What is Laparoscopic Hysterectomy

Laparoscopic hysterectomy is a minimally invasive surgery to remove the uterus and cervix. The fallopian tubes and ovaries can also be removed (bilateral salpingo-oophorectomy) during this surgery, if necessary. This procedure may be done to treat problems such as:

• Noncancerous growths in the uterus (uterine fibroids) that cause symptoms.
• A condition that causes the lining of the uterus (endometrium) to grow in other areas (endometriosis).
• Problems with pelvic support. This is caused by weakened muscles of the pelvis following vaginal childbirth or menopause.
• Cancer of the cervix, ovaries, uterus, or endometrium.
• Excessive (dysfunctional) uterine bleeding.

This surgery is performed by inserting a thin, lighted tube (laparoscope) and surgical instruments into small incisions in the abdomen. The laparoscope sends images to a monitor. The images help the health care provider perform the procedure. After this procedure, you will no longer be able to have a baby, and you will no longer have a menstrual period.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Blood clots in the legs or lungs.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• The risk that the surgery may have to be switched to the regular one in which a large incision is made in the abdomen (abdominal hysterectomy).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may be given antibiotic medicine to help prevent infection.
• You may be asked to take laxatives.
• You may be given medicines to help prevent nausea and vomiting after the procedure.

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may have an exam or testing, such as an ultrasound to determine the size and shape of your pelvic organs.
• You may have a blood or urine sample taken.
• This procedure can affect the way you feel about yourself. Talk with your health care provider about the physical and emotional changes hysterectomy may cause.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• You will be given antibiotic medicine through your IV.
• A tube may be inserted down your throat to help you breathe during the procedure.
• A gas (carbon dioxide) will be used to inflate your abdomen to allow your surgeon to see inside of your abdomen.
• Three or four small incisions will be made in your abdomen.
• A laparoscope will be inserted into one of your incisions. Surgical instruments will be inserted through the other incisions in order to perform the procedure.
• Your uterus and cervix may be removed through your vagina or cut into small pieces and removed through the small incisions. Any other organs that need to be removed will also be removed this way.
• Carbon dioxide will be released from inside of your abdomen.
• Your incisions will be closed with stitches (sutures).
• A bandage (dressing) may be placed over your incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given medicine for pain and nausea as needed.
• Do not drive for 24 hours if you received a sedative.

Summary

• Total Laparoscopic hysterectomy is a procedure to remove your uterus, cervix and sometimes the fallopian tubes and ovaries.
• This procedure can affect the way you feel about yourself. Talk with your health care provider about the physical and emotional changes hysterectomy may cause.
• After this procedure, you will no longer be able to have a baby, and you will no longer have a menstrual period.
• You will be given pain medicine to control discomfort after this procedure.

Total Laparoscopic Hysterectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain and bruising around your incisions.
• A sore throat, if a breathing tube was used during surgery.
• Fatigue.
• Poor appetite.
• Less interest in sex.

If your ovaries were also removed, it is also common to have symptoms of menopause such as hot flashes, night sweats, and lack of sleep (insomnia).

Follow these instructions at home:

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. You may need to only take showers for 2–3 weeks.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Get plenty of rest and sleep.
• Do not lift anything that is heavier than 10 lbs (4.5 kg) for one month after surgery, or as long as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing. If you need help quitting, ask your health care provider.
• Do not drink alcohol until your health care provider approves.

General instructions

• Do not douche, use tampons, or have sex for at least 6 weeks, or as told by your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• To monitor yourself for a fever, take your temperature at least once a day during recovery.
• If you struggle with physical or emotional changes after your procedure, speak with your health care provider or a therapist.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have chills or a fever.
• You have redness, swelling, or pain around an incision.
• You have fluid or blood coming from an incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from an incision.
• An incision breaks open.
• You feel dizzy or light-headed.
• You have pain or bleeding when you urinate.
• You have diarrhea, nausea, or vomiting that does not go away.
• You have abnormal vaginal discharge.
• You have a rash.
• You have pain that does not get better with medicine.

Get help right away if:

• You have a fever and your symptoms suddenly get worse.
• You have severe abdominal pain.
• You have chest pain.
• You have shortness of breath.
• You faint.
• You have pain, swelling, or redness on your leg.
• You have heavy vaginal bleeding with blood clots.

Summary

• After the procedure it is common to have abdominal pain. Your provider will give you medication for this.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Do not lift anything that is heavier than 10 lbs (4.5 kg) for one month after surgery, or as long as told by your health care provider.
• Notify your provider if you have any signs or symptoms of infection after the procedure.