Laparoscopic hysterectomy

About laparoscopic hysterectomy

A hysterectomy is an operation to remove your uterus (womb). We usually remove your cervix (neck of your womb). We may need to remove your ovaries at the same time.

Laparoscopic means it is done using a type of keyhole surgery. This can mean less pain, less scarring and a faster return to normal activities.

If you decide against a hysterectomy or it is delayed

You may prefer to put up with your symptoms, rather than have the operation. Your gynaecologist will talk to you about the risks of not having the operation.

We will monitor your condition and try to control your symptoms.

Benefits

We will discuss with you why we suggest you consider having a laparoscopic hysterectomy.

A laparoscopic hysterectomy may cure or remove the following conditions:

• Heavy or painful periods not controlled by other treatments.
• Fibroids, where part of the muscle of your womb becomes overgrown.

The following are less common reasons for having a hysterectomy:

• Endometriosis, where the lining of your uterus grows outside your uterus.
• Adenomyosis, where the lining of your uterus grows into the muscle of your uterus.
• Chronic pelvic inflammatory disease, where inflammation of your pelvis leads to chronic pain and often heavy periods.
• Ovarian cyst (a fluid-filled sac which can be cancerous, although most are not).

A hysterectomy may cure or improve your symptoms. However, pain may continue, depending on what causes it.

You will no longer have periods after a hysterectomy.

If we do not remove your ovaries, you may continue to have your usual premenstrual symptoms.

Alternative treatment

A hysterectomy is a major operation, usually recommended to women after simpler treatments have failed to control their symptoms.

For some women there may be no suitable alternatives and a hysterectomy may be recommended immediately, but this is unusual.

Heavy periods

• We can treat heavy periods using the following methods:
  • A variety of non-hormonal and hormonal oral (by mouth) medicines.
  • An IUS (intra-uterine system). This is an implant containing a synthetic form of the hormone progesterone that fits in your uterus.
  • ‘Conservative surgery’ which removes only the lining of your womb.

Fibroids

Depending on the size and position of the fibroids, we can give you medicine to try to shrink them and control the symptoms.

We can also use surgery to remove the fibroids, or shrink the fibroids by reducing their blood supply.

About the operation

We usually perform the operation while you are under a general anaesthetic (asleep). We can also use other anaesthetic techniques.

We may give you injections of local anaesthetic to help with pain, and antibiotics to help reduce the risk of infection.

During the operation [heavily edited]

We empty your bladder using a catheter (tube).

We make a small cut on or near your belly button and several small cuts on your abdomen. We use these small cuts to insert ports (tubes) and instruments so that we can perform the operation. 

Sometimes we may need to make a larger cut, usually on your ‘bikini’ line or downwards from your belly button (sometimes from above your belly button).This is so we can insert an instrument in your abdominal cavity to inflate it with gas (carbon dioxide). This gives your surgeon space inside your abdomen to operate.

We may do some or all of the following:

• Insert an instrument called a manipulator through your cervix and into your uterus. This allows us to move your uterus so we can get a good view of your pelvic area.
• Insert instruments through your vagina. We may need to make a cut around your cervix.
• Insert a tube in your abdomen to drain away fluid that can sometimes collect.
• Place a temporary pack (like a large tampon) in your vagina.
• Place a catheter in your bladder to help you to pass urine (wee). 

We may need to remove your ovaries, even if this was not originally planned. We will discuss this possibility with you before the operation.

The operation usually takes about 90 minutes.

Complications and risks

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After-effects of the operation

You can expect the following after-effects.

• Pain. We will give you medicine to control this. Take it as instructed so that you can move about and cough freely. After keyhole surgery, it is common to have some pain in your shoulders because a small amount of carbon dioxide gas may remain under your diaphragm (a muscle in the chest cavity). Your body will usually absorb the gas naturally over the next 24 hours. This will ease the symptoms.
• Scarring of your skin.
• You will no longer have periods.
• You will not be able to get pregnant.

Recovery afterwards

After the operation we will transfer you to the recovery area and then to the ward. We may give you fluid for 12 to 24 hours through a drip (small tube) in a vein in your arm.

You will probably feel some pain or discomfort when you wake and we may give you strong painkillers. Pain relief is an important part of your recovery. Tell your healthcare team if you are in pain.

If you have a catheter or drain, we usually remove it after 4 to 6 hours. We will allow you to start drinking and eating light meals. Good nutrition will speed up your recovery.

We usually remove the drip and the pack in your vagina after 12 to 24 hours.

On the second or third day, you may get wind pains. These can last for 1 to 2 days, but we can offer you medicine to relieve them.

You will be able to go home when your gynaecologist decides you are medically ready, which is usually the same day or after 1 to 2 days.

You may get a slight discharge or bleeding from your vagina for the first 2 weeks. Tell your healthcare team if this becomes heavy. Use sanitary pads, not tampons.

Nutrition and exercise

We advise you to drink plenty of fluid and increase the amount of fibre in your diet to avoid constipation.

Your healthcare team may recommend exercises to help you to recover. It is important to get out of bed and walk. We may give you breathing or other exercises. Do these, even if you feel you do not want to. They will speed up your recovery.

Look out for symptoms when you return home

Be aware of the following symptoms as they may show that you have a serious complication.

• Pain that gets worse over time or is severe when you move, breathe or cough.
• A heavy discharge or bleeding from your vagina.
• A high temperature or fever.
• Dizziness, feeling faint or shortness of breath.
• Feeling sick or not having any appetite (and this gets worse after the first 1 to 2 days).
• Not opening your bowels and not passing wind.
• Swelling of your abdomen.
• Difficulty passing urine.

Returning to everyday activities

To reduce the risk of a blood clot, follow our instructions if we give you medicine or ask you to wear special stockings.

Rest for 2 weeks and continue to do the gentle exercises we give you. Try to take a short walk every day.

Regular exercise will help you to return to normal activities as soon as possible. Before you start exercising, ask your healthcare team or GP for advice.

Eat healthily, drink plenty of fluid and rest when you need to.

You can return to work once your doctor has said you are well enough to do so. For most people this is after 4 to 6 weeks, depending on the type of work they do.

Most people feel more or less back to normal after 2 to 3 months.

While you recover, do not:

• Do not drive or ride a bike until you are confident about controlling your vehicle, including in an emergency. Check your insurance policy first and speak to your doctor if you have concerns.
• Do not have sex, use tampons or get into the bath, swimming pool or hot tub for at least 12 weeks and before any bleeding or discharge has stopped. When you have sex again, it can be uncomfortable at first and you may need to use a lubricant.
• Do not stand for too long or lift anything heavy.

Menopause and HRT

If your hysterectomy is performed while you are still having periods and your ovaries are removed during the operation, it is likely you will have menopausal symptoms.

These may include hot flushes, night sweats, passing urine more often, a dry vagina, dry skin and hair, mood swings and lack of sex drive. You can usually treat these symptoms with HRT.

Your GP is likely to recommend you take HRT until the time when you would have gone through menopause naturally (at about age 50 to 52). You can carry it on for longer if you want to. Discuss this with your GP.

Most women take HRT in tablet form but it is also available as patches, gels, nasal sprays, vaginal rings and implants. Your GP can discuss these options with you.

If we do not remove your ovaries

Your ovaries should continue to produce the hormones you need until you have reached the normal age of menopause. However, there is some evidence to suggest that some women who have had a hysterectomy may start menopause 2 to 3 years earlier.

After a hysterectomy, it can be more difficult to know when you are in menopause, as your periods will have stopped. You may need blood tests.

If you develop flushes or sweats or other menopausal symptoms, talk to your GP about HRT.