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A laparoscopic hysterectomy is a keyhole operation performed under general anaesthetic to remove the womb (uterus). It is a common surgical procedure which may also involve the removal of the fallopian tubes, ovaries and cervix to cure or alleviate a number of gynaecological complaints.
A laparoscopic hysterectomy is usually considered a last resort after other treatments have failed unless it performed as a life saving measure for conditions such as cancer. The decision to have a hysterectomy should be shared between you and your doctor. In most cases a laparoscopic hysterectomy is needed to relieve either acute or chronic painful and distressing symptoms, where other treatments have failed or there are no other treatment options. The benefit of having this operation is to resolve these symptoms and improve your life style. Some of the reasons for a laparoscopic hysterectomy include:
There are different types of laparoscopic hysterectomy including:
At your pre-op assessment and on your admission day the nurse will go through your hospital stay and explain your operation. Please do let us know about any concerns you have or if there is any information you think we should know about that will make your stay with us more comfortable.
You will need to make arrangements for your family, children or any other commitments that you have prior to coming in to hospital and to cover the length of your recovery. You will see an anaesthetist and the doctor
performing the surgery before you go to theatre. It is not unusual to feel anxious; the nursing staff will gladly discuss how you are feeling and talk you through your emotions.
A laparoscopic hysterectomy may also be referred to as keyhole surgery as it is performed through small incisions made in the abdomen. Special surgical instruments are inserted through the incisions, and the operation is carried out with the aid of an internal telescope and camera system. The uterus is removed through the vagina and other tissues (sometimes including lymph nodes) may be removed through the vagina or through the small incisions in the tummy. You will have between two and four small scars on different parts of your tummy. Each scar will be between 0.5 cm and 1 cm long. If you have had your cervix removed, you will also have a scar at the top of your vagina which will be out of sight.
A laparoscopic hysterectomy will mean staying in hospital for one night only.
There are risks with any operation but these are small. The main risks associated with a laparoscopic hysterectomy are:
In order for you to make an informed choice about your surgery please ask one of the doctors or nurses if you have any questions about the operation before signing the consent form.
As you come round from the anaesthetic you may experience episodes of pain and / or nausea. Please let the nursing staff know and they will assess you and take appropriate action.
Your nurse will be checking your blood pressure, pulse, breathing and temperature and monitor the laparoscopic incisions and any vaginal bleeding. S/he will also ask you to move from side to side and to do leg and breathing exercises once you are able, this will help prevent any pressure damage, a DVT (deep vein thrombosis) or chest infection.
You will have a drip attached (intravenous infusion); once you are fully awake you will be able to start drinking and eating. Your drip will then be discontinued.
You can expect pain and discomfort in your lower abdomen for the first few days after the operation. You may also experience shoulder tip pain from the gas and water that is used through the telescope which may get trapped under your rib cage, this is common with laparoscopic surgery. You will be given pain killers to help this.
The nursing staff will assist and encourage early mobilisation. We would normally expect you to sit out of bed and begin to walk around within a few hours of returning to the ward. You will also have a catheter which will drain your urine. This will be removed by the nursing staff at 06:00 the following
morning. We will monitor your urine output to make sure you are emptying your bladder properly and ask to measure 2 samples after the catheter has been removed. We may scan your bladder after you have passed urine to make sure it is emptying well.
You will have 2-4 small dressings on the cuts in your abdomen. These are waterproof and allow you to shower and meet your hygiene needs.
After your operation the nursing staff will administer a blood thinning injection to help prevent a DVT. You may be required to do this yourself at home, the Gynaecologist will inform you if this is relevant to you.
You may experience trapped wind which can cause discomfort, peppermint water and getting up and walking around will help this. You may also find it difficult to open your bowels at first, we will give you mild laxatives to soften your stools and prevent constipation and straining.
You will be seen and assessed by the gynaecology team the following day to check on your recovery and decisions will be made about your care, this information will be shared with you. You will then be able to go home. Please feel free to ask questions about your operation and recovery at any time.
The average length of stay following a laparoscopic hysterectomy is 1 day. As you physically recover from your operation, the nursing team will discuss your convalescence. To ensure you have a good recovery you
should take note of the following:
During the first two weeks at home it is common to feel tired, exhausted and emotional, you should relax during the day gradually increasing the number of things you do each day. Avoid crossing your legs when you are lying down.
You can expect to have some vaginal discharge/bleeding for 1-2 weeks after surgery. This is like a light period and is red or brown in colour. Some women have no bleeding initially and have a sudden gush after about 10 days; this is quite common and should settle quickly. Sanitary towels should be used not tampons to reduce the risk of infection.
Your cuts will initially be covered with a dressing. please remove in 48 hours. Your cut will be closed by stitches which are usually dissolvable. If after 7 days you notice the stitches have not dissolved then they will need to be removed. This is normally done by your practice nurse and you will need to make an appointment. We advise that you shower daily and keep the wound clean and dry. There is no need to cover the wound with a dressing.
There is a small risk of blood clots forming in your legs (DVT) after any operation. These clots can travel to your lungs (pulmonary embolism) which can be serious. Reduce these risks by:
This will be discussed with you prior to leaving the hospital.
Weeks 1-2. We recommend that you do light activities around the house and avoid any heavy lifting (not more than 1.5kgs in each hand).
Weeks 3-4. We recommend that you gradually introduce lighter household chores, dusting, washing up, making beds and ironing. You may begin to prepare food and cook remembering not to lift any heavy items.
Weeks 4-6. By this time you should resume normal daily activities.
Exercise is important and it is advisable to go for short walks each day, increasing the distance gradually. You may return to normal exercise such as cycling and swimming after 4-6 weeks. You will be able to manage the stairs on your arrival home.
A well balanced nutritious diet with a high fibre content is essential to avoid constipation. Your bowels may take some time to return to normal after your operation and you may need to take laxatives. You should include at least 5 portions of fruit and vegetables per day.
You should aim to drink at least 2 litres of water per day.
It is safe to have sex when you feel ready this is usually 2-4 weeks after the operation to allow your scar to heal. You may experience dryness which is common if you have had your ovaries removed at the time of the hysterectomy. You may wish to try a vaginal lubricant from your local pharmacy. If after this time you are experiencing pain or any problems with intercourse then you should see your GP.
Returning to work:
Depending on the surgery you will need 2-6 weeks off work. Most women are able to return to work after 2-3 weeks, please discuss this with the doctor or nurse. The hospital doctor will provide a sick certificate for this period.
It is usually safe to drive after 3-6 weeks but this will depend on your level of concentration and ability to perform an emergency stop and your car insurance company agree.
You may decide not to have surgery and want to try alternative methods of improving you symptoms such as:
These can be discussed with your doctor.
If you have any problems or are worried, please do not hesitate to contact us on the gynaecology ward:
Royal Sussex County Hospital
Level 11 Telephone: 01273 523191
Princess Royal Hospital
Horsted Keynes Ward Telephone: 01444 441881 Ext.5686
This information has been produced by the Gynaecology Ward Sister Samantha Backley.
This information is intended for patients receiving care in Brighton & Hove or Haywards Heath.
The information here is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.
Publication Date: February 2018