stephenquinn

Obstetrician and Gynaecologist

Laparoscopic Hysterectomy

What is a laparoscopic hysterectomy?


Laparoscopic hysterectomy is an operation to remove your womb(uterus) and cervix.

Laparoscopic surgery is also called keyhole surgery. This means that your surgeon can perform the operation through three or four small incisions (cuts) in your abdomen (tummy), without having to make a large incision in the skin. Sometimes your ovaries and fallopian tubes may also need to be removed during the laparoscopic hysterectomy.


What are the risks of having a laparoscopic hysterectomy?


All treatments and procedures have risks. We have listed the most common complications of a laparoscopic hysterectomy below. 


Risks include:

• severe allergic reaction to the anaesthetic

• wound infection or delayed healing

• urine infection, difficulty urinating or urinating more often

• bruising around the incisions

• haemorrhage (internal bleeding)

• deep vein thrombosis or DVT (blood clot in a vein in the leg)

• pulmonary embolism (blood clot in the lung)

• damage to the bladder and/or ureter (the tube that runs from the kidney to the bladder)

• damage to the bowel

• having to complete the procedure as open surgery (laparotomy).


How should I prepare for a laparoscopic hysterectomy?


Before surgery


Smoking

If you need support giving up smoking, talk to your GP or visit

www.nhs.uk/smokefree.

Fertility

If both your ovaries need to be removed, your fertility will be affected. Please talk to your doctor if this is a concern for you.

Going home

Make a plan for how you will get home from hospital after yoursurgery. Arrange for relatives or friends to support you with any household chores. If this is a problem, please talk to your CNS or ward nurse. You may need a social services assessment to see if you qualify for any support.

Time off work

Arrange to have some time off work. Most women feel able to return to their normal activities two weeks after surgery, but you may need longer before returning to strenuous activity. 


Asking for your consent (permission)


We want to involve you in all the decisions about your care and treatment. The team looking after you will answer any questions you may have so please ask if anything is unclear. If you decide to go ahead with the operation, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.


What happens during a laparoscopic hysterectomy?


A laparoscopic hysterectomy is carried out under general anaesthetic. This means you will be asleep throughout the whole procedure and will not feel any pain. Once you are asleep, a small tube (catheter) will be passed into your bladder and urine drained into a collection bag. A surgeon will make a small cut in the belly button and your abdomen will be filled with gas. This will help the surgeon to see more clearly inside your bdomen once a narrow telescope called a laparoscope has been put in. Your surgeon will also make two or three more small cuts in your abdomen for other surgical instruments. A total laparoscopic hysterectomy (often shortened to TLH) involves removing the womb and cervix. If the fallopian tubes and ovaries are removed as well, this is called a bilateral salpingo-oophorectomy (or BSO). The surgeon will use the laparoscope in the early steps of the hysterectomy, and the womb and cervix will finally be removed through the vagina. They will use glue or dissolvable sutures (stitches) to close the incisions and cover the wounds with simple dressings. The upper vagina will be closed with dissolvable stitches.


What happens after a laparoscopic hysterectomy?

The average stay in hospital following a laparoscopic hysterectomy is one night. When you get back to the ward, your nurse will monitor you closely and check your blood pressure, pulse, breathing and temperature. They will also examine your wounds and check for any vaginal bleeding. You will be encouraged to start moving about as soon as possible. This will include gentle leg and breathing exercises which can help with circulation and prevent you from getting a chest infection. You may feel nauseous (sick or like you need to vomit) after surgery. This is a common side effect of having a general anaesthetic. Please tell your nurse if you feel nauseous as they can give you anti-sickness medicine to help with this. You will have been given support stockings to wear during your surgery and recovery. It’s important that you wear them after your operation because they can help to prevent any blood clots from developing. We will also give ou blood-thinning injections while you are in hospital. Occasionally (especially for patients who had an open operation) we recommend the injections for 28 days. If this applies to you, your ward nurse will teach you how to do the injections yourself. You may have an intravenous drip to give you fluids directly into a vein until you are able to eat and drink normally. The urinary catheter will be removed the morning after surgery.


What side effects should I expect after a laparoscopic hysterectomy?

Pain

It is common to have some discomfort in your tummy for a few days after your surgery. Some patients also experience shoulder tip pain (pain where your shoulder ends and your arm begins). This is due to the gas that was used in your abdomen during the operation pressing on the nerve pathway to your shoulder. The shoulder tip pain usually lasts 48 to 72 hours (two to three days). We will give you painkillers but if you are still in pain it is important that you tell your ward nurse.

Constipation

You may have some difficulty opening your bowels (pooing) for the first few days after the operation. This will be temporary and we can prescribe laxatives if you need them.

Bleeding

You may have some light vaginal bleeding or discharge after surgery. This may last up to six weeks and it may be like a light period (red or brown in colour)

Menopausal symptoms

If both your ovaries have been removed, you may experience some menopausal symptoms, including hot flushes and night sweats. These can vary in severity and frequency. Depending on your diagnosis, it may be appropriate for you to take HRT (hormone replacement therapy).

Fertility

Your fertility will be affected if both your ovaries have been removed. If this is a concern for you, please talk to your doctor before having the operation.


Frequently asked questions

When will I be able to drive?

You can drive again once you are able to do an emergency stop safely and without being in discomfort. You must make sure you are not drowsy from any painkillers you may be taking. It is important that you tell your insurance company that you have had surgery.

When can I return to work?

This will depend on your type of work, but most women feel able to return to work two to four weeks after surgery

When can I fly?

We recommend that you don’t fly for three to six weeks after your surgery. 

When can I swim?

Avoid swimming or using a hot tub until your wounds have completely healed. Where possible, use a shower instead of having a bath.

When can I have sex?

We advise you not to have sex for six weeks after your surgery. This is to allow your internal wounds to heal. You may also find that you

don’t feel ready psychologically.