This is for women who have been advised to have a laparoscopic hysterectomy. It outlines the common reasons doctors recommend this operation, the potential benefits as well as risks, what will happen when you come into hospital and what to expect when you go home. If you have any questions, please telephone the Women’s Hospital Booking Officer on 01935 384 412.
What is a laparoscopic hysterectomy?
Laparoscopic hysterectomy is an operation to remove the uterus (womb) through four small cuts on the abdomen below the navel. This is known as keyhole surgery. Sometimes the ovaries and fallopian tubes are removed at the same time, which is called a salpingo-oophorectomy. In a total hysterectomy the surgeon will remove the womb and the cervix (neck of the womb).
You and your doctor should discuss the advantages and disadvantages of removing your ovaries or leaving them in (conserving them).
Why do I need a hysterectomy?
A hysterectomy may be carried out to treat many different conditions. These include:
- Heavy or irregular periods
- Suspected or proven cancer of the womb or cervix
You may have been given advice on alternatives to surgery
as drug treatments, coils or more minor surgery.
The choice of
treatment depends on the nature and extent of your conditionas well as personal factors.
If you have a hysterectomy:
- You will not have any more periods
- You cannot become pregnant – so there is no need for contraception
A hysterectomy does not mean:
- Premature aging
- Becoming less of a woman or losing your sex drive
- A space left inside your body. This does not happen as the bowel naturally moves to fill the space
How will a hysterectomy help me?
The benefits of hysterectomy depend on the type and severity of problems that you are having. Your hysterectomy may be part of a continuing treatment or it may mean the end of a health problem.
Your surgeon will discuss with you the chances of hysterectomy leading to a cure or improvement in your condition. You should weigh this against the severity of your condition and other available treatments, and also against the risk of not having the operation.
Overall, more than 90 per cent of women who have a hysterectomy are satisfied with the operation. Problems like very heavy periods and any related pain will be cured by total hysterectomy
The benefits of a laparoscopic procedure include less pain, quicker recovery and less scarring, both inside and outside of the abdomen, as compared to an abdominal hysterectomy.
The risks of hysterectomy
There are risks associated with all operations. Although hysterectomy is a relatively safe operation and serious side effects are not very common, it is still a major operation. You need to be aware of the risks when deciding on the right treatment for you. Your surgeon will help you weigh up the risks and benefits and what the alternatives may be for you.
This may occur during the operation, or after the operation in about 1-3%. If this happens you may require a blood transfusion or you may need to return to the operating theatre to stop the bleeding in less than 1%. If you do not wish to have a blood transfusion under any circumstances, please discuss this with the surgeon before your operation.
Infection may occur inside the abdomen or pelvis (2 to 10 in 100 women ). Infection may also affect the bladder, lungs or cuts on your abdomen. Most infections are easily treated with a course of antibiotics, but others can be more severe needing hospital admission.
Blood clots (deep vein thrombosis) in the legs or lungs
Blood clots can form in a leg vein, this occurs in less than 1in 100 women. A blood clot can move to the lungs causing a very serious condition called pulmonary embolism. You will be given preventative treatment to reduce the risk of blood clots forming.
Damage to the bladder or bowel or ureters
During the operation there may be accidentally damage to organs that are nearby. Damage to the bladder or one of the tubes which drain the kidney (ureters) occurs in about 1 in 100women. There can be damage to the bowel (2 in 100 women). The risk of damage to surrounding organs is higher in women who have had previous operations such as caesarean sections or women with endometriosis. If such damage occurs, you may need an additional operation that was not planned to repair these injuries.
Earlier Menopause can occur in women who are not already in menopause.
A larger cut on the abdomen may be required if there is excessive bleeding or if the surgeon has difficulty reaching your womb through the smaller cuts. This happens in 1 to 25% of women.
The alternatives to hysterectomy
Drug treatments can be used to reduce menstrual blood loss. A Mirena coil may have a beneficial effect in reducing menstrual blood loss in a normal sized uterus but is less effective than endometrial ablation.
However, hysterectomy reduces blood loss and reduces the need for future surgery compared with medical treatment or endometrial ablation but can lead to complications in up to a third of women.
Before you come into hospital
Plan ahead. When you come out of hospital you are going to
need extra help at home for the first two weeks. Make sure your family know that too.
- Smoking – If you smoke, try to stop completely. This will make your anesthetic safer, reduce the risk of complications after the operation and speed up the time it takes to recover. Perhaps this is a good opportunity to give up completely, even doing so, for a few days will be helpful. You will not be able to smoke while you are in hospital.
- Medicines – Some medicines need to be stopped or altered before the operation. You should check this with your GP. If you are anaemic then your GP will advise iron supplements before surgery.
What happens during the operation?
You will meet the anaesthetist before your operation and have the opportunity to ask any questions about the anaesthetic. The anaesthetist will also tell you about pain relief after your operation. You will usually be given a general anaesthetic to put you to sleep during the operation.
Once you are in the anaesthetic room, next to the operating theatre, a needle will be placed in your arm or wrist and attached to a drip to give you fluids and medicines. This will stay in place until you are drinking normally after the operation. Sticky pads will be attached to your chest to connect you to a machine to monitor your pulse, breathing and blood pressure.
After you are anaesthetized, a hollow needle is inserted into the abdomen through a small cut beneath the navel, and carbon dioxide gas is pumped through the needle to expand the abdomen. This allows the surgeon a better view of the internal organs. The laparoscope(telescope attached to camera) is then inserted through this cut to look at the internal organs on the video monitor.
Usually three additional small cuts (the size of a finger nail)
are made along the ‘bikini line’ to insert other instruments which are used to lift the tubes and ovaries
and to perform the surgical
procedure. The womb is removed through the vagina.
What happens after the operation?
The first few days
When you return to the ward you are likely to be very sleepy for the rest of the day. There may be a catheter (flexible tube) in your bladder to drain your urine, which will be removed within a day or two.
Most women experience some pain or discomfort for the first few days and we will offer you painkillers to help with this. For the first 24 hours after the operation you may have a Patient Controlled Analgesia (PCA) pump connected to the drip in your arm. This is a way of giving you strong painkillers through a syringe pump which you can control yourself. When you need pain relief, you can press the button on the pump and give yourself a dose of painkillers. It is not possible to give yourself too much in one go.
If you do not have a PCA pump we will offer you strong painkillers by injection to control your pain. After the first couple of days you will have the choice of tablets or suppositories for pain relief. We will encourage you to take painkillers, as being pain-free will speed up your recovery. Having an anaesthetic, being in pain and having strong painkillers may make you feel nauseous or sick and we can give you an injection or tablets to help with this.
Many women also get wind pains a few days after the operation, which can be uncomfortable and make the tummy look swollen. This should not last long and can be relieved by medicines, eating and walking about. You may have some vaginal bleeding and will need to wear a sanitary pad. We advise you not to use tampons. Your vaginal loss should change to a creamy discharge over the next 2-3 weeks (if you have any new pain, fresh bleeding or bad smelling discharge after you go home, you should contact your GP).
Going home and your longer-term recovery
Most women will stay in hospital for about one to two days after a laparoscopic hysterectomy, but it could be longer. Your exact day of discharge will depend on the reasons for your operation, your general health and how smoothly things go after surgery.
It is important to remember that everyone’s experience is different and so it is best not to compare your own recovery with that of others on the ward.
Many women feel emotionally low or tearful for a few days after their operation. This is a natural reaction and you should try not to worry about it. It may take six to eight weeks to recover and get back to your normal routine. Your body has been through a lot of stress and needs time to repair itself.
Longer term emotional reaction
Some women feel emotionally low for a longer period. This depends on many factors, including the reason for your operation, how emotionally prepared you are for it, timing of the operation, and whether your problem is cured.
Some women may feel depressed because they can no longer have children. If these problems persist you should discuss them with your GP. The organizations listed at the end of this leaflet can provide further information and support.
If you have had a total hysterectomy (the cervix has been removed) you will no longer need cervical smear tests unless you have hysterectomy due to abnormal smears.
Sex after hysterectomy
We advise you to avoid penetrative intercourse for about 6 weeks, until everything has healed up and you’ve had your check-up with the doctor. You may experience a change in sexual response after the operation. Many women say their sex life is improved because there is no longer discomfort or the risk of pregnancy.
If your ovaries have been removed, vaginal dryness may be a problem during sex. A lubricating gel, which you can buy from the chemist, may help. Your doctor can also advise you about estrogen cream or hormone replacement therapy. Because the womb has been removed, contractions that may have been felt during orgasm will no longer occur.
Exercise and weight gain
Initially because you are feeling better, experiencing reduced levels of activity and an increase in appetite, you might tend to put on weight. By paying attention to what you eat and increasing your activity level as you recover, weight gain need not be a problem. Walking is an excellent way to exercise. Gradually increase the length of your walks, but remember to only walk the distance you can achieve comfortably. Cycling and swimming are equally good.
We recommend that you do not drive for two weeks and then check with your doctor at your follow up appointment before starting to drive again, (it would be advisable to also check with your insurance company when you can start to drive again). It may be helpful to first sit in the car while it is parked and see if you could do an emergency stop without it hurting.
Hormone Replacement Therapy (HRT)
The decision to use HRT is a personal one. If your ovaries are not removed, there is no need to use HRT. If your ovaries are removed, your medical team will discuss HRT with you.
Talk to GAU on numbers provided in first week of operation if you develop any of the following complaints or you are worried, your GP after 1 week:
- Burning and stinging when you pass urine or pass urine frequently: This may be due to a urine infection. Treatment is with a course of antibiotics. Also, if you feel no control over passing urine, in that case you may need further investigations.
- Vaginal bleeding that becomes heavy or smelly: Some amount of discharge vaginally is common but if bleeding is heavy leading to frequent changing of pads, have a temperature (fever), this may be due to an infection or a small collection of blood at the top of the vagina called a vault hematoma. Treatment is usually with a course of antibiotics. Occasionally, you may need to be admitted to hospital for the antibiotics to be administered intravenously (into a vein). Rarely, this blood may need to be drained.
- Red and painful skin around your scars: This may be normal, but if there is pus coming out or you are worried please contact your GP. Treatment is with the course of antibiotics.
- Increasing abdominal pain: If you also have a temperature (fever), have lost your appetite and are vomiting, this may be due to complication of surgery, in which case you should contact your doctor earlier rather than later.
- A painful, red, swollen, hot leg: This may be due to a deep vein thrombosis (DVT). If you have shortness of breath or chest pain or cough up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolism). If you have these symptoms, you should seek medical help immediately
Further information and help
60 Redwood House
Charlton Down Dorchester, Dorset
Telephone: 0871 7811141
Information and support about hysterectomy. The website has an online discussion area for patients and their families.
Women’s Health Concern
PO Box 2126
Bucks, SL7 2RY
Telephone: 01628 488065
Information leaflets about hysterectomy, prolapse and associated health concerns.
National Osteoporosis Society
Bath, BA2 0PJ
Telephone: 01761 471771 (general enquiries)
0845 4500230 (medical queries)
Information about Osteoporosis and relevant treatments.