Laparoscopic Hysterectomy

WHAT YOU SHOULD KNOW:

Laparoscopic hysterectomy (LH) is surgery done with a special tool called a laparoscope. It is done to remove your uterus only (partial hysterectomy), or your uterus and cervix (total hysterectomy). The uterus is where a baby grows during pregnancy. During a total hysterectomy, uterine ligaments and part of your vagina may also be removed. Ovaries, fallopian tubes, or lymph nodes may also be removed during surgery.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may bleed more than expected, or you may get an infection. You may have damage to your bladder, ureters, or bowels. Your procedure may need to be done through your vagina. Larger than expected cuts in your abdomen may be needed. You may get a blood clot in your leg. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• After this surgery, you will not be able to become pregnant. You will go through menopause if your ovaries are removed. You may have vaginal bleeding, pelvic pain, or problems urinating for a time after surgery. You may get scar tissue in your abdomen that blocks your intestine or causes pelvic pain. If you had a partial hysterectomy, you will need to have regular Pap tests to check for cancer cells in your cervix. If you have cancer, this surgery may not take it away completely or forever. If you do not have the hysterectomy, your signs and symptoms could get worse. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Bowel cleansing: You may be given medicine to drink or an enema that will empty your bowel of stool. An enema is when liquid is put into your rectum.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your surgery:

You will lie on your back, with your feet up in stirrups. Caregivers clean the surgery area and may remove hair. Sterile (germ-free) sheets will be put over you to keep the area clean. One or more small incisions (cuts) are made in your abdomen. Caregivers put a laparoscope and other tools into your abdomen through the cuts. The laparoscope is a long metal tube with a light and camera on the end. Your abdomen is filled with a gas called carbon dioxide. This allows your caregiver to see inside your abdomen. Your uterus is cut free from your abdomen so it can be removed. Caregivers may also remove your cervix, fallopian tubes, ovaries, and lymph nodes. These structures are removed through the cuts in your abdomen or through your vagina. The incisions are closed with stitches.

After your surgery:

You are taken to a recovery room where caregivers will watch you until you are alert. You will then be taken to your room. Bandages on your incisions help prevent infection. You will need to wear a sanitary pad after surgery. Change the pad often to prevent infection. Caregivers will check your bandages and sanitary pad for bleeding. You may also have the following:

• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).

Medicines:

You may be given the following medicines:

• Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Intake and output:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

Deep breathing and coughing:

This will help decrease your risk for a lung infection after surgery.

• Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
  
  
• You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.

Food and drink after surgery:

You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

Preventing blood clots:

Around the time of your surgery or procedure you may need to take medicine to thin your blood. Blood thinning medicine helps prevent blood clots from forming in your veins. This medicine makes it easier for a person to bruise and bleed. You will need regular blood tests while taking this medicine. If you have a bleeding disorder or a history of bleeding or blood clots, tell your caregiver. Talk to your caregiver about all of the medicines that you use. Physical activity helps prevent blood clots. Caregivers will help you be as active as possible after your surgery or procedure.