NORTH SHORE MEDICAL CENTER

Center for Minimally Invasive Gynecologic Surgery

Post operative instructions for laparoscopic hysterectomy

Please read this carefully BEFORE your surgery.

North Shore Medical Center’s Minimally Invasive Gynecologic Surgery Program is

committed to ensuring that your post-operative experience is as comfortable as possible.

Please do not hesitate to call our office for any questions after your surgery.

The following information will help answer frequently asked questions and will help you

understand some of the common experiences that may occur after your surgery.

Please note that most patients have very few complications after surgery.

All patients should:

A. Schedule a post operative appointment for two to four weeks after your surgery.

B. Contact your gynecology surgeon if you experience any concerns or

complications after surgery. Do NOT call your primary care physician. They do

not know what specific surgery was performed, and will not be able to help you.

C. If an Emergency Room visit is necessary after your stay, always return to NSMC

where your surgery was performed. Returning to a local hospital may be

convenient, but many smaller local facilities will not be able to adequately care

for you, resulting in inadequate care. In addition, the physicians at North Shore

Medical Center may not have privileges at these hospitals, and will not be able to

take care of you should you require additional care.

What to expect immediately after surgery:

Activity

There are no standard limitations with regard to activity after laparoscopic procedures

except for driving and sexual activity (see below). In general, use common sense when

deciding what activities you are willing to perform after surgery. Every patient is

different, and different patients will have differing degrees of recovery. Gradually

advance your activity. You should NOT be bedridden after these procedures.

Continued movement and increased activity back to normal will prevent prolonged

recovery times due to “detraining”.

Average Recovery Times

About 90% of patients leave the hospital the same day, and 10% will stay overnight,

usually due to nausea or pain. The average time back to work is 7-10 days for

laparoscopy, and about two weeks for laparoscopic hysterectomy. You should be able to

walk, eat and drink the day after the surgery with mild to moderate discomfort. Please

note that every patient and procedure is different, and the times stated above can vary

from patient to patient.

Stairs

You are allowed to use the stairs if you feel able.

Lifting

There are no restrictions for those patients with 5 or 10 mm incisions. For larger

incisions, use caution immediately after surgery. Start with no more than 15 pounds.

Exercise

Gentle exercise is highly encouraged after surgery because it allows for faster return to

normal function, and also helps with pain (exercise causes release of natural pain

relieving compounds in your body). Use common sense when starting an exercise

routine after surgery.

Abdominal exercises

You may resume these exercises when you feel comfortable.

Cardio exercises

Start out slowly and gradually increase time, distance and speed. If you are starting a

new routine, consult your internal medicine physician if you have medical conditions

affecting your heart or lungs.

Driving

Driving can begin only after you have stopped taking narcotics, and if you feel strong

enough to be able to stop the vehicle in an emergency. Use common sense when you

begin driving after your surgery – if you are not confident about your driving ability, have

someone else drive for you.

Sexual Function

Sexual intercourse should not be engaged in for eight weeks after hysterectomy

type procedures. After eight weeks, deep penetration should be avoided for the first

several times to prevent injury to the vaginal cuff. After eight weeks, you should be

cleared to resume pre-hysterectomy sexual activities.

Bathing/Showering

You may take a shower the day after surgery. Tub baths should be avoided until your

incisions are healed.

Bleeding

Incisions

NSMC physicians use surgical grade glue, or Demabond © on the incision sites. This

protects the incision and will stay in place for up to two weeks or longer. The glue can

be removed by using soap and water and gentle scrubbing with a washcloth in the

shower or bath after two weeks. The glue contains an antibiotic which helps to prevent

infection. Bleeding at the incision sites is not uncommon. This can be from the incision

itself, or may be a light red-colored discharge from the adhesive barrier fluid. Please

note that at NSMC an adhesion barrier fluid called Adept is often used to prevent the

development of adhesions. To be effective, 500 to 750 cc of fluid (2 to 3 cups) is often

left inside the prevent adhesion formation. This can leak out from the incisions, often

appears to be light red, and is a normal process. If bleeding persists for more than two –

three days or is heavy, please call the office.

Vaginal

Vaginal bleeding or spotting can last up to six weeks, and is usually light. This is from

the normal healing process at the vaginal cuff. If bleeding becomes heavy, please

inform the office immediately. Bleeding that fills a pad in an hour is heavy bleeding.

Urinary or Rectal

Call the office for any burning on urination, or rectal bleeding.

Bruising

Incision

Some patients will develop bruises at the incision sites. The incision sites are made by

“trocars,” a plastic sleeve that is used for access during the surgery for the camera and

other instruments. Sometimes these trocars cut tiny vessels just beneath the skin that

cause limited bleeding. Even under the best of circumstances, it is sometimes

impossible to see these small vessels. A bruise will develop that will resolve. Those

patients with very large masses of fibroids may also develop bleeding at the incisions

that can be more extensive due to longer manipulations of the trocar sites. Rarely, this

bleeding can be extensive, leading to a large bruise that tracts to the groin area. Please

note that this type of bleeding almost always resolves. Pain or warmth may develop

from the blood under the skin. Use Motrin 600mg every six hours or 800 mg every eight

hours to relieve the pain.

Constipation

Percocet, Vicodin, Tylenol 3, Dilaudid, Morphine, or any other narcotic will cause

constipation that can be very severe. Pain medications such as IV morphine are often

given directly after surgery in the recovery room. Because of this, you may develop

constipation even though you never took any oral narcotic pain med (many patients do

not need these after surgery). To prevent constipation, use a good laxative such as milk

of magnesia, mineral oil, or other laxatives that work for you.

Colace is generally not

very effective, although percolace works somewhat better. Remember that the more

narcotics you use, the more constipation you can expect. The more constipation, the

more pain, and the more narcotics you will require. This is a vicious cycle that can lead

to severe constipation. Our recommendation is to start using laxatives immediately

after surgery for at least three days to ensure that constipation does not develop.

Milk of magnesia twice a day for three days is usually quite helpful.

Incisions

5 mm incisions (¼ inch)

These incisions heal well, but can develop small infections, bruising or bleeding.

10 mm incisions (3/4 inch)

These incisions are used to remove fibroids or ovarian masses. Please note that due to

the increased size of the incision, it is common to have more pain, bleeding or bruising

with these incisions.

4 to 5 cm incisions (2 to 2.5 inch)

These incisions are located above the pubic bone, and are usually used for removal of

extremely large fibroids. Occasionally fluid collections develop under these incisions.

For any incision, if pain, bleeding, infection, or other problems persist, please call

your gynecologic surgeons office immediately.

All incisions are closed with absorbable sutures (which will dissolve on their own) and

there is no need for removal. Incisions are then covered with glue.

Infections

Please note that hysterectomy type procedures are described as “clean-contaminated.”

This means that the procedure can be complicated by infection from the vagina. The

cervix is attached to the vagina, and removal of the uterus either with or without the

cervix increases the risk of infection due to bacteria within the vagina. If your

temperature at home is recorded at higher than 100.4, please call your gynecologic

surgeons office immediately. Some of the more common types of infections that can

occur after surgery are listed below.

Vaginal

Rarely, patients will develop a mild infection at the top of the vagina called a cellulitis or

vaginal cuff infection. An antibiotic will be given to you right before your surgery in order

to decrease this risk.

Urinary Tract

These infections are relatively common after surgery due to catheterization of the

bladder. You may not even know that you have been catheterized, since the catheter is

placed while you are asleep and sometimes removed before you awake. If you notice

frequent urination, painful urination or burning with urination, please call the

office immediately.

Incision

Infections to the skin also can occur, but are usually minor. Most of these infections can

be treated with a topical antibiotic cream you can buy at the drug store. If the incision

area appears very red or is large, call the office. Note that the antibiotic Cipro is

relatively effective against many causes of skin infections.

Lung

If shortness of breath develops after your surgery, please call the office

immediately. Rarely, infection such as pneumonia or clots traveling to the lungs can

cause these symptoms. It is not unusual to have mild pain on taking a big breath after

laparoscopy, and this should improve within 2 – 3 days.

Nausea

Anesthesia

Anesthesia is the main cause for nausea immediately after surgery. Anti-nausea

medications are given after the procedure to prevent this. Some patients will experience

nausea after the operation regardless. Although some patients will require admission

due to nausea, it will resolve within 12 to 24 hours.

Constipation

Constipation is a major cause of nausea. Prevention by using a good laxative after

surgery will prevent this (see Constipation above).

Pain

Incision

Pain around the incision sites is not uncommon, and will resolve over several days.

Most patients describe pain as minimal or moderate, and will improve daily.

Pelvic and Rectal

Some patients describe pressure and pain with urination or with bowel movements.

These symptoms resolve and are due to irritation to the rectum and bladder from the

surgical procedure, and will resolve with time.

Chest and shoulder

The carbon dioxide gas used to inflate the abdomen during the procedure (so the

surgeon can see) will irritate the phrenic nerve in some patients, leading to mild to

severe pain. This nerve tracks pain impulses from the lining of the chest cavity. The

pain can occur during deep breaths. This resolves within 24 to 48 hours, and is not

worrisome. If the pain is extreme or does not resolve, a visit to the NSMC ER is

important to rule out other causes of chest pain, such as heart or lung issues.

Pain should resolve over time, and will get better every day. Overall pain in patients with

laparoscopy is mild to moderate, and lasts for only four to seven days. If pain persists

or becomes worse, a visit to the NSMC ER at the hospital where the procedure

was performed is recommended.

Pain Medications

You will be given a prescription for Motrin prior to surgery (start Motrin after surgery) and

a narcotic (Percocet, Tylenol 3, or Vicodin) at the hospital prior to your discharge. To be

effective Motrin should be used in doses of 600 mg every 6 hours, or 800 mg every 8

hours. Narcotics should be used sparingly since they will cause constipation. The first

several days following surgery, most patients use mainly Motrin or Extra Strength

Tylenol during the day, with use of a narcotic sometimes at night to help with sleep.

Swelling

Abdominal

Some degree of abdominal distension (swelling) is to be expected after surgery. This is

due to distension of the intestines, and resolves over time. It is usually mild to moderate

only.

Extremities

Swelling of the legs and sometimes arms is not uncommon after surgery. This is due to

increased fluid given during the procedure. This will resolve over several days. If you

notice persistent or increasing swelling, tenderness to the calf or calf pain, please

call the office immediately.

Urinary Retention

Urinary retention is the inability to pass urine through the bladder. A very small number

of patients will develop this problem due to the anesthetic used for the surgery. Most

patients will have their bladder catheter removed immediately after the surgery. If you

are sent home and are not able to pass urine, please go to the NSMC emergency

room.

A catheter will be placed to allow the bladder to “rest” after the surgery, and will

be removed several days later in the office. It is important to have the catheter placed to

avoid injury to the bladder.