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Closed Method Uterine Removal Surgery

Laparoscopic Hysterectomy is the removal of your uterus by making tiny incisions in your abdomen. This is also called keyhole surgery because the uterus is removed through very small 1-2 cm incisions.

There are several types of hysterectomy.

  • Total or subtotal (that is, sometimes the uterus is completely removed, sometimes a part of the uterus (mouth) is left)
  • The ovaries are removed or not (the ovaries may or may not be removed at the same time as the uterus is removed. You should discuss this with your doctor)

Why-who is recommended laparoscopic hysterectomy?

  • If you have excessive bleeding and do not benefit from medication
  • If you have severe pain
  • If you have a chocolate cyst and your complaints do not improve with medication
  • If you have fibroids
  • If you have uterine cancer

What are the benefits of laparoscopic hysterectomy?

Because it is not like the incision we make from the abdomen;

  • Short hospital stay (patient gets up quickly after surgery)
  • Can return to normal life in 2-3 weeks
  • Less blood loss
  • Surgery scar is minimal
  • There is less wound infection and wound opening

What are the alternatives?

There are different types of uterus removal operation.

  • Robot
  • From the vagina (related article on my website) (It is completely traceless, preferred if possible, requires experience)
  • Open

Ask and discuss these options with your doctor along with Laparoscopic Hysterectomy. Check out the pictures of open and laparoscopic hysterectomy below. Open technique on the left and laparoscopic technique on the right.

What is done before the operation?

The patient is evaluated in detail before the operation. In particular, your past medical history, medications you use, smoking, etc. are questioned. Some blood tests, chest X-ray and EKG are done. You will be examined separately by an anesthesiologist.

What happens on the day of surgery?

  • You should not eat or drink anything until 8 hours before my surgery.
  • It is beneficial to take a shower the night before the surgery
  • Take off your jewelry and leave it at home. If you cannot remove it, inform your doctor.
  • Remove nail polish or artificial nails
  • Bring all the medicines you use to the hospital with you
  • When you are admitted to the hospital; The nurse will check you (temperature, pulse, blood pressure measurement). Then he will give you a surgical gown and an ID bracelet will be attached to your arm.
  • Also, if any, make-up, dentures, glasses, contact lenses should be removed.
  • Then the surgeon will see you and explain the operation again. If you have not signed the informed consent document, it will ask you and your loved one to sign it.
  • Anesthesia team will see you separately and explain the anesthesia technique to be applied to you. You should definitely tell the anesthesia team about your allergies, dental problems or a family history of anesthesia.

How long does the surgery take?

Laparoscopic Hysterectomy takes 2-3 hours, although it varies from patient to patient. However, it passes in the recovery room after a while.

What happens after the surgery?

  • After the surgery is over, you will be taken to the recovery room, where you will be taken to your bed in the clinic when you wake up completely and your general condition improves.
  • Since the operation is performed under general anesthesia, you may feel tired and sleepy for the first 24 hours. During this time, you will be given painkillers.
  • Also, intravenous fluid and nutritional therapy will be given. In this process, you will have a urinary catheter, so you will not be able to go to the toilet yourself. In addition, some patients have a tube called a "drain" that comes out of the abdomen. All of these are removed the next day.
  • The nurses will tell you when you can eat and drink water. Initially, it is recommended to drink water, warm tea or soup. Plenty of water will be beneficial in the next process. Over time, the appetite will return and you will be able to eat different, favorite things.
  • One of the most common side effects of Laparoscopic Hysterectomy is "shoulder and abdominal pain". This pain and discomfort may persist for several days. It will be beneficial to use the painkillers given to you regularly for 1-2 days when you are discharged.
  • Most patients are discharged 24 hours after surgery. In some cases, this period may be longer.
  • As the intestines work slowly due to surgery, gas may accumulate. This may cause you discomfort or pain. For this reason, it is necessary to get out of bed as soon as possible and walk a lot. Being able to pass gas is a sign of the improvement of bowel functions.
  • There will be 3-5 tiny (0.5-2 cm) incisions on your abdomen and mini bandages over them. There will also be stitches in the vagina, but they will not be visible from the outside and will dissolve on their own. The dressings on your belly are removed the next day and you can take an standing shower. (according to the condition of the sutures, your doctor will tell you the situation of the bath and shower). Do not be afraid of getting your stitches (wounds) wet. However, if it gets wet, you should dry them with clean napkins or let them air dry. If the wound sites are dry and clean, they heal quickly, so wound infection is less common.
  • It is recommended not to engage in sexual activity before 6 weeks.
  • Wash your hands before and after using the toilet. Also, wash your hands before and after touching wounds.
  • You may have slight vaginal bleeding up to 1-2 weeks after the surgery. You should use sanitary pads, never use tampons in this process.

Remember that! The post-operative recovery process is a personal experience.

What can I do to heal faster after Laparoscopic Hysterectomy?

  • Rest a lot in the first days, relax. However, be careful to stay active. You can do light chores inside the house for the first few days. It's okay to climb the stairs the first day you come home from the hospital. Gradually increase your activity each day.
  • Take care of a balanced diet, you should get the nutrients you need. It is recommended that you consume a healthy, high-fiber diet and consume 2 liters of fluid (mostly water) per day.
  • Try to quit smoking. Smoking delays wound healing.

When should I go for a check-up again?

Your doctor will tell you this clearly, but the first check is usually performed between 3-6 weeks. In addition, the pathology result is followed up by your doctor and notified to you. You can remind your doctor about the pathology result in the post-operative period.

What can delay your recovery?

  • If there is a complication in the surgery
  • If you have an additional disease (such as diabetes) before the surgery
  • Smoking
  • Being overweight
  • Sometimes, in laparoscopic surgery, we may have to enlarge the incisions or even revert to open surgery. In this case, your hospital stay may be longer and your recovery period may take 2-3 months.

What are the complications of Laparoscopic Hysterectomy?

There may be situations that we do not want in the surgery from time to time. Every surgery has some degree of risks.

  • Bleeding (bleeding enough to require blood transfusion 1-3%)
  • Vaginal hematoma (intense blood pooling may occur in the vagina): Most resolve spontaneously. It is very rarely necessary to use antibiotics or to reoperate
  • Infection: 10% (Lung, urine, wound site, groin)
  • Blood coagulation (Lung or leg, less than 1/100): It is rarer in people who are active and consume plenty of water. In addition, drugs that prevent blood clotting are used during discharge.
  • Intestinal damage (%2)
  • Urine bladder damage (%1)
  • Ureter (urinary duct) (%1)
  • Vessel and nerve damage (<%1)
  • Necessity of re-operation: There are patients who have had a second operation due to bleeding or other complications and have to have an incision in the abdomen. (%1)
  • Converting from closed technique to open technique during surgery (1-25%)

What are the post-operative emergencies?

  • Redness, swelling in the wounds
  • Burning while urinating
  • Severe vaginal bleeding
  • Swelling in the leg
  • shortness of breath
  • Chest pain
  • Severe abdominal pain
  • Loss of appetite and vomiting
  • High fever

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