What is a hysterectomy?
Hysterectomy is a surgical procedure to remove the womb (uterus) and neck of the womb (cervix). Ovaries and fallopian tubes may or may not be removed.
If you are a candidate for surgery, your surgeon may recommend:
Open surgery
The surgeon makes an incision in your tummy large enough to perform the procedure using hand-held tools.
Minimal invasive Surgery (Key-hole surgery)
Key-hole surgery can either be laparoscopic or robotic assisted. This is a surgery that would involve a laparoscope (keyhole camera) inserted through a small cut under the umbilicus (tummy button). Then the surgeon makes several other small cuts in the tummy through which the surgical instruments are inserted.
Laparoscopic assisted surgery
Your surgeons will make small incisions in the tummy and operate using special long-handled tools while viewing magnified images from the laparoscope (camera) on high definition monitors.
Robotic assisted surgery
Your surgeons control a robotic system to perform the procedure. They will make a few small incisions, and use a 3D High Definition camera for a magnified view of your womb and surrounding structures. The surgeon will then sit at a console next to you and operates through the incisions using tiny instruments and the camera. The robotic system translates your surgeon’s hand movements in real-time, bending and rotating instruments that move like the human hand.
What are the benefits of minimal invasive surgery?
- Quicker recovery period and faster return to normal activities
- Reduced pain and discomfort
- Reduced blood loss
- Minimal scaring
- Lower risk of infection
- Shorter hospital stay.
Common complications
Common risks that can occur from this surgery:
- Anaemia
- Fatigue/Tiredness
- Pain/discomfort
- Bruising
- Urinary frequency or loss of control
Symptoms to look out for
Due to your shorter hospital stay after laparoscopic surgery, it is very important that you inform us if you develop any problems once you are discharged home.
These can be signs of infection or sepsis, and include:
- Tummy swelling
- Pain
- Fevers
- Shivers
- Bleeding from your vagina
Should any of these symptoms develop in the weeks following surgery please contact your Clinical Nurse Specialist or call Ward 26 at the Queen Elizabeth Hospital on 0191 4453004 for advice.
What are other possible risks and complications?
Before you have your surgery, you will be told about the risks and will be asked to sign a consent form which will list the potential complications. Please ask questions at any time. It is important to remember that these risks are uncommon.
The anaesthetist will discuss risks associated with general anaesthetic and pain control after surgery.
Infection– The risk of post-operative infections is reduced by giving antibiotics around the time of surgery, but infection can still sometimes occur in the chest, wound, pelvis or urine. Infections are usually easily treated with antibiotics. Infection happens to two women in every 1000.
Bleeding (haemorrhage) – This may occur during the surgery or rarely afterwards. A blood transfusion may be necessary to replace blood lost during the operation, although this is very unlikely. On very rare occasions there may be internal bleeding which may require a second operation.
Clots (thrombosis) – It is possible for clots of bloods to form in the deep veins of the legs and pelvis. This is called a deep vein thrombosis (DVT). This will normally cause pain and swelling in the affected leg and is relatively simple to treat using blood thinning drugs (low molecular weight heparin). In rare cases it is possible for a clot to break away and travel to the lungs. If this occurs, it is a potentially serious complication, but several measures will be taken to reduce the risk of this happening. Moving around as soon as possible after your surgery can help as can wearing special surgical stockings and having injections to thin your blood. 4 women in every 10000 develop blood clots to the legs or lungs after this type of operation.
Bruising may develop around the wound site which should resolve in a few days. Sometimes patients may develop a hernia over the scar, this is a bulging of the abdominal wall due to muscle weakness after the operation. This may require further surgical correction. Sometimes you might also experience numbness around the scar area and the top and outside of the legs, this is due to damage of the small nerves. This may resolve with time.
Occasionally vaginal cuff problems may occur including scar tissue over the vaginal incision, infection, pooling/clotting of blood, opening or separation of the incision, vaginal shortening, vaginal fistula (abnormal hole from the vagina into the urinary tract or rectum), vaginal tear or deep cut.
There is a small chance that we may have to convert to open surgery (laparotomy) if the surgery cannot be completed by keyhole surgery or when internal organ injuries occur. There is a risk of bowel and blood vessels injuries (2 in 1000) associated with laparoscopic surgery. If a laparotomy is performed the incision is usually closed with metal clips, which are removed 7 days following surgery, either on the ward or by a District Nurse at home. The ward staff will arrange this prior to discharge
There is a risk that a small hole can develop in the bladder, or in the ureter (tube which carries urine to the bladder). This may require a further procedure to correct either at the time of the operation or at a later date. Occasionally, injury is not noted at the time of surgery, particularly if a fistula develops (a connection between the ureter (tubes that drain the bladder) and a nearby organ). If this occurs, you will be referred to a urologist (A Doctor who specialises in urinary problems).
With any type of operation, there is a small risk of death.
Getting back to Normal
Around the house
While it is important to take enough rest, you should start some of your normal daily activities when you get home and build up slowly. You will find you are able to do more as the days and weeks pass. If you feel pain, you should try doing a little less for another few days. It is helpful to break jobs up into smaller parts, such as ironing a couple of items of clothing at a time, and to take rests regularly. You can also try sitting down while preparing food or sorting laundry. For the first one to two weeks, you should restrict lifting to light loads such as a one litre bottle of water, kettles or small saucepans. You should not lift heavy objects such as full shopping bags or children, or do any strenuous housework such as vacuuming until three to four weeks after your operation as this may affect how you heal internally. Try getting down to your children rather than lifting them up to you. Remember to lift correctly by having your feet slightly apart, bending your knees, keeping your back straight and bracing (tightening or strengthening) your pelvic floor and stomach muscles as you lift. Hold the object close to you and lift by straightening your knees.
Driving
Before you drive you should be:
- free from the sedative effects of any painkillers
- able to sit in the car comfortably and work the controls
- able to wear the seatbelt comfortably
- able to make an emergency stop
- able to comfortably look over your shoulder to manoeuvre.
In general, it can take two to four weeks before you are able to do all of the above. It is a good idea to practise without the keys in the ignition. See whether you can do the movements you would need for an emergency stop and a three-point turn without causing yourself any discomfort or pain. When you are ready to start driving again, build up gradually, starting with a short journey
Having sex
You should usually allow four to six weeks after your operation to allow your scars to heal. It is then safe to have sex – as long as you feel comfortable. If you experience any discomfort or dryness (which is more common if your ovaries have been removed at the time of the hysterectomy), you may wish to try a vaginal lubricant. You can buy this from your local pharmacy.