Hysterectomy

Obstetrics & Gynecology

Contact:

Wright State Physicians Health Center
725 University Blvd.
Fairborn, OH 45324
(937) 245-7200

 Hysterectomy

uterus

The uterus is a hollow, round
organ in your lower abdomen (belly). It is where your baby
grows when you are pregnant. The cervix opens into your vagina
and is the lowest part of the uterus. The fallopian (fu-low-p-un)
tubes are attached to each side of your uterus. The ovaries
are below and behind the fallopian tubes.

What is a Hysterectomy?

There are three kinds of hysterectomy

  1. A simple or total hysterectomy is a surgery that takes out
    your uterus and cervix.
  2. A subtotal (supracervical) hysterectomy takes out your uterus, not your
    cervix.
  3. Sometimes the ovaries and fallopian tubes are taken out in
    addition to the uterus and cervix. The removal of the ovaries
    and fallopian tubes is called a bilateral salpingo-oophorectomy.

Having a hysterectomy

This surgery can be done four different ways. You will want to
discuss which surgery your doctor feels is best for you. They are:

  1. Abdominal Hysterectomy: This surgery
    removes your uterus through an incision (cut) in your abdomen.
  2. Vaginal Hysterectomy: This surgery
    removes your uterus through an incision (cut) in your vagina.
  3. Laparoscopically Assisted Vaginal Hysterectomy (LAVH): Your
    doctor uses a laparoscope (lap-er-uh-skop) and other tools to
    make tiny incisions (cuts) into your abdomen. The laparoscope
    or “scope” is a long metal tube with a tiny magnifying
    glass and a light on the end. An incision is then made inside
    your vagina. The doctor will look through the scope in your abdomen
    as he or she removes your uterus through your vagina.
  4. Da Vinci® Hysterectomy: If you are a candidate for this state-of-the-art procedure, a specially trained surgeon will use the da Vinci Surgical System to perform minimally invasive surgery. You can read about this type of surgery by visiting our Da Vinci Hysterectomy web page.

Preparation and Tests

To prepare for this surgery, it is important that you
know
:

  1. About the tests you will have before surgery;
  2. What parts of
    your body will be removed during surgery;
  3. How you should care
    for yourself after surgery.

This guide tells you the care you can expect before, during, and
after your hospital stay. Since no one person is alike, this guide
may be changed to fit your special needs. After reading it, please
ask your nurse or doctor any questions, or share any feelings you
may have about your surgery or medical condition.

Pre-admission testing:

Your doctor may order a variety of tests. These tests are usually
done before your surgery. The tests will give the doctor information
about your general health and they will also be used to compare
with tests you may have after surgery.

Tests may include:

  • Blood tests—To see if the different parts of
    your blood (white cells, red cells, etc.) are normal.
  • X-rays, such as a chest x-ray—To see a picture
    of your lungs.
  • EKG (Electrocardiogram)—To check the condition
    of your heart.
  • Urinalysis—To check that your urinary tract and
    kidneys are working well.

If you are taking Aspirin, Coumadin, or other drugs that may thin
your blood and affect clotting, they should be stopped three to
seven days before your surgery. Your doctor may also tell you to
stop taking medicines like Advil®, Motrin®, Aleve®,
and Celebrex® two weeks before your surgery. Tell your doctor
or nurse about any over-the-counter medicines you are taking such
as vitamins, herbs, food supplements, or laxatives. Your doctor
can find out if these medicines interact with medicines you may
need during surgery. You should discuss any questions or concerns
with your doctor or nurse.

You may be told to give yourself an enema to empty your bowel
and a betadine douche to help clean the vaginal area.

Do not eat or drink anything after midnight on the night before
your surgery. Ask your doctor before taking any medicine on the
day of surgery. These medicines include insulin, diabetic pills,
high blood pressure pills, or heart pills. Bring a list of your
medicines or the pill bottles with you to the hospital. Make sure
you get a good night’s sleep.


When to Arrive

You should arrive at Miami Valley Hospital two hours before the
time of your surgery.

What You Need to Know

Informed consent:

You have the right to understand your health. In words you can
understand, you should be told what tests, treatments, or procedures
may be done to treat your problem. Your doctor should also tell
you about the risks and benefits of each treatment.

You may be asked to sign a consent form. If you are unable to
give your consent, someone who has permission can sign this form
for you. (A consent form is a legal piece of paper that gives your
doctor permission to do certain tests, treatments, or procedures.)
This form should tell you exactly what will be done to you. Your
doctor should tell you what the risks and benefits of each treatment
are before you sign the form. Before giving your consent, make
sure all your questions have been answered so that you understand
what may happen.

While you are in pre-op holding (before your surgery):

An anesthesiologist (the doctor who will put you to sleep for
your surgery) will stop by to talk with you. Anesthesia is medicine
to make you comfortable during surgery. You may be awake or completely
asleep. You and your doctor will decide which type of anesthesia
is best for you.

The different types of anesthesia are:

  • Spinal anesthesia: This is medicine
    put into your back through a shot. You are awake during surgery
    but numb below the waist. Feeling returns in about two hours.
  • Epidural anesthesia: This is medicine
    put into your back through a tiny tube. The tube is left in place
    to give you more medicine later if needed. You are awake during
    surgery but numb below the waist. Feeling returns to your legs
    when the medicine wears off.
  • General anesthesia: This is medicine
    given as a liquid in your IV. Or, it is given as a gas through
    a face mask or a tube placed in your mouth and throat. This tube
    is called an endotracheal (end-o-tra-kee-ull) tube or “ET
    tube.” Usually you are asleep before the tube is placed
    in your throat. The ET tube is usually removed before you wake
    up. You are completely asleep during surgery.

Also, you may be given medicine about 30 minutes before you go
to surgery. It will help you relax and feel sleepy, and it may
make your mouth dry. After you have been given your medicine, the
side rails on your bed will be raised for your safety. If you need
to get out of bed, please call your nurse for help.

You will also have a:

  • Gown: A hospital gown is needed so that your
    doctors and nurses can easily check and treat you. They will
    show you how to put on your gown. You will not be allowed to
    wear your own bedclothes or undergarments to the operating room.
    This is because you may need monitors on your skin during surgery.
    When you feel better you may be able to wear your own bedclothes.
  • Heart monitor: This is also called an EKG or
    ECG, or electrocardiogram (e-lek-tro-KAR-d-o-gram). Sticky pads
    are placed on different parts of your body. Each pad has a wire
    that is hooked to a TV-type screen. This allows the doctors and
    nurses to see a tracing of the electrical activity of your heart
    Your doctors and nurses will watch the tracing closely during
    your surgery. The heart monitor helps them make sure you are
    handling surgery well.
  • IV: An IV is a tube placed in your vein for
    giving medicine or liquids.
  • Pulse oximeter (oks-ih-mih-ter): This is a
    machine that tells how much oxygen is in your blood to see if
    you need more oxygen. A cord with a clip or sticky strip is placed
    on your ear, finger, or toe. The other end of the cord is hooked
    to a machine.
  • Vital signs check: This includes taking your temperature,
    blood pressure, pulse (counting your heartbeat), and respirations
    (counting your breaths). To take your blood pressure, a cuff
    is put on your arm and tightened. It is attached to a machine
    which gives your blood pressure reading. Your doctor or nurse
    may listen to your heart and lungs by using a stethoscope. Your
    vital signs are taken so the doctors and nurses can see how you
    are doing.

After Your Surgery (Same Day)

You will spend some time in the Recovery Room (PACU) before
you go to your hospital room.

Later that day you will be given ice chips and something to
drink if you are not sick to your stomach.

You will still have your IV.

You may have a tube (Foley catheter) in your bladder to drain
your urine. It may be taken out the evening of surgery or the
next morning. After the tube is taken out, your nurse will keep
track of your urine each time you go to the bathroom.

Your nurse will often ask you about the amount of pain you may
be feeling. The nurse will ask you to rate your pain on a scale
of 1 to 10 with 10 being the worst. Rating your pain helps make
sure that you are getting enough medicine to relieve your pain.
This medicine may be given as a shot, by mouth, or through your
IV or epidural catheter in your back. Tell your nurse if the
pain does not go away or comes back. A special pump may be used
that allows you to push a button and give yourself the medicine
through your IV or the epidural catheter. This is called patient
controlled analgesia (ah-null-g-z-uh) and is set up so you cannot
accidentally give yourself too much medicine. You will receive
only the amount of medicine you need for the day, as directed
by your doctor.

If you have an upset stomach (nausea) you will be given medicine
to lessen or stop your nausea.

It is important to keep your lungs healthy after surgery. When
you lie in bed after surgery it can cause you to breathe shallow.
Shallow breathing can make mucus collect in your lungs and can
give you an infection. This is why it is so important to cough
and deep breathe after your surgery. It will help keep your lungs
clear and help keep you from getting pneumonia. It is best to
cough and deep breathe at least every one to two hours. To help
you do this, you will be given an incentive spirometer. A video
showing how to use an incentive spirometer is shown three times
a day on our Patient Education TV, Channel 5. If you put a blanket
or pillow against your incision when you deep breathe and cough
it will help lessen the pain.

Because smoking can cause lung problems, we encourage you not to
smoke before your surgery and during your recovery. We also ask
you not to go to the smoking area during your
hospital stay. If you would like Nicotine Replacement Therapy,
please ask your nurse or doctor.

To help prevent blood clots you will be shown how to do leg
exercises. Making circles with your feet, pushing your legs into
the bed and tightening and relaxing your leg muscles will also
help blood flow. You may also wear stocking on your legs; these
will also help to prevent blood clots.

Our staff will help you get out of bed the evening of your surgery.

The first day after your surgery:

You will begin to eat a regular diet.

Our staff will help you get out of bed and sit in a chair. You
will also be encouraged to walk. Doing these activities several
times a day will improve your blood flow and help keep blood
clots from forming.

Your IV will be taken out and your pain medicine will be changed
to pills that you will take by mouth.

The tube (Foley catheter) that drains the urine from your bladder
will be taken out, if it was not taken out the night before.

You may be allowed to go home.

When you go home:

Your nurse will give you instructions on how to take care of
your incision, if you have one; what activities you may do; and
any medicines you will need to take.

Your doctor will give you a prescription for pain medicine.
It is important that you get this from the drug store the day
you go home.

Vaginal discharge is normal after surgery. It should slow down
and stop in about two to four weeks.

When you get home and feel able, you may slowly increase your
activity. But do not do anything hard such as housework, sweeping,
or exercising. You may go up and down stairs. If you work outside
of your home, your doctor will tell you at your follow-up appointment
when you may go back to work.

Your follow-up appointment will be about 4 to 6 weeks after
you are home. But, you will be seen sooner if needed.

Feelings you may have after your surgery:

Since you no longer have your uterus, you will no longer be
able to have children. Also, you will no longer have monthly
periods. If you do not have your ovaries removed then you will
keep making female hormones and will have menopause (change of
life) at your normal time. If your ovaries are removed you may
feel symptoms of menopause, such as hot flashes, vaginal dryness
or mood changes. Talk to your doctor about hormone medicines
that will help you as you go through menopause.

Sexual feelings should not change because of this surgery. You
should not have sex or douche vaginally until your doctor tells
you that your body is healed. Also, talk to your doctor about
any concerns you may have about sex.

Accepting that you have had a hysterectomy may be hard. You
may have the following feelings; anger, fear, nervousness or
anxiety, frustration or depression. These feelings are normal.
It will help you to share these feelings with your loved ones,
friends, nurse, and doctor. They can help you to deal with these
feelings as you get well.

It is unusual to have problems after you go home, but you should
call your doctor if you have any of the following:

  • Have vaginal bleeding that makes you use more than one
    pad an hour.
  • Have difficulty breathing.
  • Have a fever higher than 100.4° or chills.
  • Have more pain than you were told to expect.
  • Have any redness, drainage, or swelling of your incision
    or if your incision comes open.
  • Have vaginal discharge that has a bad odor.
  • Are unable to pass gas.
  • Have not had a bowel movement (BM) for two to three days.
  • Have any other problems that concern you.

Your comfort and trust are very important to our staff at Miami
Valley Hospital. We welcome your questions and hope that you
will let us know if we can serve you further.

More information

If you would like more information on your surgery or health
condition please call the Craig Memorial Library at Miami Valley Hospital (937) 208-2612.
They will locate the information you are looking for and send
it to you at no charge.


©11974-2004 Thomson MICROMEDEX All rights reserved
The CareNotes ™ System Vol. 31. Abdominal Hysterectomy, Vaginal
Hysterectomy, and Laparoscopically Assisted Vaginal Hysterectomy


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