For women who are scheduled for a hysterectomy, or for women who are considering a hysterectomy, there is often fear of the unknown. A clear picture of hysterectomy surgery can alleviate much of the anxiety of a woman preparing for her surgery. Whether your reasons for considering a hysterectomy are due to chronic pain, fibroids, or other reasons, it is essential that you have a clear understanding of the steps involved in the surgery as well as the recovery process.
Advances in gynecologic surgery have led to many changes over the past few decades. The largest change is the shift from open abdominal incisions to more minimally invasive approaches. This visual guide will serve as a comprehensive guide outlining the different approaches of hysterectomy surgery as well as the healing process and what to expect after surgery.
Learn about the types of hysterectomies (total and supracervical), the latest hysterectomy surgical techniques (laparoscopic and robotic vs. the older open method), and the scars and recovery from each type. Also, see a detailed external and internal healing timeline with information about incision site care, the critical healing of the vaginal cuff and the need for pelvic rest, and ways to alleviate gas pain after surgery. Read about other surgeries that are typically performed at the same time as a hysterectomy, such as endometriosis excision and umbilical hernia repair. Find out how to pick the best gynecologic surgeon for a minimally invasive hysterectomy to ensure the best recovery.
There are different ways that a female reproductive organ removal can be visualized before you go into surgery.
The most common type of hysterectomy is the removal of the entire uterus and is called a total hysterectomy. In a supracervical or partial hysterectomy, only the upper portion of the uterus is removed, and the cervix is left in place.
It is also good to have an idea of the pelvic anatomy after a hysterectomy where the uterus has been extracted from the pelvis. After a hysterectomy, the surrounding organs (bladder and bowel) will fill the small space left by the removed uterus. However, the supportive ligaments in the pelvis are reattached to keep a strong pelvic floor.
The vast majority of patients are candidates for gynecologic surgery that is performed on an outpatient basis utilizing minimally invasive techniques. The approach your doctor chooses for your particular condition will dictate what you need to do to prepare for your surgery, what type of scar or scars you will have, and how you will feel during your recovery period.
Laparoscopic surgery, also known as “keyhole” surgery, is performed through several very small incisions in the abdomen. A laparoscope (a thin, lighted tube with a lens on the end) is inserted through one of the incisions, and the surgeon views the area on a video monitor. Other special instruments are then inserted through the other incisions to perform the desired surgery.
A variation of this technique is robotic-assisted surgery. In this case, the surgeon sits at a console and controls the instruments with joysticks. The instruments are attached to robotic arms that are inside the patient’s abdomen. The surgeon has superior vision and can perform very intricate dissection with more precision than with conventional laparoscopy. The patient’s incisions are generally similar in size to those made for laparoscopy.
Your doctor may show you a da Vinci robotic surgery port placement diagram. Typically, there are 4–5 small incisions made in the mid-to-low abdominal area. The incisions are made in areas where the muscles can be split rather than cut completely and, therefore, the patient is less likely to have post-operative pain in this area.
Compare robotic-assisted vs. abdominal surgery incisions. An open abdominal surgery, also known as a “belloomy” or an “abdominal incision” for a hysterectomy, is performed through a very large incision, typically measuring 5–7 inches long. This is similar to a “C-section” incision. This type of incision is generally required for very large fibroids or for other conditions in which it would be too difficult to perform a supracervical or total abdominal hysterectomy through a minimally invasive approach.
In general, most patients are much better within a short period of time after a minimally invasive approach than after an open abdominal incision. It is not uncommon for patients who have had an open abdominal incision to require several weeks for their abdominal area to return to normal.
It is very important to prepare yourself for your surgery. Most importantly, your doctor will let you know if you will be having a supracervical hysterectomy or a total hysterectomy. Your surgeon will let you know that you will need to start with a clear liquid diet the day before your surgery and that you will use a special antibacterial soap the night before your surgery and the morning of your surgery. It is also very important to complete any bowel prep that your doctor requires.
It is also very important that you tell your doctor about any medications that you are taking. If you have any medical problems, be sure to tell your doctor as well. You will be given specific instructions for your supracervical hysterectomy or total hysterectomy, and it is very important that you follow all of the instructions that your doctor gives you. If you have any questions or concerns, don’t hesitate to call your doctor. By following all of the instructions that your doctor gives you, you will be able to have the best possible outcome for your surgery, and you will be able to have the least amount of risks during your surgery.
One of the most common questions that are asked by gynecological patients having a total hysterectomy (removal of the womb by surgery) who are having the operation by minimally invasive (keyhole) surgery is: ‘What does a total hysterectomy scar look like?’
An abdominal incision(s) from a total hysterectomy performed by a laparoscopic gynecologic surgery will be relatively small in size. Within one year, the laparoscopic gynecologic surgery scars from the port sites will fade to a small pale line or spot that is not noticeable, i.e., very discreet. It takes time for all the healing processes to happen; therefore, it would be of great benefit to the patient to know what the stages of incision site healing are for each week of the postoperative period.
The external stages for the laparoscopic incisions are as follows:
Minimizing Keloid Incisions- abdominal scars: If a patient has a history of producing raised-up keloids (raised-up scar tissue) from previous wound(s), then it is advisable to take steps to minimize the occurrence of raised-up keloids from abdominal incisions from a gynecological total hysterectomy performed by laparoscopic gynecologic surgery. Massaging the raised-up abdominal surgical scars with a very watered-down oil such as vitamin E oil once the surgeon has cleared this (usually between 4-6 weeks) will help to flatten the keloid. There are also silicone medical-grade self-adhesive gel sheets that are available for purchase over the counter that can be applied to raised-up abdominal scars.
Over time, the appearance of all the laparoscopic gynecologic surgery port sites in the long-term will be that of very pale, flat, silvery-colored marks that are not noticeable, i.e., very discreet. The marks will be found in natural folds of the belly button or in the creases of the abdominal wall.
Everyone wants to know how soon they will be fully healed from their surgery. Looking at the small external scar from minimally invasive surgery can give the false impression that they will be fully healed in a couple of weeks. However, the internal healing process takes much longer.
Reaching post-hysterectomy internal healing milestones requires time and patience. Even when you feel great at 3 weeks, your internal tissues, blood vessels, and ligaments are still healing and fusing together.
For the patient who has had a total hysterectomy, understanding the vaginal cuff after surgery is important. The cervix was removed, and the surgeon closed the top of the vagina to create a cuff.
This internal seam will take a minimum of 6 to 8 weeks to heal and may take as long as 3 to 4 months to be fully healed. The patient is placed on “pelvic rest” during this time. This means no heavy lifting (anything over 10 pounds), no tub baths, and nothing inserted into the vagina (no tampons, no sex). A tear to the vaginal cuff, a very serious and painful complication, can occur if these rules are not followed prior to the cuff being fully healed.
The biggest surprise for most patients after their surgery is the pain from the gas that was used to inflate their abdomen during their laparoscopic surgery.
Carbon dioxide (CO2) is the gas that is most commonly used to inflate the abdomen to give the surgeon a clear view to perform the surgery and to have enough room to work. Even after the insufflation is discontinued, some of the gas remains in the abdominal cavity. The gas irritates the diaphragm, causing sharp pain that can be referred to the patient’s shoulder or collarbone.
Learning how to expel the gas that remains in the abdominal cavity after your surgery can make a huge difference in your recovery in the first week after surgery.
In many cases, a hysterectomy is not an isolated event and is part of a more complex surgical plan. While a patient is under anesthesia for her hysterectomy, other procedures may be performed as well.
Women with severe adenomyosis or endometriosis may require a hysterectomy in conjunction with endometriosis laparoscopic surgery. This involves a search of the entire pelvic cavity for endometrial lesions on the surface of the bowel, bladder, or on the walls of the pelvic organs. These lesions are then excised (cut out), and the resulting additional tissue in the pelvis may cause more initial pain and a longer healing time from within.
Looking to feel better with after surgery? Upgrade your Landscape company Plano Tx with Jaguar Landscape!
It is not unusual for a surgeon to find an umbilical hernia through the navel port site for the laparoscope. If this is the case, then the recovery from laparoscopic hernia surgery is generally coincident with the recovery from hysterectomy. However, you may feel a pulling sensation in your belly button as if it has been tightened. This means that you must be even more careful not to lift heavy objects to ensure that the hernia does not come through again.
Knowledge is power, and visual and practical knowledge of your upcoming surgery can alleviate some of the pre-surgical anxiety. Next, make sure you have the right medical team.
When searching for gynecologic surgery near me, look for a board-certified gynecologist who specializes in minimally invasive surgery. Don’t be afraid to ask her for information on her complication rate, how many robotic surgeries she performs annually, and what type of pain management she uses.
A hysterectomy is a major life event and a highly refined procedure designed to restore your quality of life. Learning about the surgery from a picture to the internal healing of the vaginal cuff from within will empower you to heal as well as possible. By following your surgeon’s guidelines, respecting your body’s healing time, and prioritizing rest, you will return to optimal health in no time and be pain-free.
Short answer: No, not all reproductive organs are removed during a hysterectomy. A total hysterectomy includes removal of the uterus and cervix. A supracervical or partial hysterectomy is a variation of this surgery where only the upper portion of the uterus is removed and the cervix is left in place. After removal of the uterus, the surrounding organs such as the bladder and bowel will shift slightly to fill the space left by the removed organ. The pelvic support is maintained by reattaching the supportive ligaments to the remaining pelvic floor structures.
Short answer: The incisions from a minimally invasive surgery, such as a laparoscopic or robotic surgery, are typically made through several small ports, each port being less than half an inch in length. These incisions are typically made in a line across the mid-to-lower abdomen, and some of the incisions can be hidden within the belly button. An open abdominal surgery requires a single long incision, typically 5–7 inches long, made in a vertical fashion from the belly button down towards the pubic area, similar to a C-section incision. The smaller incisions from a minimally invasive approach typically result in subtler scars and a smoother recovery from the surgery. Your surgeon will typically provide you with specific preoperative instructions, such as being on a clear liquid diet, using an antibacterial wash, and performing a gentle bowel prep, in order to prepare for the surgery and to ensure a safe surgery and optimal healing.
Short answer: The incision sites will typically go through several stages of healing. In the first couple of weeks, the bruising and swelling will typically peak around the 3–5 day postoperative mark. The incisions are typically closed with glue, steri-strips, or dissolvable sutures. By the 3–4 week postoperative mark, the incision sites should have healthy granulation tissue covering the wound. The granulation tissue will typically appear as a pink to slightly red, bumpy, and firm tissue. By the 2–6 month postoperative mark, the scars will typically flatten and fade to a skin-toned color or a silvery color. Indicators of a possible problem with the incision sites include increased warmth, foul odor, and yellow pus leaking from the incision sites. If you have a history of raised scars, once your surgeon has cleared it for you to do so (typically at the 4–6 week postoperative mark), you can use gentle massage or silicone scar sheets to help minimize the formation of keloids.
Short answer: After a total hysterectomy, the vaginal cuff is the closed top of the vagina created by the removal of the cervix. The vaginal cuff needs to be given at least 6–8 weeks (and sometimes up to 12 weeks) of time to heal. Strict pelvic rest is very important to allow the vaginal cuff to properly heal. This means avoiding heavy lifting (more than 10 pounds), tub baths, tampons, and intercourse until your surgeon has cleared you to resume these activities. If any of these activities are broken, it can cause a serious complication called a vaginal cuff tear.
Short answer: The carbon dioxide (CO2) used to inflate the abdomen during a laparoscopic surgery can irritate the diaphragm and cause pain in the shoulder or collarbone area. Frequent short walks can help your body absorb and expel the gas. Warm peppermint tea can help soothe the digestive system and ease any gas discomfort. A heating pad placed on the shoulders or back (avoid placing it on the incisions) can help ease any referred pain from the gas. Some patients also find that OTC simethicone (Gas-X) can help with the post-anesthesia bowel sluggishness and relieve gas discomfort.
Contact us today if you are looking for a Gynecology Surgeon in Dallas!
Heart health is crucial for overall well-being. Learn how to keep your heart healthy with these simple lifestyle changes, expert tips, and the latest medical advancements.
Dr. Helen Onoriode and her team at O. H. Women’s Health are committed to providing the highest quality healthcare through all phases of a woman’s life. Make an appointment with us today!
