What is a hysterectomy?
A total hysterectomy is an operation where the womb (uterus) and neck of womb (cervix) are removed. Less commonly a subtotal hysterectomy is performed where the womb is removed but the cervix is left behind. The operation is sometimes combined with the removal of fallopian tubes (called salpingectomy) with or without the removal of ovaries (oophorectomy).
Why is a hysterectomy performed?
Hysterectomies are performed to treat symptoms such as heavy, painful periods as well as a range of conditions such as fibroids, adenomyosis, endometriosis, prolapse and cancer.
Hysterectomy might be chosen when medical or other less invasive surgical treatments have been tried and not worked or have been declined. Other treatment options must be discussed with your doctor before deciding on hysterectomy.
A hysterectomy can be carried out in different ways:
- Vaginal hysterectomy- this is where the surgery is performed through the vagina so that there are no visible scars on the lower part of the belly (abdomen). This is suitable for those with prolapse and where the uterus is normal in size.
- Abdominal or open hysterectomy- this is where a cut is made either across the lower part of the tummy (abdomen) or in an up and down cut to remove the womb. This is offered where the uterus is too large to be removed by vaginal or keyhole routes.
- Laparoscopic (keyhole) hysterectomy.
What happens during a laparoscopic hysterectomy?
- The procedure is performed under a general anaesthetic (while you are asleep). It usually takes about 1-2 hours but the length of time depends from person to person.
- A catheter is inserted into your bladder. Usually it is either used at the beginning to drain your bladder or urine and immediately removed (also known as an ‘in and out’ catheter) or it is kept in during your procedure and removed at the end.
- Your abdomen is filled with some gas (carbon dioxide) and a laparoscope (telescope attached to a camera) is inserted through a cut in your belly button (up to 2cm) to allow space to see your internal organs and perform the procedure.
- Two to four smaller cuts (between 0.5 and 1cm) are made in your abdomen to introduce the tools required to do the procedure.
- Your uterus (and sometimes the fallopian tubes and ovaries) are removed through the upper part of your vagina (also known as the vaginal vault). The vaginal vault is then closed with dissolvable sutures.
- The cuts on your abdomen are closed with either dissolvable stitches or glue. Dressings are normally applied to your skin wounds if stitches are used to close the skin.
What are the advantages of a laparoscopic hysterectomy (LH)?
When compared to an open hysterectomy, where a bigger cut is made to perform the procedure:
- There is less pain following LH.
- The scars after LH are smaller.
- The complication of severe haemorrhage (escape of blood) is lower.
- The stay in hospital is shorter. Sometimes you can have the procedure and go home the same day as the surgery.
- Recovery time once home and returning to normal activity is shorter, usually 2 to 4 weeks.
Will I have my fallopian tubes removed at the time of LH?
Removal of fallopian tubes is called salpingectomy. Most people will have their fallopian tubes removed at the time of LH, as long as this doesn’t cause a raised risk of complications during surgery. For example, if there is scar tissue making removal very tricky.
Salpingectomy at the time of LH is offered because:
- It is safe and does not increase the risk of complications such as blood transfusions, readmissions, and postoperative complications, infections, or fever compared with hysterectomy alone.
- The way ovaries work does not appear to be affected by salpingectomy.
- Salpingectomy appears to reduce the risk of ovarian cancer in women who are not having their ovaries removed (also known as oophorectomy).
Please feel free to discuss this further with your doctor or nurse.
Will I have my ovaries removed at the time of LH?
Removal of the ovaries is called oophorectomy.
Your ovaries create eggs that allow you to potentially get pregnant. They also create hormones that affect your period cycle. When your ovaries stop producing hormones you enter menopause. If you are having your hysterectomy after the menopause you will be offered oophorectomy at the same time.
Removing your ovaries at the time of surgery before reaching menopause causes a ‘surgical menopause’.
Going through a surgical menopause you may experience the same symptoms as people going through a natural menopause including:
- Hot flushes.
- Night sweats.
- Palpitations.
- Insomnia.
- Joint aches.
- Headaches.
- Vaginal dryness and loss of sex drive.
- Changes in storing wee.
During the natural menopause these symptoms might change with the changes in ovarian function. In people with a surgical menopause these symptoms can continue for a while. Ovaries are not routinely removed before the menopause. However, some
pre-menopausal people might be offered oophorectomy at the time of LH if they have:
- Uterine cancer.
- Severe endometriosis.
- Severe premenstrual dysphoric disorder.
Your doctor will explain the positives and negatives of removing or leaving your ovaries before your operation.
Risks of laparoscopic hysterectomy (LH)
- Infection – Although we give antibiotics during the operation, there is a small risk of infection in the bladder, chest, abdomen and wound sites.
- Blood clots – Clots in the legs or lungs occur in less than 1 in 250 people who have LH.
- Bleeding – Excessive bleeding is very uncommon during both types of hysterectomy. It is however, more common during LH than traditional hysterectomy. Approximately 1%
(1 in 100) of patients having LH will need a blood transfusion. - Internal injury – There is a greater risk of injury to the bladder and ureters (tubes connecting the kidneys to the bladder) during LH compared to traditional surgery. The risk of this occurring is approximately 1 in every 100 LH operations. Damage to other internal organs such as bowel or blood vessels occurs less often than 1 in 100 LH operations.
- Converting to open operation – In about 1 in 30 operations, it may be necessary to convert the keyhole hysterectomy (LH) to an open operation, either with a low horizontal cut or very rarely a central “up-and-down” cut (in the abdomen). This occurs if it is technically impossible to complete the LH or if a complication, such as bleeding occurs.
What might I expect after laparoscopic hysterectomy?
- Stay in hospital – This is normally day case, although some people stay overnight. Very occasionally, people stay for two nights. See below if you might be eligible for day case hysterectomy.
- Bladder catheter – If you are having day case surgery you will not have a bladder catheter (tube inserted into your bladder to empty it of urine) in place after your operation to shorten your recovery time while in hospital. If, however, you need to stay at least one night after your operation, you might have a catheter in place for a few hours after the operation or until the next day.
- Pain in your abdomen and shoulder – You will be given strong pain relief while in hospital. You can take paracetamol (1 gram FOUR times a day) and ibuprofen (400 milligrams FOUR times a day) once at home regularly for the first 7 days. You must reduce the dose of Ibuprofen to 400 milligrams THREE times a day or less after this.
- Eating and drinking – You will usually be encouraged to eat and drink within a few hours of your procedure. You are advised to chew chewing gum from two hours after your operation and to continue doing so every two hours for 15 minutes until you pass wind. This reduces the risk of developing bowel complications (postoperative ileus). Please bring your own chewing gum with you.
- Vaginal bleeding – You should expect slight vaginal bleeding (less than a period) for a few days after your operation.
- Stitches/ glue to skin – Stiches are normally buried under the skin and dissolve within 12-21 days. Glue tends to fade after 7-10 days. In both cases you should not scrub the skin affected to avoid re-opening the wound for at least 7-10 days after the operation.
Could I have Same Day Discharge Laparoscopic Hysterectomy?
Your gynaecologist will discuss if Same Day Discharge Laparoscopic Hysterectomy is suitable for you.
There are advantages to going home on the same day of your surgery:
- Faster recovery. In carefully selected people, same day discharge laparoscopic hysterectomy is associated with quicker recovery and return to normal daily activities when compared with staying in hospital.
- Less likely to develop blood clots in your legs and lungs (venous thromboembolic disease).
- Your surgeon and anaesthetist may feel that you are suitable for Same Day Discharge Laparoscopic Hysterectomy and discuss this with you. Below are reasons why you might be suitable for same day discharge laparoscopic hysterectomy.likely to get a hospital acquired infection such as MRSA. There is also less likelihood of hospital acquired COVID-19.
- Recovering at home often feels better than recovering in hospital with more freedom in when you take your pain relief, eat etc. and in a familiar environment. Additionally, hospitals can be noisier during the nights and are unfamiliar places which can affect sleep that is important during recovery.
Your surgeon and anaesthetist may feel that you are suitable for Same Day Discharge Laparoscopic Hysterectomy and discuss this with you. Below are reasons why you might be suitable for same day discharge laparoscopic hysterectomy.
- You are happy for day case surgery.
- You have physical and emotional support at home for the first 24-48 hours after surgery.
- Your BMI is less than 40.
- Your womb size is less than the equivalent of 14 weeks pregnancy size.
- You do not have current alcohol or drug dependence.
- You do not have a current medical condition or past anaesthetic problems that would increase your anaesthetic risks.
- You have not had past complex abdominal surgery and this planned surgery is not anticipated to be complex.
- You do not have a history of difficulty controlling pain and can take tablet pain relief at home.
- Your preassessment check does not raise concerns about offering you Same Day Discharge.
Activity and work
- Week 1
Rest and gentle activity. - Week 2
Light duties, e.g. desk work. - Week 3
Gradually restart normal activities. - Exercise
Light exercise can start from four to six weeks after your operation. Exercise level should increase gradually, reaching your normal levels six to ten weeks after your operation. - Washing
For the first four weeks, shower or kneel in shallow water. Do this rather than soaking in the bath, to allow the internal wounds to heal without getting wet. - Sex
Penetrative sex should be avoided for at least six weeks after your operation, to allow the internal wounds to heal sufficiently. - Driving
Avoid driving for at least two weeks after your operation. Please check with your motor insurance company and make sure you can perform all the manoeuvres (including emergency stops) without pain before you restart driving. - Cervical smears
When the uterus and cervix are removed, you no longer need to have smears unless your doctor advises otherwise.
Follow up
You and your GP will receive a letter with the details of your procedure. You will receive a letter with the results of your histology (tissue sample report) from your surgery about
6-12 weeks after your procedure and whether further follow up is required with gynaecology.
You will be given details to contact our Gynaecology Acute Treatment Unit if you have any concerns during your recovery.
When should I call the Gynaecology Acute Treatment Unit (GATU)?
Where can I find more information?
If you have any questions about this leaflet or other aspects of your care, please feel free to ask your doctor or members of the nursing staff.