Hysterectomy: What to Expect on the Day of Surgery

A hysterectomy is performed when you had a medical condition that makes the removal of the uterus, and cervix necessary. A hysterectomy can be performed in several ways, from a full abdominal surgery to minimally invasive laparoscopic or vaginal methods. The type of surgery you have will depend on your situation, the reason for your hysterectomy and your health history. The decision should be made by you and your healthcare provider. Regardless of the technique, remember a hysterectomy is major surgery and you have to prepare for its impact both physically and emotionally.

Before the Surgery

As with any major surgery, a number of tests will have to be conducted by your healthcare provider in the weeks before your surgery, as well as on the day of. Leading up to the surgery, you and your healthcare provider should discuss the purpose of the surgery, and what technique will be used.

This is a good time to ask questions about the surgery, including what will be done during the surgery, expectations and risks of the procedure, and what to expect after the procedure. Your healthcare provider may make some changes to your medication regimen in the days before your surgery, removing medications that may thin the blood or have other effects that could be harmful during your operation. You will also discuss plans for anesthesia during the procedure, the details of your hospital stay, arrange for transportation from the hospital, and plan for help at home after your surgery.

In addition to routine blood work like a complete blood count (CBC), basic or complete metabolic panel, and coagulation studies, your healthcare provider may also perform the following tests before a hysterectomy:

• Pap test: This can reveal the presence of abnormal cervical cells or cervical cancer, and may change the approach your healthcare provider takes during surgery,
• Endometrial biopsy: Detects endometrial cancer or abnormal cells in the lining of the uterus.
• Pelvic ultrasound: This test can reveal the size of fibroids, polyps, or cysts.

The day before the surgery, your healthcare provider will instruct you when to limit your food and drink and may ask you to shower with a special cleanser to kill bacteria on the surface of your skin and prevent infection. Your healthcare provider may also request that you use a vaginal douche or rectal enema in preparation for your surgery.

On the day of your surgery, you will most likely have additional preoperative blood and urine tests. Your hair will be clipped in the surgical area, and your skin will be cleaned with an antibacterial solution. Your healthcare provider should review the plan for the day, any potential risks or complications that are expected, and what postoperative care is anticipated. One or more intravenous lines will be placed for medication administration during the surgery, and you should receive intravenous fluids and antibiotics to prevent potential infection from the surgery.

During the Surgery

When it’s time to begin your surgery, you will be brought to the operating room and meet your surgical team. This will include your surgeons, an anesthesiologist, and nursing staff.

An anesthesiologist should meet with you before the surgery to discuss their plans for the procedure. Hysterectomies typically use general anesthesia. In general anesthesia, you are not awake, and a breathing tube is placed to help you breathe while staff monitor your vital signs. Regional anesthesia, through an epidural, may also be used. It blocks your pain so that you can stay awake during the procedure. Your healthcare provider should ask you about past experiences with anesthesia and address any potential complications or concerns that you have.

There are many types of hysterectomies, and your healthcare provider will recommend an approach based on your health and reason for the procedure.

• Subtotal, supracervical or partial hysterectomy: The uterus is removed, but the cervix is left intact.
• Total or complete hysterectomy: The uterus and cervix are both completely removed.
• Total hysterectomy plus unilateral salpingo-oophorectomy: The uterus and cervix are removed completely. One fallopian tube and one ovary are removed as well, and one fallopian tube and one ovary are left intact. This is done when at least one ovary is healthy, and allows your body to continue making females hormones. Continued hormone production delays the early onset of menopause that could result from a hysterectomy.
• Total hysterectomy plus bilateral salpingo-oophorectomy: The uterus, cervix, both fallopian tubes, and both ovaries are removed completely. Menopause will occur after this surgery is you have not already reached menopause.
• Radical hysterectomy: The uterus, cervix, both fallopian tubes, both ovaries, and lymph nodes in the pelvis are all completely removed. This procedure is most often done when a hysterectomy is performed to treat gynecological cancers.

In addition to the type of hysterectomy, your healthcare provider will also choose a technique for your surgery. Roughly half of hysterectomies today are done laparoscopically or robotically using minimally invasive tools, which uses cameras and instruments inserted through small cuts to perform the surgery. In laparoscopic hysterectomies, the uterus is removed through the vagina in fragments through small abdominal incisions. Your surgeon may also elect to perform an abdominal hysterectomy, where the uterus is removed through a cut in the abdomen. Hysterectomies can be performed completely vaginally, as well, through a small cut in the vagina instead of the abdomen. About 20% of hysterectomies are done this way, and recovery time is much faster than in traditional techniques.

The total surgery time for a hysterectomy is around one to three hours. It will begin with anesthesia—and the placement of a breathing tube is you are going under general anesthesia—and the insertion of a urinary catheter, as well as cleansing of the surgical area. The next steps will depend on the type of hysterectomy you are having.

• Abdominal hysterectomy: Surgeons will make a 5- to 7-inch incision vertically or along the bikini line in your abdomen. The blood vessels and structures supporting the uterus will be detached, and the uterus is removed through the incision. The incision will then be closed with staples, sutures, or surgical adhesive.
• Laparoscopic hysterectomy: Three to four small incisions are made in the abdomen and surgical instruments and a camera are inserted. These tools are used to detach the blood vessels and support of the uterus and other structures that will be removed. The uterus and other structures are either taken out in pieces through small incisions or through the vagina. At the end of the surgery, the small incisions are closed with sutures or surgical adhesive.
• Vaginal hysterectomy: In this procedure, a small incision is made in the upper part of the vagina, and sterile instruments are used to detach the uterus from blood vessels and support structures.

After the Surgery

After surgery, you will be taken to a recovery area, where your vital signs will be monitored and your breathing tube should be removed. You will be monitored for pain and medicated as needed. When you are in a stable recovery phase, you will be moved from the recovery area to a hospital room, where you will likely be monitored for a day or two. You will need to use sanitary pads to manage vaginal bleeding and discharge, which typically last several days to a few weeks after a hysterectomy.

Your healthcare provider will give you instructions about incision care, and the type of material used to close the surgical incision will dictate bathing and hygiene practices. Surgical staples will need to be removed by your healthcare provider, as well as some types of sutures.

After surgery, your recovery will depend largely on your body’s awakening after anesthesia, your pain level, any other physical complications from the surgery or anesthesia, and your ability to complete your activities of daily living (ADLs). You will be allowed to move from liquid to solid foods based on your bowel activity, as your digestion can sometimes take some time to wake up after surgery. When you can eat, eliminate your bladder and bowels, and perform your own basic care, your team will begin planning your discharge.

Post-Operative Care

When you are ready to leave the hospital, you should have someone to take you home and help care for you. Your medical team will review your medication list, any new prescriptions, and your post-operative care instructions. These may include:

• Incisional care
• Instructions for bed rest or limited activity
• Lifting restrictions—nothing heavier than 10 pounds for four to six weeks
• Exercise restrictions—normal exercise after about four weeks
• Avoiding sexual activity for about six weeks

Follow-Up

Before you leave the hospital, your healthcare provider should schedule a follow-up visit, check your incision, and review any complications you may be having. Some complications from a hysterectomy may include:

• Post-operative blood clots called deep vein thrombosis
• Excessive bleeding
• Infection
• Bowel or bladder injuries
• Injuries to nerves within the pelvic area from surgery

Signs of Complications

While there are normal discomforts over the course of recovery, there could be several signs that you are experiencing abnormal complications or infection. Your healthcare provider should instruct you to call if you experience:

• A fever of 100 degrees Fahrenheit or higher
• Bright red vaginal bleeding
• Bleeding, discharge, or swelling at your incision site
• An opening at your incision site (dehiscence)
• Difficulty urinating or having bowel movements
• Increasing pain
• Intense feelings of sadness or depression
• Nausea, vomiting, or abdominal pain
• Pain during intercourse, once you have gotten the OK to resume normal activity.

A Word From Verywell

Recovery is not the end of the changes you will experience following a hysterectomy. If you had not reached menopause already, you will likely enter this process after your hysterectomy. This depends on whether you retained your ovaries after your hysterectomy or not. You will no longer have menstrual periods or be able to become pregnant. If your cervix was left in place after your hysterectomy, you will have to continue with regular Pap smears to monitor for cervical cancer.

You may experience some bloating and discomfort similar to menstrual pain for some time after your surgery, and light bleeding or brown discharge can continue for up to a year after surgery. While you will likely have relief from the symptoms that led you to have a hysterectomy, it is not uncommon to experience depression or sadness from the loss of fertility and hormonal changes that can come after a hysterectomy. You should consult your healthcare provider if your physical or emotional symptoms become overwhelming or difficult to manage.