This guide will help you prepare for your robotic-assisted or laparoscopic hysterectomy at Memorial Sloan Kettering (MSK) and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.
About Your Surgery
A hysterectomy is a surgery that removes the uterus. You may be having a hysterectomy because you have uterine, cervical, or ovarian cancer, uterine fibroids, endometriosis, heavy vaginal bleeding, or pelvic pain. Your doctor will explain why you are having the surgery.
The uterus is located in the lower abdomen between the bladder and rectum. The lower narrow end of the uterus is called the cervix (see Figure 1). The ovaries and fallopian tubes are attached to the uterus.
After your hysterectomy, you will not be able to have children naturally. Menstruation will also stop. A hysterectomy does not cause menopause unless your ovaries are removed. If you have questions about preserving your fertility, ask your doctor for a referral to a fertility specialist.
You will have either a robotic-assisted or a laparoscopic hysterectomy. Both types will allow your surgeon to perform a precise and less invasive procedure than open surgery.
In both types of hysterectomies, your surgeon will make several small incisions (surgical cuts) on your abdomen (belly). A laparoscope, (a tube-like instrument with a camera) will be placed into your abdomen. The tool is connected to a video camera and television that allows your surgeon to see the inside of your abdomen. Gas (carbon dioxide) will be pumped into your abdomen to create space, which gives your surgeon more room to perform the surgery. Tiny tools will also be inserted into the incisions on your abdomen.
In a laparoscopic hysterectomy, your surgeon sees the image on a monitor and can remove tissue with the instruments. In a robotic-assisted hysterectomy, your surgeon uses a robot as a tool to do the surgery. Your surgeon sits at a console with a 3-dimensional view of the surgical site; he or she does the surgery from there, using a robot that he or she controls.
In both approaches, your surgeon will remove your uterus and cervix through your vagina, if possible. If your uterus or cervix cannot be removed through your vagina, your surgeon will make one of your incisions larger, and remove the organs from there. Your incisions will be closed with sutures (stitches).
Your surgeon may also perform one or both of the procedures listed below. If so, this is done at the same time as your hysterectomy.
Depending on your surgery, one or both of your ovaries and fallopian tubes may be removed. This is called a salpingo-oophorectomy. If both ovaries are removed, you will go into menopause, if you have not already. If you have already gone through menopause, you should not notice any changes. If you have not started menopause, you may experience common symptoms, including night sweats, hot flashes, and vaginal dryness. Speak with your doctor about ways to manage these symptoms.
Your surgeon may do sentinel lymph node mapping and may remove some of your lymph nodes, which is called a lymph node dissection. Lymph nodes are small, bean-like structures that are found throughout your body. They make and store the cells that help fight infections. If cancer cells spread to the lymph nodes, they need to be removed.
Sentinel lymph nodes are the lymph nodes that are the ones most likely to be affected if your cancer has spread.
For sentinel lymph node mapping, your surgeon will inject a small amount of dye while you are under anesthesia. Your surgeon will discuss with you the type of dye that he or she will use. This dye travels to the sentinel nodes and turns them blue or green. Once the sentinel node(s) are located, your surgeon will make a small incision. He or she will remove the sentinel node(s) (the nodes that have turned blue or green) and they will be examined to see if they contain cancer cells.Back to top
Before Your Surgery
The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
You and your healthcare team will work together to prepare for your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medications to help prevent them.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you want to quit, call our Tobacco Treatment Program at 212-610-0507. You can also ask your nurse about the program.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your surgery.
Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
Your nurse practitioner will talk with you about which medications you should take the morning of your surgery.
It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you are taking, including patches and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Complete a Health Care Proxy Form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.
Identify Your Caregiver
Your caregiver plays an important role in your care. He or she will learn about your surgery with you from your healthcare provider. Your caregiver will need to be present after your surgery for the discharge instructions so that he or she is able to help you care for yourself at home. Your caregiver will also need to take you home after your surgery.
Do Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, please read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.
Try to do aerobic exercise every day, such as walking or other forms of exercise. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.
Eat a Healthy Diet
You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet talk to your doctor or nurse about meeting with a dietitian.
Stop Taking Certain Medications
If you take vitamin E, stop taking it 10 days before your surgery. If you take aspirin, ask your surgeon whether you should continue. Medications such as aspirin, medications that contain aspirin and vitamin E can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Purchase Hibiclens® Skin Cleanser, if Needed
If you need to wash with Hibiclens before your surgery, your nurse will tell you. Hibiclens is a skin cleanser that kills germs for 6 hours after using it. Showering with Hibiclens before surgery will help reduce your risk of infection after surgery. Hibiclens is available at your local pharmacy without a prescription.
If you take a multivitamin, talk with your doctor or nurse about whether you should continue. Stop taking herbal remedies or supplements 7 days before your surgery. For more information, please read Herbal Remedies and Cancer Treatment.
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.
Follow a Clear Liquid Diet, if Needed
You may need to follow a clear liquid diet the day before your surgery. A clear liquid diet includes only liquids you can see through. Examples are listed in the table below. You cannot eat any solid foods while on a clear liquid diet. Your nurse will tell you if you need to follow a clear liquid diet.
Do Not Drink
Sweets and Desserts
Begin Bowel Preparation, if Needed
You may also need to do a bowel preparation in order to empty your bowels before surgery. If you need to do this, your nurse will give you instructions.
Shower With Hibiclens, if Needed
If your doctor or nurse told you to shower with the Hibiclens solution, do it the night before your surgery. To use Hibiclens, open the bottle and pour some solution into your hand or a washcloth. Rub it gently over your body from your neck to your waist and rinse. Do not let the solution get into your eyes, ears, mouth, or genital area, or on wounds. Do not use any other soap. Dry yourself off with a clean towel after your shower.
Go to bed early and get a full night’s sleep.
Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids (see Figure 2).
Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
- Gelatin, such as Jell-O®
- Clear fruit juices (no pulp), such as white cranberry, white grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
Shower With Hibiclens, if Needed
If your doctor or nurse told you to shower with Hibiclens, shower with it just before you leave. Use the Hibiclens the same way you did the night before. Do not use any other soap. Do not put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.
Take Your Medications
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Things to Remember
- Do not put on any lotions, creams, deodorants, makeup, powders, or perfumes.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- CD player and CDs or an iPod, if you choose. However, someone will need to hold these items for you when you go into surgery.
- Your incentive spirometer, if you have one.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Once You’ve Arrived for Your Surgery
You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.
Get Dressed for Surgery
You will be given a hospital gown, robe, and nonskid socks.
Meet With Your Nurse
A nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.
Meet With Your Anesthesiologist
He or she will:
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you will receive.
- Answer any questions you may have about your anesthesia.
Prepare for Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area.
You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs. You may also have a blood pressure cuff and EKG pads to monitor you during surgery.
Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.
Once you are fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You may also have a urinary catheter placed to drain urine from your bladder.
Once your surgery is finished, your incisions will be closed Steri-StripsTM (thin pieces of tape) or Dermabond® (surgical glue) and covered with a dry dressing. Your breathing tube is usually taken out while you are still in the operating room.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your stay and after you leave. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU) or your
A nurse will be monitoring your body temperature, blood pressure, pulse, and oxygen levels.
You may have a urinary catheter (Foley®) in your bladder to help monitor the amount of urine you are making. The Foley catheter should come out before you go home. You will also have compression boots on your lower legs to help your circulation.
Your pain medication will be given through an IV line or in tablet form. If you are having pain, tell your nurse.
Your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.
- It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs.
- Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, please read How to Use Your Incentive Spirometer.
Will I have pain after surgery?
Yes, you will have some pain after your surgery, especially in the first few days. Your doctor and nurse will ask you about your pain often. You will be given medication to manage your pain as needed. If your pain is not relieved, please tell your doctor or nurse. It is important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.
Will I be able to eat?
Yes, you will be able to eat a regular diet or eat as tolerated. You should start with foods that are soft and easy to digest such as apple sauce and chicken noodle soup. Eat small meals frequently, and then advance to regular foods.
If you experience bloating, gas, or cramps, limit high-fiber foods, including whole grain breads and cereal, nuts, seeds, salads, fresh fruit, broccoli, cabbage, and cauliflower.
Will I have pain when I am at home?
The amount of pain or discomfort varies for each person. Some people do not need any pain medication at home. You will be given a prescription for pain medication and possibly an anti-inflammatory before you are discharged or at your consent appointment. Follow the guidelines below to manage your pain:
- Call your doctor if the medication prescribed does not relieve your pain.
- Take your medication as directed and as needed.
- Do not drive or drink alcohol while you are taking prescription pain medication.
- Keep track of when you take you pain medication. Taking it when your pain first begins is more effective than waiting for the pain to get worse. Pain medication is most effective 30 to 45 minutes after taking it.
- You should start to take less pain medication as you are recover from your surgery.
How can I prevent constipation?
Your bowel patterns will change after surgery. It is normal to have some constipation right after surgery. To avoid constipation, take the stool softener docusate sodium (Colace®) 3 times a day and 2 tablets of senna (brand names include Senokot®) at bedtime until you are able to move your bowels without any difficulty. Drink plenty of liquids and make sure to do plenty of walking after surgery, as this can help with constipation.
Can I shower?
Yes, you should shower 24 hours after your surgery.
How do I care for my incisions?
You will have several small incisions on your abdomen. The incisions are closed with Steri-Strips or Dermabond. You may also have square white dressings on your incisions (Primapore®). You can remove these in the shower 24 hours after your surgery. You should clean your incisions with soap and water.
If you go home with Steri-Strips on your incision, they will loosen and may fall off by themselves. If they haven’t fallen off within 10 days, you can remove them.
If you go home with Dermabond over your sutures (stitches), it will also loosen and peel off.
What are the most common symptoms after a hysterectomy?
It is common for you to have some vaginal spotting or light bleeding. You should monitor this with a pad or a panty liner. If you have having heavy bleeding (bleeding through a pad or liner every 1 to 2 hours), call your doctor right away.
It is also common to have some discomfort after surgery from the air that was pumped into your abdomen during surgery. To help with this, walk, drink plenty of liquids and make sure to take the stool softeners you received.
When is it safe for me to drive?
You may resume driving 2 weeks after surgery, as long as you are not taking pain medication that may make you drowsy.
What are my limitations after surgery?
You should not place anything in your vagina for 8 weeks after surgery. Do not have vaginal intercourse for 8 weeks after your surgery. Some patients will need to wait longer than 8 weeks, so speak with your doctor before resuming sexual intercourse.
If you are traveling by plane within a few weeks after your surgery, make sure you get up and walk every hour. Be sure to stretch your legs, drink plenty of liquids, and keep your feet elevated when possible.
Will I need any supplies?
Most people do not need any supplies after the surgery. In the rare case that you do need supplies, such as tubes or drains, your nurse will order them for you.
When can I return to work?
The time it takes to return to work depends on the type of work you do, the type of surgery you had, and how fast your body heals. Most people can return to work about 2 to 4 weeks after the surgery.
What exercises can I do?
Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your doctor or nurse before starting more strenuous exercises.
When can I lift heavy objects?
Most people should not lift anything heavier than 10 pounds (4.5 kilograms) for at least 4 weeks after surgery. Speak with your doctor about when you can do heavy lifting.
How can I cope with my feelings?
After a hysterectomy, you may have new and upsetting feelings. Many patients say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support.
The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It is always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you are in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.
When is my first appointment after surgery?
Your first appointment after surgery will be 2 to 4 weeks after surgery. You can set this appointment up before your surgery or you will be given the phone number to call in your discharge paperwork. At this appointment, your doctor will discuss your test results with you in detail.
- Have a temperature of 101° F (38.3° C) or higher
- Have pain that does not get better with pain medication
- Have redness, drainage, or swelling from your incisions
- Have swelling or tenderness in your calves or thighs
- Cough up blood
- Have any shortness of breath or difficulty breathing
- Do not have any bowel movement for 3 days or longer
- Have nausea, vomiting, or diarrhea
- Have any questions or concerns
After 5:00 pm, during the weekend, and on holidays, call 212-639-2000. Ask to speak to the doctor on call for your surgeon.Back to top
This section contains a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.
Call with any questions about anesthesia.
Call for more information if you are interested in donating blood or platelets.
MSK welcomes patients from around the world. If you are an international patient, call for help arranging your care.
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.
Offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.
Learn techniques to help you feel better about your appearance by taking a workshop or visiting the program online at www.lookgoodfeelbetter.org.
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.
Call Patient Billing with any questions regarding preauthorization with your insurance company. This is also called preapproval.
Call if you have any questions about the Health Care Proxy Form or if you have any concerns about your care.
Call if you have any questions about MSK releasing any information while you are having surgery.
Patients may request private nurses or companions. Call for more information.
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also refer you to community agencies and programs, as well as financial resources if you’re eligible.
For additional online information, visit LIBGUIDES on MSK’s library website at http://library.mskcc.org or the Ovarian Cancer section of MSKCC.org. You can also contact the library reference staff at 212-639-7439 for help.
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.
Provides travel to treatment centers.
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
A comprehensive resource for education, tools, and events for employees with cancer.
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Provides support and education to people affected by cancer.
Provides education and support for those who care for loved ones with a chronic illness or disability.
Free travel to treatment across the country using empty seats on corporate jets.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance,meet the income criteria, and be prescribed medication that is part of the Good Days formulary.
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.
Provides a list of places to stay near treatment centers for people with cancer and their families.
Provides support and advocacy for the LGBT community, including a online support groups and a database of LGBT friendly clinical trials.
Free cancer legal advocacy program.
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Helps qualifying patients without prescription drug coverage get free or low-cost medications.
Provides assistance with copayments for patients with insurance.
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
Provides assistance to help people obtain medications that they have trouble affording.
Offers support groups for survivors of breast, metastatic breast, and ovarian cancer in Manhattan, Queens, Brooklyn, and Staten Island. For additional online information, visit LIBGUIDES on MSK’s library website at: http://library.mskcc.org. You can also contact the library reference staff at 212-639-7439 for help.