
New York, NY 10001
Consulting, groups support, educational workshops, publications and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and educational materials for people facing cancer.

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

Organization Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel for medical treatment around the country through available seats on corporate flights.

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

Good Days Organization
www.mygooddays.org
877-968-7233
Offers financial assistance to cover copayments during treatment. Patients must have health insurance, they must meet a number of criteria, and they must be prescribed medications that are on the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover co-payments, health insurance premiums, and deductibles for certain drugs and treatments.

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

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

LIVESTRONG Fertility Organization
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides information on fertility and support for cancer patients whose treatment involves fertility risks and cancer survivors.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to help you learn more positive perceive your appearance.For more information or to sign up for a workshop, call the above phone number or visit the program 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 educational materials, training courses, and advocacy for LGBT cancer survivors at risk.

Needy Meds Resource
www.needymeds.org
Provides a list of programs that support patients in obtaining generic and registered brand drugs.

NYRx Organization
www.nyrxplan.com
Provides prescription drug benefits to eligible current and former New York State public sector employees.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps eligible patients who do not have prescription drug coverage get drugs for free or purchase them at a low cost.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides co-pay assistance for insured patients.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to medical care, financial assistance, insurance assistance, job security and access to a national resource directory for people with insufficient health insurance.

Organization RxHope
www.rxhope.com
877-267-0517
Provides help with getting drugs that people may not have enough money for.

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Educational resources

This section provides a list of the training materials that have been referenced in this manual. These resources will help you prepare for your surgery and recover safely from it.

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

For information on lymphedema, also see resource , Understanding Lymphedema, , by the New York State Department of Health.

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90,000 Hysterectomy. Removal of uterus

A hysterectomy is an operation to remove the uterus. Today it ranks second in Russia in terms of frequency after operations on the uterine appendages.
In the Medgard MDK, the removal of the uterus is carried out as an open access (through an incision in the lower abdomen), laparoscopic (through three small punctures) and a vaginal access. paths.

Indications for hysterectomy

Removal of the uterus is a serious surgical intervention, the decision to carry out which is made on the basis of a thorough diagnosis and assessment of all accompanying factors.The indications for surgery are:

• tumor diseases and large fibroids that affect nearby organs
• with prolapse or prolapse of the uterus
• for malignant neoplasms of the cervix
• for inflammatory diseases of the uterus and appendages that do not respond to conservative treatment

At the age of up to 40 years, preference is given to organ-preserving operations.Their goal is treatment while preserving reproductive function. The final decision on the method of surgical treatment is also influenced by the patient’s reproductive plans.

Types of hysterectomy

Depending on the involvement in the pathological process, as well as the patient’s history, there are

• subtotal hysterectomy – removal of the uterus with preservation of the cervix
• total hysterectomy – removal of the body of the uterus and its cervix
• radical hysterectomy – removal of the uterus, cervix, appendages and ovaries

Subotatal hysterectomy is performed before the age of 50 and allows subsequent sexual activity.However, with this, the risk of developing cervical cancer remains. That is why laboratory diagnostics (smear for oncohistology) comes to the fore when making a decision.

Total hysterectomy is the most common type of such surgery. It is performed with uterine fibroids and high risks of developing cervical cancer (colposcopy data, identified by HPV).

Radical hysterectomy is performed in case of high risks of further development of ovarian cancer. But since menopause occurs as a result of the operation, the decision to carry it out is made based on many factors.The patient’s age is one of them.

Methods of carrying out hysterectomy

The laparotomic approach allows the surgeon to remove the uterus (cervix and appendages) through an incision in the abdominal wall in the lower abdomen (10-20 cm).
The disadvantage of laparotomic hysterectomy in the high trauma of the operation, pain in the recovery period, which require the use of analgesics.

Laparoscopic hysterectomy is performed through three small punctures (in the navel and lower abdomen).The surgeon manipulates the instruments under the control of the optics, which displays the image on the screen. Thus, a low invasiveness and a short recovery period, small blood loss, a good cosmetic effect, as well as better visualization when enlarging the image are achieved, which allows you to act, on the one hand, targeted, on the other hand, not to miss the details.

Vaginal hysterectomy is performed through an incision in the upper third of the vagina, so there are no sutures and scars on the anterior abdominal wall.With the advantages of this method (low trauma, low blood loss, quick recovery), it should also be taken into account that the operation is possible with a sufficient volume of the vagina and a moderate size of the uterus. The maximum weight of the uterus removed by the gynecologists of the Medgard Medical Center by vaginal access is 860 grams.

Recovery period

The operation takes about 3 hours. After that for 3-5 days it is necessary to stay in a round-the-clock hospital “Medgarda” under the supervision of a doctor and medical staff.
After laparoscopic and vaginal hysterectomy, it is allowed to turn, sit down and get up on the day of the operation. The next day, walk and eat (in accordance with the postoperative diet).
For two to three weeks, it is recommended to shower only and treat existing wounds. For a period of up to a month, a ban is imposed on any physical activity over everyday life.
A month after the operation, a control appointment and examination are prescribed, followed by a histological examination and recommendations for the recovery period.

Antibiotic prophylaxis for elective hysterectomy | Cochrane

Review question

Are antibiotics effective and safe for preventing postoperative infection in women undergoing elective (non-emergency) hysterectomy.

Relevance

Surgery to remove the uterus (hysterectomy) is often performed. In most cases, non-emergency (elective) procedures are performed for benign conditions in the uterus, such as menstrual pain or abnormal bleeding.Antibiotics are usually given before surgery (prophylactic antibiotics or antibiotic prophylaxis) to prevent or reduce the risk of infection after the procedure. Researchers at the Cochrane Collaboration reviewed the evidence regarding the efficacy and safety of antibiotics used to prevent infections after non-emergency surgery to remove the uterus. The evidence is current to November 2016.

Study characteristics

We identified 37 randomized controlled trials (RCTs), which included 6079 women, and compared 20 different types of antibiotics with placebo (inactive medicine – “dummy”) and among themselves.

Key Findings

This review found moderate-quality evidence that antibiotics are effective in preventing infections in women undergoing non-emergency surgery to remove the uterus through the vagina or abdomen. This suggests that antibiotic prophylaxis reduces the average risk of postoperative infection after vaginal hysterectomy from 34% to 7-14%, and after abdominal hysterectomy from 16% to 1-6%.

However, there is insufficient evidence to show whether prophylactic antibiotic use affects the incidence of adverse effects (side effects) or whether a particular antibiotic is more effective or safer than others.

When antibiotics were compared with each other, or combinations of antibiotics were compared with one antibiotic, it was not clear which antibiotic was more effective and safer, and whether using the combination of antibiotics was more effective and safer than using only one antibiotic.The quality of the evidence for these comparisons is very low.

It is also not clear which dosing regimen or route of administration of antibiotics is the safest or most effective in women undergoing elective hysterectomy.

The most recent studies included in this review were published 14 years ago at the time of our search. Thus, the results from the included studies may not reflect current practice in perioperative and postoperative care and may not be consistent with local antibiotic resistance (antibiotic resistance) data.

Quality of evidence

The quality of the evidence for our main comparisons ranged from very low to moderate (moderate). The main limitations of this evidence are the risk of bias due to poor presentation of randomization methods, inaccuracy due to small sample sizes and low event rates, and inadequate reporting of adverse effects.

Removal of the uterus in Israel, prices, reviews

Tell me the prices

The most gentle option for carrying out a hysterectomy is a robotic-assisted operation, in which the blood vessels and nerve endings are minimally damaged, and the risks of medical errors are reduced to zero.If after a classic hysterectomy with a wide tissue excision, the recovery period is from a month to one and a half, then after a minimally invasive patient, after a few weeks, they can be discharged from the hospital and go home. At the Top Ichilov clinic, safety and comfort requirements are strictly observed. The attentiveness and high professionalism of the clinic’s medical staff allow avoiding complications in the postoperative period. Therefore, reviews of hysterectomy in Israel, in most cases, are positive.

Indications for hysterectomy

The most common reason for the need to remove the uterus is considered to be oncological diseases of the organ. Moreover, benign tumors are preferred to be removed while preserving the uterus, and only if the neoplasm shows rapid growth, it is removed together with the organ. But there are other conditions for which doctors choose to have the uterus removed – if other treatments are found to be ineffective. In particular, indications for hysterectomy may be the following diseases:

• Cancer of the uterus, ovaries, cervix
• Extensive endometriosis
• Septic endometritis
• Adenomyosis
• Benign tumors (myoma, uterine polyps10, endometrial fibroids
• ) 900
• Prolapse or prolapse of the uterus in an advanced stage
• Tuberculosis of the fallopian tubes
• Abundant and frequently recurring uterine bleeding.

How the uterus is removed in Israeli clinics

Depending on the degree of organ damage and the prevalence of pathology, the following types of surgery to remove the uterus are distinguished:

• Subtotal: only the uterus is removed, the cervix is ​​not removed
• Total: the uterus is removed and cervix
• Hysterosalpingo-oophorectomy: removal of the uterus and its appendages, ovaries, tubes
• Radical: not only the uterus is removed, but also part of the vagina, lymph nodes, adipose tissue, appendages.

Once doctors have decided on the type of hysterectomy to perform, they begin to consider different options for the operation. At the Top Ichilov clinic, preference is given to minimally invasive techniques, but sometimes, in order to save the patient’s life and guarantee her recovery, an open operation has to be performed. We will list the types of surgical interventions and tell you about the features of their implementation.

Abdominal surgery. Open surgery with a wide incision in the peritoneum.Such an operation is inevitable if the patient has a large tumor or a pronounced adhesive process. Since the surgeon gets the opportunity to visually review the affected tissues, he can assess the prevalence of the pathology and see such features that could not be detected during the diagnosis. During the operation, a tissue sample may be taken for histological analysis (biopsy). If necessary, intraoperative radiotherapy can be performed – irradiation with ionizing rays.The operation is performed by highly qualified surgeons who are proficient in all the necessary surgical techniques.
Transvaginal hysterectomy. The least invasive variant of the operation, it is most often performed when the patient is diagnosed with uterine prolapse. Access to the pathology area is through a vaginal incision, so after the operation there are no visible scars or scars on the abdomen. The affected tissues of the uterus are excised, an electrosurgical unit is used: this instrument allows the blood vessels to be cauterized immediately after the excision of the tissues, due to which large blood loss does not occur.The recovery period after such an operation takes a minimum of time.
Laparoscopic hysterectomy. The most commonly performed operation, it removes the uterus through small incisions in the abdominal wall. Surgical instruments are inserted through incisions of several centimeters, a laparoscope is brought to the operating area – an instrument that illuminates the area where the intervention will be performed, and transmits its image to the surgeon’s monitor. The doctor does not have direct visual contact with the area that he is operating, he conducts all his manipulations, tracking them on the monitor.The undoubted advantage of such an intervention is the absence of large blood loss, the minimum risk of infection, as well as a short recovery period after surgery. Currently, the Top Ichilov clinic is also performing operations on a modified version of laparoscopy – SILS. It involves making only one puncture in the wall of the abdominal cavity, near the navel. There are no visible scars on the body after such an operation.
Robot-assisted hysterectomy. A new format for hysterectomy, which became possible with the advent of innovative robotic equipment – the Da Vinci robot.Those operations that were previously impossible to perform laparoscopically due to the fact that there were restrictions in the movements that the surgeon could perform, are now performed minimally invasive. Instead of a surgeon, all operational actions are performed by the “hands” – manipulators of the robot. They have great freedom of movement in confined spaces and can perform organ excision with minimal trauma to healthy tissue.
Rehabilitation After the operation, the patient is under medical supervision for some time.After minimally invasive operations, the duration of hospital stay is from three days to a week, after open surgery – up to one and a half weeks. Full recovery takes place in a period from two weeks (with minimally invasive hysterectomy) to one and a half months (after open surgery). the patient is prescribed antibiotics, sometimes hormonal drugs (if the ovaries were removed).

How much does the removal of the uterus cost in Israel

In order to determine the price, the doctor must have a complete picture of the disease – it is after this that we can talk about the type of surgery.The cost of removing the uterus in Israel depends on the following nuances:

• Type and type of operation
• The nature of the pathology
• The scale of the surgical intervention
• The period that the patient will spend in the hospital
• The need to include other types of therapy in the treatment plan.

The Ichilov Top has very reasonable prices – if we compare prices in clinics of the same level in Europe or the United States. The price difference can be 30-50%.

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Operative gynecology – Ekaterininskaya Clinic

Uterine myoma is a benign formation of muscle and connective tissue of the uterus.Today, a surgical method of treating a tumor is the most common. The volume of surgical intervention can be different – from the removal of one myomatous node to the complete removal of the uterus. For young women planning pregnancy in the future, our experienced obstetricians-gynecologists perform organ-preserving and reproductive surgeries.

MYOMEECTOMY

In the course of this organ-preserving operation, only fibroids are removed. In our clinic, it is possible to perform myomectomy in several ways: laparoscopic, vaginal and laparotomy.

Laparoscopic myomectomy is the least traumatic method of surgical treatment. Removal of the neoplasm is performed through punctures in the anterior abdominal wall, after which there are no visible scars on the patient’s body.

MYOMECTOMY IN WOMEN PLANNING PREGNANCY AND CHILDBIRTH

The experience of our surgeons allowed them to formulate the principles for the most optimal choice of the method of surgical treatment of fibroids in women planning pregnancy and childbirth. Laparoscopic myomectomy is not suitable for such patients, since the area of ​​coagulation necrosis formed during this type of surgery prevents the formation of a durable scar on the uterus.An incompetent scar can lead to rupture of the uterus along the scar line after 16 weeks of gestation. If a woman is planning a pregnancy, then the most optimal method of surgery is laparotomic myomectomy, which allows a high-quality durable scar.

Myomectomy lasts 1 to 1.5 hours and is performed under general anesthesia. After the operation, the patient can recover under the round-the-clock supervision of doctors in the comfort of our hospital.