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Laparoscopic Assisted Vaginal Hysterectomy

This information describes your laparoscopic assisted vaginal hysterectomy surgery at Memorial Sloan Kettering Cancer Center (MSKCC) and what to expect afterward.

Introduction

This booklet describes the laparoscopic assisted vaginal hysterectomy (LAVH). This surgery may be done if you have:

  • Fibroids
  • Ovarian cysts
  • Endometriosis. This is when the tissue that lines the uterus grows outside of the uterus.
  • Constant heavy periods or pelvic pain
  • Cancer of the cervix, uterus or ovary

The Uterus

The uterus is located in the lower abdomen between the bladder and the rectum. The uterus is also called the womb. The lower, narrow end of the uterus is the cervix (see Figure 1). When a woman is pregnant, the baby grows in the uterus until he or she is born.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

In some types of hysterectomies, the doctor makes a large incision or cut across the abdomen. In LAVH, the doctor does not make a large incision. Instead, he or she makes several small incisions (see Figure 2).

LAVH is done under general anesthesia. A small telescope-like tool is put into your abdomen through a small cut. It is connected to a video camera and television. This allows the inside of the abdomen to be seen on a screen. Small incisions are also made in the abdomen so that tiny tools can be inserted. Ligaments that support the uterus are cut with these tools. The uterus is removed through the vagina. The ovaries, fallopian tubes and lymph nodes can also be removed in this way.

Salpingo-oophorectomy

Sometimes one or both ovaries and fallopian tubes are also removed (see Figure 1). This is called a salpingo-oophorectomy. If both ovaries are removed, you will start menopause. If you have already gone through menopause and have no symptoms, there may be very little change. You may not feel any different after the
surgery. If you have not already started menopause, you may have symptoms. These can include:

  • Night sweats
  • Hot flashes
  • Vaginal dryness

Lymph Node Dissection

Your doctor may also remove some of your lymph nodes. This is called a lymph node dissection. Lymph nodes are small bean-shaped structures. They are found throughout the body and make and store cells that fight infection. Sometimes cancer cells spread to the lymph nodes, which is why they are removed. Only select lymph nodes are removed if a cancer is suspected.

Changes after the Surgery

You cannot bear children after this procedure. Menstruation will also stop. But, a hysterectomy does not cause menopause unless the ovaries are also removed.

There are some risks with this surgery because the uterus is near the bladder and rectum. There may be an impact on the way you urinate, defecate and have sexual intercourse. The doctor will try to preserve your normal function as much as possible. The goal is to protect your:

  • Urinary function
  • Bowel function
  • Sexual function

Preparation For The Surgery

  • You will be scheduled for a pre-surgical testing (PST) visit before your surgery. During the PST visit, you will meet with a nurse practitioner and discuss anesthesia. This is the medicine used to put you to sleep during the surgery. You will also have some tests done such as:
    • An electrocardiogram (EKG)
    • A chest X-ray
    • Blood tests
    • Other tests that your doctor may decide are necessary
  • Your nurse will give you the following fact cards to review. Please read them carefully:
  • Do not eat or drink anything after midnight the night before surgery.

The Day Of Surgery

Surgery will be performed at:

Memorial Hospital
1275 York Avenue (between East 67th and 68th Streets).

The hospital garage is located on 66th Street between York and First Avenue.

Recovery In The Hospital

After the surgery you will be in the Post-Anesthesia Care Unit (PACU). You will be there while you recover. You can have ice chips and water as soon as you are fully awake. Family members may also visit you in the PACU. After the recovery phase, you will be taken to your hospital room.

Fluids will be given to you through an intravenous (IV) line, which is a line in a vein. The IV line will remain in place until the day of discharge. You can eat that evening or the morning after the surgery. Most people do not pass gas (flatus) or have a bowel movement for several days after surgery. You do not have to pass gas or have a bowel movement before you leave the hospital.

Pain management

You will feel some pain after the surgery. To help relieve this pain, medicine will be given to you while you are in the PACU. Right after surgery, pain medicine will be given through your IV line or through an epidural. An epidural is a small tube that is placed into your spine with a needle to deliver pain medicine. You will have a patient-controlled analgesia (PCA) pump. Your nurse will give you the Patient-Controlled Analgesia fact card. You will be changed to oral pain medicine within a few days. The nurses and doctors will ask you about your pain frequently. If your pain is not relieved, please tell your nurse.

Your incisions

You will have several small incisions in your abdomen. The incisions will be closed with Steri-Strips® (small strips of tape). Before you leave the hospital, your nurse will show you how to clean your incisions. You may shower 48 hours after surgery.

Breathing and circulation

Breathing and circulation problems can develop after any surgery. The goal during the first few days after your surgery will be to prevent these problems. You must walk in the hallways at least 3 to 4 times a day to help your breathing and circulation. Your nurse will help you get out of bed the same day you return to your room. You will also have compression boots on the lower part of your legs to prevent circulation problems. They are connected to a pump and will squeeze your legs from time to time while you are in bed. The boots should be worn when you are in bed until you are discharged. You may also be given an injection to prevent blood clots from forming.

You will be taught to use a small breathing device, called an incentive spirometer (in-sen-tiv spir-ah-mih-ter). It will help you expand your lungs. You must use it at least ten times every hour while you are awake. Take three deep coughs after every ten breaths with this device. Your nurse will also teach you to splint your incision. This will reduce movement of your stomach muscles and decrease pain while you do the coughing exercises.

Drains and tubes

After surgery, you may have some drains and tubes in place.

  • You may have a Foley® catheter in your bladder. It allows urine to drain.
  • You may have a drain in your abdomen. It allows fluid in the abdomen to drain.

Diet after surgery

You can begin eating solid foods after your surgery. Start with soft, easy to digest foods such as:

  • Farina
  • Applesauce
  • Canned fruits
  • Chicken noodle soup
  • White toast and crackers

Eat small frequent meals and gradually advance to regular foods.

Milk and carbonated beverages can cause discomfort. Only have these foods in small amounts during the first few days after surgery. If you have bloating, gas, or cramps, limit the amount of high fiber foods such as:

  • Whole grain breads and cereals
  • Nuts
  • Seeds
  • Beans
  • Salads
  • Fresh fruits
  • Gassy vegetables such as broccoli, cabbage, cauliflower, beans and onions

If you have any questions, call (212) 639-7312 to speak with a dietitian.

Preparing for discharge

Patients are usually discharged one to two days after surgery. You will be ready for discharge once you:

  • Have adequate bowel activity. This will be based on a physical exam. It usually means that bowel sounds can be heard and your stomach is soft. You are not required to pass gas (flatus) before discharge.
  • Are able to eat solid food. It may take several weeks for your appetite to be what it was before surgery. However, you must be able to eat some solid foods before you go home.
  • Have adequate pain relief. You should expect to have discomfort after surgery, but you will get pain medicine. It should make you comfortable enough to manage at home.
  • Are able to walk. In some cases, a physical therapist may be needed.

Travel arrangements should be discussed before your admission. You will be discharged between 8:00 am and 11:00 am. Please make arrangements for a friend or family member to bring you home. The discharge nurse will help you plan your transition from the hospital to home. He or she will give you instructions about:

  • Activity restrictions
  • Supplies
  • Prescriptions
  • When to see your doctor for a post-operative visit

Recovering at Home

Caring for yourself

Tubes or Drains

Some patients go home with tubes or drains. You may have the Foley® catheter or drain in your abdomen. If you go home with either of these, you or a family member will be taught how to care for it. Any supplies you need will be ordered for you. If there is a need for visiting nurse services at home, the case manager will discuss this with you. Coverage for these services depends on your insurance benefits.

Your incisions

Clean the incisions with soap and water as your nurse taught you. If you are discharged with Steri-Strips®  covering your incisions, you may shower with these on. They will begin to peel off in about 1 week. If they have not fallen off after 7 to 10 days, please remove them in the shower.

It takes 6 to 8 weeks for the area to heal. Do not strain or lift anything over 10 pounds (4.54 kg) until you have healed. Your doctor or nurse will tell you when you have healed completely.

Home medications

You will be discharged with medicines for pain. These will usually be the same ones that you took in the hospital. Common medicines used for pain are acetaminophen and hydrocodone (Vicodin®) and diclofenac (Voltaren®). If these did not work well for you in the hospital, your doctor may order you another pain medicine.

Activity

Do not drive if you have pain or are taking pain medicines stronger than Tylenol®, aspirin or Advil®. Discuss any plans to travel with your doctor. If you are traveling by airplane or have a long car ride, get up and walk every hour. Be sure to stretch your legs, drink plenty of fluids, and keep your feet elevated when possible.

Daily exercise such as walking will help you recover faster. Wait until your doctor or nurse says it is safe before beginning heavy exercise such as:

  • Jogging
  • Weight lifting

Returning To Work

Most people can return to work about four to six weeks after the surgery. If your work requires heavy physical activity, it may take longer.

Call your doctor or nurse immediately if you:

  • Have swelling or tenderness in your calves or thighs
  • Become short of breath
  • Cough up blood
  • Have a temperature of 101° F (38.3° C) or higher

Call your doctor or nurse during business hours if:

  • You have not had a bowel movement in 3 days.
  • You have diarrhea. Do not take an antidiarrheal medicine [such as loperamide (Imodium®) or bismuth subsalicylate (Kaopectate®)] until you speak to your doctor or nurse.
  • You have any questions or concerns about this information.

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