Hysterectomy – The Basics

Here is a great summary of the general information that is helpful when considering a hysterectomy.  Over the next several weeks, I hope to break down this information in even more detail. For example, what are the reasons for a hysterectomy and what are the main risk factors.  Check in during this time to get more information on the topics mentioned here.Image

Hysterectomy

Description

During a hysterectomy, the surgeon may remove the entire uterus or just part of it. The fallopian tubes and ovaries may also be removed.

Types of hysterectomy:

  • Partial (supracervical) hysterectomy: The upper part of the uterus is removed. The cervix is left in place.
  • Total hysterectomy: The entire uterus and cervix are removed.
  • Radical hysterectomy: The uterus, cervix upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.

Your doctor will help you decide which type of hysterectomy is best for you. The choice often depends on your medical history and reason for the surgery.

Why the Procedure is Performed

There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:

Hysterectomy is a major surgery. It is possible that your condition may be treated without this major surgery. Talk with your doctor or nurse about all your treatment options. Less invasive procedures include:

Risks

Risks of any surgery are:

Risks of a hysterectomy are:

  • Injury to the bladder or ureters
  • Pain during sexual intercourse
  • Early menopause if the ovaries are removed
  • Decreased interest in sex
  • Increased risk of heart disease if the ovaries are removed before menopause

Ask your doctor if taking estrogen can help lower the risk of heart disease and help menopause symptoms.

Before the Procedure

Before deciding to have a hysterectomy, ask your doctor or nurse what to expect after the procedure. Many women who have had a hysterectomy notice changes in their body and in how they feel about themselves. Talk with your doctor, nurse, family, and friends about these possible changes before you have surgery.

Tell your health care team about all the medicines you are taking. These include herbs, supplements, and other medicines you bought without a prescription.

During the days before the surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

  • You will usually be asked not to drink or eat anything for 8 hours before the surgery.
  • Take any medicines your doctor told you to take with a small sip of water.
  • Arrive at the hospital on time.

After the Procedure

After surgery, you will be given pain medicines to relieve any discomfort.

You may also have a tube, called a catheter, inserted into your bladder to pass urine. The catheter will likely be removed before you go home.

You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds recovery.

You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as you can without causing nausea or vomiting.

How long you stay in the hospital depends on the type of hysterectomy.

  • You can likely go home the next day when surgery is done through the vagina using a laparoscope or after robotic surgery.
  • When a larger surgical cut (incision) in the abdomen is made, you may need to stay in the hospital 1 to 2 days. You may need to stay longer if the hysterectomy is done because of cancer.

Outlook (Prognosis)

How long it takes you to recover depends on the type of hysterectomy. Average recovery times are:

  • Abdominal hysterectomy: 4 to 6 weeks
  • Vaginal hysterectomy: 3 to 4 weeks
  • Robot-assisted or total laparoscopic hysterectomy: 2 to 4 weeks

A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy. Discuss with your doctor the risks and benefits of this therapy.

If the hysterectomy was done for cancer, you may need further treatment.

Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm

What you can expect – anesthetic (article from Mayo Clinic)

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There are lots of things that you learn about when you decide to go in for a hysterectomy.  Unfortunately, some of these things are only learned after we actually went through the surgery.  For me, one of those things was about anesthetic.  I had ‘been under’ twice before – once for removal of tonsils and once for removal of wisdom teeth – wow, doctors apparently really like taking things out of my body!).  I knew I always woke up very nauseated and both previous times I threw up in short order – something I really wanted to avoid right after a hysterectomy!  Well, apparently, it was not the anesthetic but the codeine that made me sick.  I had no codeine this time and woke up feeling pretty good.  However, what I did have was a sore throat and no idea why.  This post from the Mayo Clinic explains why.  It was from the tube they inserted in my throat while I was under.  It was fairly minor overall, but just one of those things that I didn’t learn until after it actually happened.  Hopefully this post will help you be a little more prepared for these effects than I was!

From the Mayo Clinic: http://www.mayoclinic.com/health/anesthesia/MY00100/DSECTION=what-you-can-expect

Before general anesthesia
Before you undergo general anesthesia, your anesthesiologist will talk with you and may ask questions about:

  • Your health history
  • Your prescription medications, over-the-counter medications and herbal supplements
  • Allergies
  • Your past experiences with anesthesia

The information you provide will help your anesthesiologist choose the medications that will be most appropriate and safe for you.

During general anesthesia
In most cases, your anesthesiologist delivers the anesthesia medications through an intravenous line in your arm, but sometimes the anesthesia may be given as a gas that you breathe from a mask. For example, children may prefer to go to sleep with a mask.

Once you’re asleep, a tube may be inserted into your mouth and down your windpipe to ensure you get enough oxygen and to protect your lungs from blood or body secretions, such as from your stomach. You’ll be given muscle relaxants before doctors insert the tube, to relax the muscles in your windpipe. In some cases this breathing tube isn’t needed, which reduces your chance of a sore throat after surgery.

Your doctor may use other options, such as a laryngeal airway mask, to help manage your breathing during surgery.

A member of the anesthesia care team monitors you continuously during your procedure, adjusting your medications, breathing, temperature, fluids and blood pressure as needed. Any abnormalities that occur during the surgery are corrected by administering additional medications, fluids and, sometimes, blood transfusions.

Blood transfusions may be necessary in some situations, such as complex surgeries. Anesthesiologists and other members of the anesthesia care team monitor your condition and deliver blood transfusions when necessary. However, blood transfusions may involve risks, particularly in people who are older, who have low blood red cell volume or who are undergoing complex heart surgeries.

After general anesthesia
When the surgery is complete, the anesthesia medications are discontinued, and you gradually awaken either in the operating room or the recovery room. You’ll probably feel groggy and a little confused when you first awaken. You may experience common side effects such as:

  • Nausea
  • Vomiting
  • Dry mouth
  • Sore throat
  • Shivering
  • Sleepiness
  • Mild hoarseness

You may also experience other side effects after you awaken from anesthesia, such as pain. Side effects depend on your individual condition and the type of surgery. Your doctor may give you medications after your procedure to reduce pain and nausea.

No Safety Benefit Found in Use of Robot for Hysterectomy

Here is a recent article from Bloomberg News that suggests that robotic-assisted hysterectomies may not be much better for reducing complications than other forms of hysterectomy.  However, there is some disagreement on the type of patients that were studies and whether direct comparisons can be fairly made.  It seems to say there is less chance od needing a blood transfusion but more chance of pneumonia.  I was fortunate enough to not have had any complications after surgery, although I did need a blood transfusion prior to surgery.  What has your experience been with complications after a hysterectomy?  Feel free to post in the comments section below.
Surgery to remove the uterus using a $1.5 million robot from Intuitive Surgical Inc. (ISRG) doesn’t reduce complications and may raise pneumonia risk compared with conventional less-invasive techniques, according to a second extensive study to find no added benefit from the devices.

Researchers examined data from about 16,000 women who had hysterectomies for benign conditions in 2009 and 2010. The robot operations cost hospitals $2,489 more per procedure with a similar complication rate as the standard practice of removing the uterus with minimally invasive equipment, according to the study released in the journal Obstetrics & Gynecology.

“Unfortunately, the greater costs associated with robotic-assisted hysterectomy were not reflected in improvement in outcomes,” said researchers at the University of Texas Southwestern Medical Center at Dallas.

The results released yesterday are from the second large-scale research published this year to find higher costs with no added benefit for robotic hysterectomy. In February, Bloomberg News reported that U.S. health regulators were surveying surgeons on the robots following a rise in reports that included as many as 70 deaths since 2009. In July, Sunnyvale, California-based Intuitive said sales growth slowed in the second quarter and that it had received a regulatory warning letter concerning reporting issues for the devices.

Intuitive fell less than 1 percent to $384.52 at 9:52 a.m. New York time. The shares have declined 33 percent since Feb. 27, the day before Bloomberg News reported the Food and Drug Administration survey of surgeons about the products.

Top Product

The company’s da Vinci system, used in more than 1,300 hospitals, is its primary product. Revenue from the robot and related instruments and supplies generated $1.8 billion in 2012, Intuitive has reported.

In the study released yesterday, while patients who got robotic hysterectomies had a lower rate of needing blood transfusions, they had double the risk of getting pneumonia after the operation.

The pneumonia finding may be related to a trend toward a higher number of robotic hysterectomy patients needing intubation after their operation, the University of Texas Southwestern researchers wrote. Lengthy robotic operations with patients in steep head-down positions may result in fluid buildup in the airways, the authors suggested. The trend was not statistically meaningful.

No Benefit

The net result was no benefit in reducing complications for robotic surgery. The complication rate was 8.80 percent for robotic hysterectomy surgery and 8.85 percent for a standard minimally invasive hysterectomy, according to the study.

Intuitive Surgical, in an e-mail, said patients in the study getting robotic surgery tended to be older, heavier and had a higher rate of chronic conditions.

“Given these facts, it is likely that a substantial percentage of patients who received a robotic-assisted hysterectomy would have otherwise received an open hysterectomy,” Angela Wonson, a spokeswoman for the company, said in the e-mail.

In the study, which culled data from more than 800,000 hysterectomies, the complication comparison was based on a subset of patients with similar ages, obesity rates and health status.

With standard minimally invasive surgery, called laparoscopy, surgeons manipulate instruments through several tiny incisions in the abdomen while looking inside the patient through a camera called a laparoscope.

High-Definition Screen

Robotic surgery is similar, except that the surgeon sits at a console a few feet away and maneuvers robotic arms while looking into a high-definition display. Unlike the standard equipment, the robotic instruments have wrists, potentially enabling finer control and movement.

In February, a study in the Journal of the American Medical Association found that robotic hysterectomies for benign conditions cost hospitals $2,189 more per procedure than the same surgery without the robot. That research, which looked at data from 441 hospitals from 2007 to 2010, showed complication rates were 5.5 percent for the robot surgery and 5.3 percent for a less invasive hysterectomy.

Click here to see the original article.

My Open Letter to The World ~ Post Op

Ah, yes, dealing with needing the help of others…that’s a challenge! We always want to put on a brave face and not rely on anyone. Thankfully, I had dear family and friends who insisted on helping and I am so glad they did. I’m fully healed now thanks to their good care. And now, I really miss all of those wonderful meals everyone made for me!

Bittersweet Joy

IMG_2576Dear World,

Exactly one week ago I was sophisticatedely  hacked in to by three surgeons and a robot.  I know, it sounds like the start of a bad joke but it’s not.  It is true to life ~ I could not even joke about my cystoscopy/stint application/hysterectomy/appendectomy procedure if I wanted to.  Before I entered the ice-cold operating room, I was quizzed at least four times as to what procedures I was having done.  By Person #3, I was beginning to wonder if the test was for me or if they really knew what they were going in there to do.  Needless to say, the operation(s) went well.  Almost five hours later, I did not wake up too well to a very sore midsection which looks (to this day) very much like Frankenstein’s forehead.

This is the first day I’ve sat down to write thank you notes to my friends…

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My Own Process

A story about one woman’s experience with hysterectomy. She does discuss her experience of having one child and if this is something that is hard for you to read, you may want to skip it. Check in tomorrow though for a posting from a woman who was not able to have children before her hysterectomy.

Finding Hope In Change

Lately I have been reading a lot of blogs about hysterectomies because I want to know how others are recovering from the surgery and what they’ve experienced along the way. These blogs are written by women who have this surgery prophylactically (preventatively) or because of medical necessity (fibroid tumors, cancer, etc.). Some of them still have their ovaries so their recovery is different than what I’ll be experiencing because they aren’t going through menopause. It’s still helpful to read their blogs because they detail what it’s like to be limited with movement, restrictions on lifting items over a certain weight and other physical challenges.

They’re also, often times, in their 20’s and 30’s, childless, and struggling with the realization that they can never carry a pregnancy. Maybe they are newlyweds and had been waiting a few more years before starting a family. Maybe they are single, still looking for a partner, and weren’t quite ready to have a baby…

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Oh dear, I’m bored already!

I find it so interesting to read about other people’s recoveries. I did find it so disappointing after my surgery, how little I got accomplished. I knew that I shouldn’t plan to get ‘things’ done but I was hoping to tackle some books, etc. However, I didn’t have the focus to do so for the first while, it was really surprising to me. I mean, how much energy does reading a book actually take. I see now that a lot of people have a similar experience.

No Children, What Now?

It’s been two weeks since my ovary was removed, and although my recovery is going ok, I’m already getting fed up. It’s early days, I know! I have to take it easy, I know! In fact I can’t do anything else, but take it easy. I sat on the couch all day yesterday instead of sitting in bed, and by 9.00pm my stomach felt like had been put in a vice. I had to take a codeine.

Today, I have been in and out of bed to get drinks and food. I sat on the floor and sorted the laundry into piles of mine and Gs and tried to tidy up a bit. I have found it difficult to do the smallest of tasks and it’s depressing. G has gone back to work now, so I’m on my own all day and I can’t leave the house because I’m not…

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Recovery Expectations – Video Link

blog pic 18  A major concern for women undergoing a hysterectomy is how long is the recovery.  Google this and you will find a multitude of responses.  Why?  Because there are so many factors that impact your recovery.  My recovery was quite quick and easy, which was not completely expected as it was an emergency surgery rather than a planned one.  However, I am on the younger side of patients having this surgery, I was healthy going in to surgery, I eat well and exercise, so I definitely had several things going in my favour.  Here is a video that discusses some of the factors that may impact your recovery time.  The video is a little goofy in my opinion, but it does have some good information to consider.  You may want to skip ahead to about the 40 second mark though.