Laparoscopic Hysterectomy - Recovery & Benefits

1. By: Dr. Valeria Simone MD (Southlake General Surgery, Texas, USA) Laparoscopic Hysterectomy: Recovery & Benefits

2. OVERVIEW Facing a laparoscopic hysterectomy can raise questions about recovery, risks, and the surgical process. This article targets these concerns head-on, providing detailed insights into how this minimally invasive procedure could lead to a smoother recovery and fewer postoperative complications. You’ll gain knowledge on everything from the initial consultation to the careful steps of the aftercare that follows, giving you confidence as you approach your treatment.

3. Key Takeaways • Laparoscopic hysterectomy is a minimally invasive procedure to remove the uterus, which has a faster recovery time and lower risk of infection than traditional abdominal hysterectomy. • Proper preparation for the surgery involves a comprehensive consultation, a complete physical examination, and various screenings to ensure the patient’s readiness for the procedure. • While generally safer, laparoscopic hysterectomy still carries risks such as blood clots, the potential for organ damage during surgery, and common surgical risks including infection and complications from anesthesia.

4. Laparoscopic Hysterectomy: An Overview

5. Also known as keyhole surgery, laparoscopic hysterectomy is a procedure used to remove the uterus using a laparoscope, a long, thin tube with high-intensity light, and a high-resolution camera at the front. One of the variations of this procedure is laparoscopic assisted vaginal hysterectomy. Compared to traditional abdominal hysterectomy, these methods significantly reduce scarring, blood loss, and the risk of infection, making them preferred choices for many. The recovery period for laparoscopic hysterectomy is usually shorter, typically around 1-2 weeks. Despite its minimally invasive nature, this minimally invasive procedure is still considered major surgery. Like any other surgical procedure, it carries certain risks, such as potential blood loss and infection, although these are considerably lower compared to an abdominal hysterectomy. The procedure’s primary purpose is to remove the uterus, but in some cases, it may also involve the removal of other parts of the reproductive system.

6. Types of Laparoscopic Hysterectomy Depending on the patient’s needs and the extent of organ removal, there are two distinct types of laparoscopic hysterectomy: laparoscopic supracervical hysterectomy (LASH) and total laparoscopic hysterectomy (TLH). The former involves the removal of the uterus while preserving the cervix, which can expedite and enhance the safety of the procedure. On the other hand, TLH involves the removal of both the uterus and the cervix. Many variables affect the type of procedure that is appropriate for a patient, including: • the clinically estimated uterine size • surgical risk factors • body mass index • the presence of benign gynecologic conditions Thus, a comprehensive consultation with your healthcare team is necessary to determine the most suitable procedure for you.

7. Conditions Treated with Laparoscopic Hysterectomy Laparoscopic hysterectomy is not just a procedure; it’s a potential solution to various health conditions. One of the conditions it effectively addresses is abnormal uterine bleeding, where it surpasses other surgical treatments like vaginal hysterectomy and offers enduring symptom relief. Another condition it positively impacts is fibroids. By eliminating the uterus – the source of fibroid growth, a significant reduction in symptoms such as heavy menstrual bleeding, pelvic pain, and pressure is observed. Laparoscopic hysterectomy is another option for treating endometriosis- related chronic pelvic pain, particularly when other treatments have failed.

8. Preparing for a Laparoscopic Hysterectomy Preparation is key for any surgical procedure, and laparoscopic hysterectomy is no different. It involves a pre-operative appointment for a history and physical examination, blood sampling, and a consultation with the anesthesia department. This process is similar to the preparation for abdominal surgery. Patients are also recommended to avoid food or beverages after midnight on the evening before surgery. In preparation for the surgery, patients will need to undergo various blood tests, including: • Complete blood count (CBC) • Kidney and liver function tests • Blood sugar tests • Possibly an electrocardiogram (ECG) The anesthesia department will need to know about the patient’s alcohol consumption, as they may need to refrain from it before surgery. It’s also necessary for the patient to quit smoking before the procedure, as it can significantly lower the chances of wound infections and respiratory complications after anesthesia.

9. Consultation with Your Healthcare Team Your healthcare team plays a pivotal role in the laparoscopic hysterectomy procedure. From preparing you for the surgery, executing the procedure, and providing post- operative care, they are with you every step of the way. So, how can you effectively communicate with them about your laparoscopic hysterectomy? Start by asking about the procedure and openly disclosing your medical history and any concerns you may have. Actively engage in discussions, take notes during consultations, and don’t hesitate to seek clarification or ask additional questions. Remember, your understanding of the procedure and active participation in the discussions will significantly contribute to receiving optimal care.

10. Physical Examination and Tests Prior to a laparoscopic hysterectomy, a physical examination and tests are crucial to evaluate your overall health, identify any underlying conditions that could impact the surgery, and ensure your suitability for the procedure. This includes a pelvic examination, which plays a critical role in evaluating the health of the reproductive organs, determining uterine size, and post-surgery assessments. Imaging tests, such as ultrasound and MRI, may be advised before the procedure to assist in surgical planning and detect any irregularities, like uterine fibroids, endometrial polyps, or ovarian cysts. The decision to perform these tests is based on your specific circumstances and the evaluation of the surgeon.

11. The Laparoscopic Hysterectomy Procedure

12. Now, we will discuss the laparoscopic hysterectomy procedure itself. The surgery involves the administration of general anesthesia, ensuring your comfort throughout the process. Following this, small incisions are made in the abdomen, including an incision in the belly button, to accommodate the laparoscope and the surgical instruments. The use of a laparoscope offers visual guidance to the surgeon, enabling precise and accurate surgical maneuvers. The steps involved in a laparoscopic hysterectomy are as follows: 1.The uterus is detached from adjacent tissues and blood vessels. 2.The uterus is then removed through one of the incisions. 3.In some cases, other reproductive organs, such as the ovaries and fallopian tubes, may also be removed if necessary.

13. Anesthesia and Incisions General anesthesia is predominantly employed for administering anesthesia during a laparoscopic hysterectomy. This is administered through the induction of anesthesia, using intravenous medications to induce a state of deep sleep in the patient. There are potential risks and side effects associated with general anesthesia, including: • Nausea • Vomiting • Sore throat • Dry mouth • Shivering • Sleepiness • Muscle aches • Itching When it comes to incisions, they are typically made in the abdominal wall, including one in the belly button. There are usually 2 to 4 small scars at various locations through the abdomen.

14. Surgical Process The surgical process of a laparoscopic hysterectomy entails: • The extraction of the uterus and, if required, other reproductive organs • This is achieved through small incisions in the abdomen • Resulting in a less invasive approach compared to conventional methods. The specific procedures involved in a laparoscopic hysterectomy include: 1. Ensuring proper patient, material, and surgical team organization 2. Gaining access to the abdominal cavity and creating a pneumoperitoneum 3. Inspecting the abdominal cavity to assess the organs and structures 4. Using specialized tools such as a laparoscope to visualize the area and guide the removal of necessary tissues to ensure completeness of the procedure 5. Removing the uterus and other organs carefully to prevent damage to the surrounding organs.

15. Post- Surgery Care and Recovery

16. After the procedure, you’ll experience the following: • Close monitoring for the effects of general anesthesia • Using a catheter for 12 to 24 hours • Gradual resumption of eating and drinking • Removal of dressings from the surgical sites the day after the procedure • Visit a ward physiotherapist to discuss exercises and mobility At home, you’ll need to implement various measures to alleviate discomfort, such as engaging in regular walking and consuming peppermint water to address trapped wind. For pain management, you’ll likely be prescribed medication, and it’s important to adhere to your doctor’s instructions on its administration. You can also expect to have light vaginal bleeding for a few weeks, which is typically red or brown in color.

17. Hospital Stay and Discharge Most patients are usually discharged from the hospital within 24 hours following the procedure, depending on their overall condition, pain management, ability to tolerate oral intake, and absence of complications such as fever, excessive bleeding, or infection. When determining the appropriate time to discharge a patient, the healthcare team closely monitors the patient’s vital signs, wound healing, and recovery progress. While the decision to discharge is typically based on the patient’s recovery progress, several other factors can impact the duration of hospitalization. These factors encompass patient satisfaction, quality of life, and complications.

18. Pain Management and Medication Managing postoperative pain is a crucial part of the recovery process. Typical pain medicine prescribed post laparoscopic hysterectomy includes acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. Surgeons must prescribe a minimal effective opioid dosage to mitigate the potential for excessive opioid consumption. The potential side effects of pain medication administered after a laparoscopic hysterectomy may encompass: • Nausea • Vomiting • Itching • Drowsiness • Constipation • Stomach upset To minimize the risk of constipation while using painkillers containing codeine or dihydrocodeine, it is recommended to increase the intake of fruits and fiber.

19. Returning to Daily Life

20. Returning to daily life after a laparoscopic hysterectomy requires some adjustments. Here are some guidelines to follow: 1. Engage in light activities around the house for the first few days after the procedure. 2. Safeguard your pelvic floor muscles by engaging them prior to activities that exert pressure, such as lifting, coughing, or sneezing. 3. If you experience postoperative pain, reduce activity levels for a few additional days to facilitate the recovery process. It’s also important to note that patients may experience feelings of tearfulness and emotional sensitivity post- procedure, as these are typical aspects of the emotional recovery phase. Following a laparoscopic hysterectomy, it is generally advisable to wait 4 to 6 weeks before resuming sexual activity.

21. Activity Restrictions and Guidelines Patients usually recover fully within six days to two weeks following a laparoscopic hysterectomy. After 6 weeks, they can typically resume their regular activities, including driving and exercise. However, it’s important to follow certain activity restrictions and guidelines to ensure optimal recovery. Proper lifting technique involves holding objects close to the body, lifting with the knees and not the back, and bracing the pelvic floor and stomach muscles. It is advisable to restrict lifting to light loads such as a one-litre bottle of water, kettles, or small saucepans, and to avoid heavy objects like full shopping bags or children, as well as strenuous housework like vacuuming for three to four weeks post-surgery. Patients are also advised to wait at least 12 weeks post-procedure before resuming sexual activity and should seek approval from their healthcare provider before proceeding.

22. Emotional Well-being and Support Addressing your emotional well-being is just as important as your physical recovery. Patients can emotionally prepare for a laparoscopic hysterectomy by establishing a support system prior to the surgery and incorporating relaxation techniques or physical activity into their preparation. Post-surgery, patients may encounter a variety of emotional responses, such as anxiety, depression, stress, grief, and a sense of emptiness. Support from family and friends can be invaluable during this time, providing practical help with daily tasks, emotional support, companionship, and a listening ear. For those who need it, counselling, support groups, and guidance from medical professionals are available.

23. Potential Complications and Risks

24. While laparoscopic hysterectomy is considered safe, like any surgical procedure, it carries certain risks. For instance, there is a small potential for the formation of blood clots in the veins of the legs and pelvis. The risk of clots can be minimized by engaging in early mobility post-surgery, utilizing leg compression devices, and potentially taking prescribed clot prevention medication

25. Common Surgical Risks Common surgical risks include surgical infection, excessive bleeding, and complications associated with anesthesia. The risk of a surgical infection can be managed by evaluating and addressing patient risk factors, utilizing preoperative skin preparation, and administering antibiotic prophylaxis. Excessive bleeding is observed in approximately 1% to 3% of laparoscopic hysterectomy cases, with factors such as hemorrhagic disorders or liver disease increasing this risk. Potential complications associated with anesthesia during the procedure may encompass: • Fluid overload • Gas embolism • Postoperative nausea and vomiting (PONV) • Sore throat • Dental injury • Post-operative atelectasis

26. Laparoscopic Hysterectomy-Specific Risks Specifically, with laparoscopic hysterectomy, there is a risk of damaging surrounding organs. However, measures like: Let’s explore more: Laparoscopic Hysterectomy: Recovery & Benefits - Southlake General Surgery

27. Make an Appointment To schedule a consultation or to learn more about laparoscopic hysterectomy, please get in touch with our team at Southlake General Surgery, Texas, USA. We are here to answer your questions, address your concerns, and guide you through your journey to wellness. You can book an appointment by phone at +1 (817) 748- 0200 or through our online platform. We look forward to partnering with you for your health and well-being.

28. Medically Reviewed By: Dr. Valeria Simone MD Board-certified General Surgeon at Southlake General Surgery, Texas, USA. Follow us on Facebook and YouTube. Source: Laparoscopic Hysterectomy: Recovery & Benefits - Southlake General Surgery

29. THANK YOU! SOUTHLAKE GENERAL SURGERY 1545 E. Southlake Blvd, Suite 270 Southlake, TX 76092 EMAIL: info@southlakegeneralsurgery.com VISIT US AT: www.southlakegeneralsurgery.com