This guide will help you get ready for your robotic-assisted or laparoscopic hysterectomy at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery. Show
Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your healthcare team will refer to it as you learn more about your recovery. Back to topAbout Your SurgeryA hysterectomy (HIS-teh-REK-toh-mee) is a surgery to remove your uterus. You may be having a hysterectomy because you have:
Your healthcare provider will talk with you about why you’re having the surgery. About your reproductive systemYour reproductive system includes your ovaries, fallopian tubes, uterus, cervix, and vagina (see Figure 1). Your uterus is in your lower abdomen (belly) between your bladder and rectum. The lower narrow end of your uterus is called your cervix. Your ovaries and fallopian tubes are attached to your uterus. After your hysterectomy, you won’t be able to have children naturally. You’ll also stop menstruating (getting your monthly period). A hysterectomy doesn’t cause menopause unless your ovaries are removed. If you want to have biological children in the future, ask your healthcare provider for a referral to a fertility specialist. Figure 1. Your reproductive system Robotic-assisted or laparoscopic hysterectomyYou’ll have either a robotic-assisted or a laparoscopic hysterectomy. With both types of hysterectomies, your surgeon will make several small incisions (surgical cuts) on your abdomen. They’ll put a laparoscope (long, thin surgical tool with a video camera) through one of the incisions into your abdomen. The laparoscope lets your surgeon see the inside of your abdomen. Carbon dioxide gas will be pumped into your abdomen to make space. This gives your surgeon more room to do your surgery. Your surgeon will also put long, skinny surgical tools into the other incisions on your abdomen.
With both types of hysterectomies, your surgeon will remove your uterus and cervix through your vagina, if possible. If your uterus or cervix can’t be removed through your vagina, your surgeon will make one of your incisions bigger and remove your uterus and cervix from there. Then they’ll close your incisions with sutures (stitches). You might also have one or both of the following procedures during your hysterectomy. Your surgeon will talk with you about the plan for your specific surgery. Salpingo-oophorectomyA salpingo-oophorectomy (sal-PIN-goh-oh-oh-foh-REK-toh-mee) is a surgery to remove your ovary and fallopian tube on 1 or both sides of your body. If you haven’t started menopause, you’ll go into menopause if both of your ovaries are removed. You may have some of the common symptoms, including night sweats, hot flashes, and vaginal dryness. Talk with your healthcare provider about ways to manage these symptoms. If you’ve already gone through menopause, you shouldn’t notice any changes. Sentinel lymph node mapping and lymph node dissectionLymph nodes are small, bean-shaped glands that make and store the cells that help your body fight infections. Lymph nodes are found throughout your body. Sentinel lymph nodes are the lymph nodes most likely to be affected if you have cancer and it has spread. If your surgeon thinks you may have cancer, they may do sentinel lymph node mapping and remove some of your lymph nodes during your surgery. This is called a lymph node dissection. For sentinel lymph node mapping, your surgeon will inject a small amount of dye in the area where the cancer may be. They’ll talk with you about the type of dye they’ll use. This dye will travel to the sentinel lymph node(s) and turn them blue or green. Once the sentinel node(s) are located, your surgeon will make a small incision. They’ll remove the sentinel node(s) and send them to the Pathology Department to be checked for cancer cells. Back to topGetting Ready for Your SurgeryThis section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready. As you read through this section, write down questions to ask your healthcare provider. Getting Ready for SurgeryYou and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you’re not sure.
About Drinking AlcoholThe amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
Here are things you can do before your surgery to keep from having problems:
About SmokingIf you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507. About Sleep ApneaSleep apnea is a common breathing problem. It causes you to stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep. OSA can cause serious problems during and after a procedure. Please tell us if you have or think you might have sleep apnea. If you use a breathing device (such as a CPAP machine), bring it on the day of your procedure. Using MyMSKMyMSK (my.mskcc.org) is your MSK patient portal account. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care. If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office. For help, watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593. Within 30 days of your surgeryPresurgical Testing (PST)You’ll have a PST appointment before your surgery. The date, time, and location will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your appointment. It’s helpful to bring these things to your appointment:
During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care. Examples are:
Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery. Identify Your CaregiverYour caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home. For Caregivers Caring for a person going through cancer treatment comes with many responsibilities. MSK offers resources and support to help you manage them. For information, visit www.mskcc.org/caregivers or read A Guide for Caregivers. Arrange for Someone to Take You HomeYou must have a responsible care partner take you home after your surgery. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your surgery. If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you. Complete a Health Care Proxy FormIf you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment. A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.
Do breathing and coughing exercisesPractice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read How To Use Your Incentive Spirometer. ExerciseExercising will help your body get into its best condition for your surgery and make your recovery faster and easier. Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center. Follow a Healthy DietFollow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist. Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®), if neededYour nurse will tell you if you need to wash with a 4% CHG solution antiseptic skin cleanser before your surgery. Follow their instructions. 4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription. 7 days before your surgeryFollow Your Healthcare Provider’s Instructions for Taking AspirinIf you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to. For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E. Stop Taking Vitamin E, Multivitamins, Herbal Remedies, and Other Dietary SupplementsStop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. If your healthcare provider gives you other instructions, follow those instead. For more information, read Herbal Remedies and Cancer Treatment. 2 days before your surgeryStop Taking Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. NSAIDs can cause bleeding. If your healthcare provider gives you other instructions, follow those instead. For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E. 1 day before your surgeryNote the Time of Your SurgeryA staff member from the Admitting Office will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014. The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go. Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens), if neededIf your healthcare provider told you to, shower using a 4% CHG solution antiseptic skin cleanser the night before your surgery.
Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower. Instructions for Eating Before Your Surgery The morning of your surgeryInstructions for Drinking Before Your Surgery You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else. Do not drink anything starting 2 hours before your scheduled arrival time. This includes water. Take Your Medications As InstructedA member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications. Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens), if neededIf your healthcare provider told you to, shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower. Things to remember
What to bring
Once you’re in the hospitalStaff members will ask you to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day. When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear. Meet with a nurseYou’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (including prescription and over-the-counter medications, patches, and creams) and the time you took them. Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it in the operating room. Meet with an anesthesiologistYou’ll also meet with an anesthesiologist before surgery. They will:
Get ready for your surgeryWhen it’s time for your surgery, you’ll need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles, if you have them. You’ll either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed and place compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs. You may also have a blood pressure cuff and EKG pads to monitor you during your surgery. Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery. During your surgeryAfter you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. A urinary (Foley) catheter will also be placed to drain urine (pee) from your bladder. Once your surgery is finished, your surgeon will close your incisions with sutures and cover them with Steri-Strips™ (thin pieces of surgical tape) or Dermabond® (surgical glue). They may also cover them with a dry, square, white dressing (bandage) called a Primapore® dressing. Your breathing tube is usually taken out while you’re still in the operating room. Back to topRecovering After Your SurgeryThis section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home. As you read through this section, write down questions to ask your healthcare provider. In the Post-Anesthesia Care Unit (PACU) or your recovery roomWhen you wake up after your surgery, you’ll be in the PACU or your recovery room. A nurse will be keeping track of your body temperature, blood pressure, pulse, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose. You’ll also have compression boots on your lower legs. You may have a urinary catheter in your bladder to help keep track of how much urine (pee) you’re making. If you do, it should be removed before you go home. Managing your painYou’ll get pain medication through your IV line or as a tablet that you swallow. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications. Moving around and walkingMoving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse or physical therapist will help you move around, if needed. Read the resource Call! Don't Fall! to learn what you can do to stay safe and keep from falling while you’re in the hospital. Using your incentive spirometerUse your incentive spirometer 10 times every hour you’re awake. This will help your lungs expand fully, which helps prevent pneumonia. For more information, read the resource How To Use Your Incentive Spirometer. Leaving the hospitalBefore you leave, look at your incisions with one of your healthcare providers. Knowing what they look like will help you notice any changes later. Most people don’t need any supplies after surgery. If you do, such as if you’re leaving the hospital with tubes or drains, your nurse will order them for you. Before you leave, your healthcare provider will write your discharge order and prescriptions. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave. At homeFilling out your Recovery TrackerWe want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker. Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes. Your answers to these questions will help us understand how you’re feeling and what you need. Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read About Your Recovery Tracker. Eating and drinkingYou’ll be able to eat after your surgery. Start with foods that are soft and easy to digest, such as applesauce and chicken noodle soup. Eat small meals often. Then start adding your regular foods to your diet. If you have bloating, gas, or cramps, limit high-fiber foods, such as:
Managing your painYou’ll have some pain after your surgery, especially in the first few days. The length of time each person has pain or discomfort varies. Follow these guidelines to help manage your pain at home.
It’s 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 your healthcare provider gave you. Preventing and managing constipationSome prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual). Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.
If any of these medications cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if needed. If you haven’t had a bowel movement in 2 days, call your healthcare provider. Caring for your incisionsYou’ll have several small incisions on your abdomen. They’ll be closed with Steri-Strips or Dermabond. They may also be covered with square white Primapore dressings.
Don’t get your incisions wet for the first 24 hours (1 day) after your surgery. After that, clean them with soap and water in the shower every day. ShoweringDon’t shower for the first 24 hours after your surgery. After that, take a shower every day to clean your incisions. Taking a warm shower is also relaxing and can help muscle aches. During your shower, use soap to gently wash your incisions. After your shower, pat the areas dry with a clean towel and leave your incisions uncovered (unless there’s drainage). Call your healthcare provider if you see any redness or drainage from your incision. Don’t take tub baths until you talk with your healthcare provider at your first appointment after your surgery. Managing vaginal spotting or bleedingIt’s common to have some vaginal spotting or light bleeding after surgery. Use a pad or a panty liner so you can see how much you’re spotting or bleeding. Don’t use a tampon. If you have heavy bleeding (you’re bleeding through a pad or liner every 1 to 2 hours), call your healthcare provider right away. Sexual activityDon’t put anything in your vagina or have vaginal intercourse (sex) for 8 weeks after your surgery. Some people will need to wait longer than 8 weeks, so speak with your healthcare provider before starting to have vaginal sex again. Driving and travelingYou can start driving again 2 weeks after surgery as long as you aren’t taking pain medication that may make you drowsy. It’s OK to travel after your surgery. If you’re 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. Going back to workMost people can return to work about 2 to 4 weeks after the surgery. Talk with your healthcare provider about your job and when it may be safe for you to start working again. 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. Physical activity and exerciseDon’t lift anything heavier than 10 pounds (4.5 kilograms) for at least 4 weeks after surgery. Speak with your healthcare provider about when you can do heavy lifting. Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your healthcare provider before starting more strenuous exercises. Managing your feelingsAfter surgery for a serious illness, you may have new and upsetting feelings. Many people 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. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200. The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness. Follow-up appointments after surgeryYour first appointment after surgery will be 2 to 4 weeks after surgery. Your nurse will give you instructions on how to make this appointment, including the phone number to call. When to call your healthcare providerCall your healthcare provider if:
Contact informationMonday through Friday from 9:00 a.m. to 5:00 p.m., call your healthcare provider’s office. After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider. Back to topSupport ServicesThis section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery. As you read through this section, write down questions to ask your healthcare provider. MSK Support ServicesVisit the Cancer Types section of MSK’s website at www.mskcc.org/types for more information. Admitting Office Anesthesia Blood Donor Room Bobst International
Center Caregivers
Clinic Counseling
Center Female
Sexual Medicine & Women’s Health Program Food Pantry Program Integrative Medicine
Service You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550. Male Sexual and Reproductive Medicine Program MSK
Library Nutrition Services Patient and Caregiver Education Patient and Caregiver Peer Support
Program Patient
Billing Patient Representative Office Perioperative Nurse
Liaison Private Duty Nurses and Companions Resources for Life After Cancer (RLAC) Program This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues. Social
Work Our social workers can also help refer you to community agencies and programs. They also have information about financial resources, if you’re having trouble paying your bills. Spiritual Care MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call. Tobacco Treatment
Program Virtual Programs Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register. External support servicesAccess-A-Ride Air Charity
Network American Cancer Society (ACS) Cancer and Careers CancerCare Cancer Support Community Caregiver Action
Network Corporate Angel Network Gilda’s Club Good
Days Healthwell
Foundation Joe’s House LGBT Cancer Project LIVESTRONG Fertility
Look Good Feel Better
Program National Cancer
Institute National Cancer Legal Services Network National LGBT Cancer Network Needy Meds NYRx Partnership
for Prescription Assistance Patient Access Network Foundation Patient Advocate Foundation RxHope Educational ResourcesThis section has the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery. As you read through these resources, write down questions to ask your healthcare provider.
For information about lymphedema, you can also read the New York State Department of Health’s resource Understanding Lymphedema. Back to topHow long does it take to heal from robotic laparoscopic hysterectomy?Recovery after robotic hysterectomy is shorter and less painful than after an abdominal hysterectomy. A full recovery might take three to four weeks. Even if you feel recovered, don't lift anything heavy — more than 20 pounds (9.1 kilograms) — or have vaginal intercourse until six weeks after surgery.
How long is a robotic hysterectomy with bilateral salpingectomy?Surgery time may range from 3 to 4 hours. This is what may happen during the surgery: Three or 4 small incisions are made near your belly button.
What is a total abdominal hysterectomy with bilateral salpingectomy?In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed.
How long do you stay in the hospital after a robotic hysterectomy?Following the procedure, patients can expect to spend about 2 – 4 nights in the hospital, depending on the extent of their procedure and their postoperative progress.
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