Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

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1 Gynaecology Services Laparoscopic Assisted Vaginal Hysterectomy (LAVH) Information you may find useful before your admission If you need this information in another format or language Further information about the Trust is available on the following websites: KGH - NHS Choices - Ref: PI 348 May 2015 Review: February 2017

2 Why do I need a hysterectomy? The reasons for a woman needing a hysterectomy are varied. On occasions, a hysterectomy is the preferred treatment option but it is only advised after all other medical and surgical options for menstrual problems have been tried. These other options should have been discussed with you at your outpatient appointment. If this is not the case then please contact your consultant. Reasons for a hysterectomy include the presence of fibroids, ovarian cysts, endometriosis and persistent heavy bleeding and pain, which have not responded to other forms of treatment. What are the alternative for a hysterectomy? The womb (uterus) can be removed through the abdomen, using a cut just above the pubic hairline. This is called an abdominal hysterectomy. Alternatively it can be removed through the vagina. This is called a vaginal hysterectomy. A vaginal hysterectomy avoids the need for an abdominal cut, but it is not always possible to proceed this way if there is no prolapse. However the use of instruments through 3 or 4 small cuts in the abdomen can result in the operation being completed vaginally rather than through the abdomen. What is a laparoscopic assisted vaginal hysterectomy (LAVH)? An LAVH is an operation to remove the womb through the vagina, with the aid of small cuts in the abdomen. If the ovaries are to be removed at the same time then this can be incorporated within the LAVH procedure. What does it involve? An LAVH normally takes place using a general anaesthetic. A small instrument called a laparoscope is passed through an incision just below the belly button. Two or three further small cuts are made in the lower abdomen, just above the pubic hairline. Through these cuts the specialised instruments are passed. These are used to free the womb and ovaries from their supports in the abdomen. The womb is then removed through the vagina. What are the benefits of a LAVH? Not only should the operation ensure you have relief from the symptoms that you have been experiencing, but the recovery from a laparosopic assisted vaginal hysterectomy is usually quicker and often less painful than that of a traditional hysterectomy. This results in a shorter stay in hospital (2 or 3 days) and an earlier return to normal activities. On average this is approximately 2 weeks sooner than a normal hysterectomy

3 What are the risks of the operation? All operations carry a small risk. However specific complications that may occur during this operation include heavy blood loss and damage to other organs that are close to the womb. These include the bladder, bowel and ureters. Compared to an abdominal hysterectomy, there is a slightly higher risk of urinary tract injury and of severe bleeding. However there is no significant difference in the incidence of bowel injury between either types of hysterectomy. It may not always be possible to complete the procedure through the vaginal route, either due to technical difficulties or other problems and then it would be necessary to complete the operation using a bikini line cut in the lower abdomen. This would then mean that the hysterectomy would be completed through the abdomen. Please be aware that if it has been necessary to make a bikini line cut in your abdomen, you will need to stay in hospital for longer than normal and that recovery at home will take longer. Risks of the anaesthetic Please read the leaflet You and your anaesthetic that you will have been given. Preparing for your operation Approximately 2-3 weeks before coming into the hospital you will receive your admission details. You will also receive an appointment to attend the pre-operative assessment clinic. At this clinic you will see the pre-operative assessment nurse. Your operation, care while in hospital and the care you will need when you go home, will be discussed with you. It also gives the staff the opportunity to answer any questions you may have. Any tests that are required prior to your operation will be arranged/performed, including any specific tests your consultant has requested. This appointment should last approximately 1-2 hours. It is important that you keep this appointment as your operation could be cancelled if you do not attend. About the ward Maple Ward is on the first floor of Rockingham Wing. It consists of 2 four bedded bays and 9 single rooms. Maple Ward is managed in teams and you will be allocated a bed in one of these teams and will be looked after during your stay by the nurses from that team. This ensures good continuous quality of care for patients

4 Do I need to make any arrangements before coming into hospital? Arrange for a responsible adult over the age of 18 years to come to the ward to collect you and accompany you home in a car or taxi; Do not arrange to go home alone or by public transport; Be aware that you will need an adult with you at least overnight for the first few days after your operation; Make provision for enough time off work, depending upon your job and advice from your consultant. On the day of admission On the day you are due to be admitted to the ward, you are asked to contact the ward to ensure a bed is available for you. Occasionally, when the ward is very busy you may be asked to telephone again later in the day. The staff will do everything they can to ensure your admission. However, sometimes it is necessary to cancel an admission due to a bed not being available. If this occurs then you will be contacted by the waiting list officer and offered another date as soon as possible. Preparing for admission Please follow these guidelines: If you are being admitted on the day prior to your operation, this is usually around 2pm. Before you come into hospital you may eat and drink as you normally would. After your admission, staff on the ward will advise you when you need to stop eating and drinking. Alternatively, you may have been asked to come into hospital for your operation on the morning/day of your operation. If this is the case, please follow the instructions below. For 7.30am admissions: After midnight do not eat or drink anything before your admission except small amounts of water After 6am do not have anything to eat or drink at all If you are due to take any medication on the morning of your admission then do so using as little water as possible

5 For (Midday) admissions Have a light breakfast no later than 7.30am (toast and a hot drink) Between 7.30am and 11am do not have anything to eat or drink apart from small amounts of water if necessary. After 11.00am do not have anything to eat or drink. If you are due to take any medication on the morning of your admission then do so using as little water as possible. Please do not have any chewing gum or sweets on the day of your admission as they can cause a build-up of acid in your stomach and may lead to your operation being cancelled. What do I need to bring in with me? This is a suggestion of the things that you may need for your stay in hospital Nightwear (either pyjamas or nightdress) and slippers; Dressing gown. It can get quite warm on the ward so you might prefer a lightweight dressing gown rather than a thick one; Toiletries: Hairbrush/comb, shampoo and shower gel etc Hand and bath towels; Clean underwear. It is advised that bigger pants are more comfortable at least during your hospital stay; A pack of sanitary towels. These do not need to be large thick ones; Change for the telephone; Books/magazines. Please bring any regular medication, in the original containers, and hand them to the nurse on your admission to the ward. Some ladies prefer to dress once they are able to be up and about. The ward staff encourage this. Please ensure the clothes are comfortable and loose fitting. All jewellery, including body piercing and tongue studs will need to be removed prior to going for your operation. However, you may keep your wedding ring on if you wish and the nurse will cover this with tape for you. Please remove all make up, nail varnish and/or false nails prior to admission, as the condition of your nail beds is used to assess your recovery from anaesthetic. Please do not bring anything electrical with you. Electrical equipment needs to be safety checked use. There is a hairdryer available for your use on the ward. Please do not bring any large amounts of cash or valuables into hospital. Unless you have handed any valuables to the ward staff to deposit in the hospital safe and have received a receipt for them, you will be responsible for their safety

6 If you are uncertain about anything please do not hesitate to contact the ward or the preoperative assessment nurses and they will be able to advise you. Smoking You are advised not to smoke on the day of your operation. Nicotine, anaesthetic gasses and strong painkillers do not mix well. Smoking, including vapping, is not allowed in the hospital or grounds. If you think this will cause you a problem while on the ward, please see your GP prior to your admission in order to obtain some help and advice (such as nicotine patches) On admission On arriving on the ward you will be greeted by a member of the ward staff and will be escorted to the bed that has been allocated to you during your stay. You will be shown the layout of the ward and allowed to settle in. The nurses will put a band on your wrist showing your name etc. If you have any allergies you will be given a red wristband. For safety reasons please do not remove this band while you are in hospital. The ward doctor may see you. Your surgeon, his registrar and the anaesthetist may also see you. If you have not already done so, you will be asked to sign a consent form for the operation. Please do not leave the ward without telling a member of staff. Time of operation The approximate time of your admission / operation will have been explained to you when you attended the pre-operative assessment clinic. It will have been explained to you when you need to stop eating and drinking before the operation. Occasionally it may be necessary to delay your operation for a short while. This is normally because there is an emergency that requires immediate attention. If this occurs you will be kept informed by the ward staff

7 Visiting hours Please check visiting times with ward staff on arrival to the ward. We ask that on day of operation that only one person visit, in the evening. At all other times we ask that there are only 2 visitors at one time. Children Whilst we do not discourage children from visiting, we do ask that they are kept under control and not allowed to run about the ward. However we discourage children to visit between pm. For children under the age of 12 years, please ask the ward staff before entering the ward. Please remember that there are other patients on the ward, some of whom may have recently returned from the operating theatre. We ask that you respect their privacy and dignity. Telephones Mobile phones will need to be switched off when you are on the ward and may only be used in public areas. There is a telephone for patient use in the corridor outside the gynaecology wards. However, please be aware this does not take incoming calls. Relatives may contact the ward at any time to enquire after your condition. However, please be aware that this is the ward phone and can be very busy, so it may not be possible for you to use the phone to speak to your relatives but the staff will gladly pass any messages on to you. Leaflets There are information leaflets available on the ward for your use. The nursing and medical staff will be happy to give these to you and to answer whatever questions you or your relatives may have

8 On the day of your operation It is requested that you have a bath or shower before your operation. You may also require a pubic shave but your nurse will advise you of this. You may be given a suppository to ensure that your bowel is empty for your operation. Following your operation you will be given an assisted bed bath. This is generally within the first 24 hours after your operation. After 48 hours you may have a bath or shower, but please check with the ward staff first. Before your operation When it is time to get ready for your operation, you will be asked to put on an operating gown and will be given a pair of anti-embolus stockings to wear. You will need to remove all your undergarments. If, when you saw the anaesthetist, it was decided that you would need a pre-med, (medicine to make you relaxed and sleepy) you will be given this about an hour before the operation. When the time comes to go to the operating theatre, the nurse will take you there on your bed. If you do not have a pre-med, then the nurse will walk with you to the operating theatre. After your operation Following your operation you will wake up with a drip in a vein in your hand or arm, a catheter into your bladder and a pack in your vagina. The drip is removed once you are drinking well and any vomiting / nausea has settled. This is usually within 24 hours of your operation. The pack and catheter are usually removed the day after your operation. You will be given a small injection, once a day, until you are up and about. They are to help reduce the risk of blood clots developing in your legs and are given into your lower abdomen. You will have a blood test performed, the day after your operation, to check that you are not anaemic. Recovery from a LAVH is such that it is anticipated that, as long as there are no complications, you should be able to go home 48 hours after your operation

9 Stitches that have been used in the vagina or in the small cuts in the abdomen usually dissolve and any dressings that cover the small cuts will be removed before you leave hospital. You will need an adult, over the age of 18, to come to the ward to collect you and to take you home by car or taxi. Please do not go home by public transport. When you get home It is advisable that you have a responsible adult with you (over the age of 18) for at least the first few days once you are at home. You must have easy access to both a telephone and transport in case you are feeling unwell. Please rest as much as possible for the first 2 weeks, but please do not stay in bed. General movement is encouraged. Having a major operation will often make you feel tired for some time once you are at home, but this will gradually improve as the weeks go on. You may bath or shower as you feel able to but it is advised that you have an adult around with you for the first few weeks. Please do not lock the bathroom door and do not have the water too hot. Please wash and dry the wounds gently. Please avoid talcum powder, body creams, bubble bath or scented soaps until the wounds are completely healed. Any stitches used during your operation will take some time to dissolve. Please contact your GP if they become red, swollen or uncomfortable. Vaginal bleeding or discharge is common following this operation and may continue for several weeks. Please do not use tampons as they may lead to infection. If the bleeding or discharge becomes heavy or smelly, please contact your GP for advice. Please do not drive for at least 4 weeks after your operation, and then only start with short journeys. Sit in the car, with the engine off and seat belt on. Press the pedals as if doing an emergency stop. Then turn in the seat as if going to reverse the car. If these actions feel comfortable then you can start driving again. Please ensure that when you do start driving again, you have an adult with you the first few times you go out. Please check with your car insurance company for their advice, as you may not be covered for a specific period after an operation. Sexual intercourse can be resumed once any bleeding or discharge has cleared and you feel comfortable. This is usually about 6 weeks after your operation

10 Please avoid any heavy lifting for up to 3 months after your operation. This includes the heavy shopping bags, vacuum cleaner etc. The time you need away from work depends upon the type of job that you do. Women who have non-manual jobs, such as sitting down at a computer etc should be able to return earlier than those in a more physically demanding job. We would normally recommend approximately 8 weeks away from work after your operation. Please do not go back to work until after your follow up appointment after your operation. This is usually between 6 and 8 weeks. If you are planning to travel by air, a long distance by car or coach, within 4 weeks of your general anaesthetic (before or afterwards), then you are advised to contact your travel insurance company for their advice. If you are travelling any distance by car, please ensure you take regular comfort breaks every hour or so. Get out of the car, stretch your legs and have a rest. Contact numbers If you have any worries or queries, we will be pleased to discuss these with you over the phone, on the contact numbers given below: Maple Ward (anytime) Pre-Operative Assessment Nurses (9.00am to midday) Alternatively you can contact one of the services listed below: Your local Pharmacist NHS