Gynaecology Leaflet: How to Recover Quickly from Laparoscopic and Robotic-Assisted Surgery

Leaflet Details

Patient Information

Contents

• Introduction
• Laparoscopic and Robotic-Assisted Surgery
• Before your Operation
• Your Operation
• After your Operation
• Risks and Complications
• Useful Telephone Numbers

For more information about the treatments available at CEMIG, please visit our website at https://cemig.info/

Introduction

This information leaflet is for those who have or are about to have laparoscopic or robotic surgery. We look forward to welcoming you to Ashford and St Peter’s Hospitals for your operation.

Our aim is for you to come into hospital as strong as possible, ready for your surgery, and to make a quick recovery. To achieve this, we have created this booklet to provide information on how to prepare and recover from your operation. Everyone recovers differently and the speed of recovery may depend on how complex the operation was, how fit you are, the reason for the operation and if there were any complications during the operation.

Together, we will use the various steps listed below to help you achieve the best recovery.

For people having unplanned or emergency surgery e.g. ectopic pregnancy, tubo-ovarian abscess, suspected adnexal torsion, some of these steps will not be applicable as your operation was not pre-planned (elective). We still encourage you to read the whole leaflet as this will contain relevant information about the operation, benefits, risks as well as post-op care.

The key steps that can aid your recovery include:

• Being in good health and ensuring any medical conditions are well managed e.g. diabetes, raised blood pressure etc. beforehand, especially if your operation is pre-planned.
   
• Eat a healthy and balanced diet
   
• Stop smoking as this delays your healing and increases the risk of chest and wound infection
   
• Having good pain relief following your operation
   
• Being able to get out of bed and move around with/without assistance soon after your operation.
   
• Getting back to the comfort of your own home as soon as possible.
   
• Having a positive outlook and attitude
   
• Keeping your weight within a healthy range (increased weight increases the risk of infection, delays your recovery and increases the risk of venous thrombosis)
   
• Regular exercise

You may find the video on the website of the Royal College of Obstetricians and Gynaecologists useful.

It explains how to recover well from a laparoscopy. To access the video, go to https://www.rcog.org.uk/ and click on “For the Public”. Next click on “Browse all patient information leaflets” and select “Laparoscopy - recovering well patient information leaflet”.

Alternatively scan the QR code.

Laparoscopic and Robotic-Assisted Surgery

What is a Laparoscopic and Robotic-Assisted Surgery?

Laparoscopic and Robotic-Assisted Surgery are both forms of minimally invasive surgery laparoscopy (also known as keyhole surgery) offered at Ashford and St Peter’s Hospitals under a general anaesthetic. Usually, three to five small cuts (half to one centimetre in length) are made in the abdomen, allowing your surgeon to insert a small telescope so that they can see inside your abdomen and your reproductive organs directly. Your abdomen will be filled with gas to create space and provide a clear picture and if necessary, to treat any problems as agreed with you before your operation. Before you agree to surgery and sign a consent form, your surgeon will discuss what is planned. This is called informed consent.

At the end of surgery as much gas as possible is released from the abdominal cavity and the incisions are closed.

Why do you need a surgery?

You have been offered a laparoscopic or robotic-assisted operation because conservative or medical treatment of your problem has failed or is not suitable.

Minimally invasive surgery is commonly used in the treatment of various problems which include:

• To help us diagnose the cause of your symptoms - this is called diagnostic.
   
• Ovarian cysts
   
• Fibroids
   
• Adhesions (this is where internal organs are stuck to each other)
   
• Ectopic pregnancy
   
• Pelvic infection e.g. tubo-ovarian abscess
   
• Removal of the uterus (hysterectomy)
   
• Treatment of endometriosis
   
• Torsion (twisting) of the ovary with / without the tube

Advantages of a laparoscopy

• Quicker recovery
   
• Shorter hospital stays
   
• Less pain following procedure
   
• Smaller incisions
   
• Less scar formation under the abdomen

In most cases you will go home on the day of surgery, so you need to plan for transport home and ensure that someone is at home to help you for the first 24 hours following surgery,

Every operation carries risks, and this should have been discussed by your doctor. We have summarized these in the section titled ‘Risks and Complications’.

Before your Operation

Having seen your doctor and agreed to surgery, you will need to think ahead and plan how you will manage your usual activities whilst in hospital for your operation and during your recovery. Your surgeon will discuss what to expect during your recovery period and how long you will be off work. Please see the section ‘Preparing for Admission’.

You will receive an appointment to attend pre-operative assessment clinic. The purpose of this clinic is to prepare you for your admission and discharge from hospital. At this clinic we will have the opportunity to discuss your home circumstances for safe discharge, assess your fitness for anaesthesia and give you a chance to ask any questions you may have. During this appointment the staff will discuss any other illnesses you may have (e.g., diabetes), record your blood pressure and record your height and weight. All patients are checked for MRSA (skin swab sample) prior to their operation so any infection can be treated before surgery. The team may arrange blood tests, ECG (heart recording) and / or to see an anaesthetist before your operation date.

During your pre-op assessment appointment, we will also review any regular medications that you are taking and check if these will interfere with your operation (e.g., blood thinning medications). Please bring in all your medications and a note of any allergies with you. If you don’t want to bring your medications, a list of your medications or your repeat prescription may be suitable. Please continue to take your medications as usual UNLESS you have been advised to stop them during your pre-op assessment.

Consent

You will be asked to sign a consent form which confirms you have agreed to the procedure. If you do not understand anything or would like someone with you, please let the doctor taking the consent know before you sign. Signing this form does not stop you from asking questions or changing your mind.

Eating and drinking

You will be advised when you need to stop eating and drinking prior to the operation.

Bowel Preparation

It is not routine for bowel preparation medication to be given to those undergoing a laparoscopic or robotic-assisted surgery, but in some circumstances it is appropriate. If you do require bowel preparation medication, you will be given information on how to take it correctly in your pre-op assessment.

Contraception

If you are sexually active and having regular periods, it is important you are not pregnant at the time of the operation. Please ensure you are using some form of contraception and see your GP for advice about this if needed.

You may be asked to stop your contraception for a few weeks before the operation if it contains oestrogen (such as the Combined oral contraceptive pill, NuvaRing etc.), as this may increase the risk of developing blood clots after the operation. Please use barrier contraception or abstinence as alternative. You will be advised when to restart it (usually 2 weeks after you are back to your normal mobility). If it is not possible to stop your contraception, please let your surgeon know.

Please avoid unprotected intercourse for at least 7 days prior to your operation, as we might have to reschedule your procedure otherwise.

We will perform a urine pregnancy test on the day of the procedure, and your surgery may be cancelled / postponed if you are pregnant. This may not be applicable if you are having emergency laparoscopy e.g., for ectopic pregnancy.

Preparing for Admission

It is important for you to be thinking about planning your discharge now, before you go into hospital. You can help yourself by arranging help and support before you come into hospital for the following:

• Make sure you know who can come and collect you from hospital. Please bring their contact details with you.
   
• Ask friends and relatives if they can come to stay or visit to help around the house when you get home.
   
• Arrange for a friend or relative to do some shopping for you or make extra portions of food to freeze.
   
• Get up to date with any housework before you come into hospital, this will help reduce the load when you get home.
   
• Arrange additional childcare or help with the school runs where necessary.
   
• Get some over the counter painkillers like paracetamol and / or ibuprofen

Your Operation

The operation is done under a general anaesthetic (you will be asleep).

Once your operation is over, you will be taken to the theatre recovery unit. You may wake up with an oxygen mask over your face.

Painkillers will be provided but please tell the nurse or doctor if any pain is not relieved by the painkillers you are given.

You may be given fluids through a drip in your arm. Once you can take fluids by mouth you will be encouraged to start drinking and eat light meals. Good nutrition is important to your recovery. A good fluid intake (1.5-2 litres in 24 hours) and increase in fibre in your diet will minimise the risk of constipation.

If you are going home on the same day of your operation, before you are discharged home the nursing team will make sure that you have passed urine and that you are able to walk comfortably.

For some minor day case operations, we may agree with you to go home without passing urine after discussing with your surgeon. Prior to going home, please ensure you are advised on what to do should you not pass urine later at home. In a few cases, we may send you home with a catheter and arrange a follow-up to have this removed later. You will be given a discharge letter containing details of your operation, medications and advice on who to call if you have any problems once home.

You may be transferred to a ward for observation or for a planned overnight stay. Sometimes it may be necessary to stay overnight for observation even though your surgery was planned as a day case. This may be because the operation was more complex than originally. anticipated.

After your Operation

Having a general anaesthetic can make you very “groggy”. You might feel less coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important. It’s normal to feel tired but this should gradually get better.

Driving

You should not drive for 24 hours after a general anaesthetic. Each insurance company will have its own conditions for when you are insured to start driving again. Please check your insurance.

Before you drive you should be:

• Free from the sedative effects of any painkillers
   
• Able to sit in the car comfortably and work the controls
   
• Able to wear the seatbelt comfortably
   
• Able to make an emergency stop
   
• Able to comfortably look over your shoulder

Return to work

When you can return to work will depend on the extent of surgery performed and what your work entails and whether it involves heavy lifting. This will be discussed at your initial consultation.

We may be able to provide a sick note if this is expected to be more than 5 working days.

Vaginal Bleeding

You should expect some bleeding for 24 - 48 hours or slightly longer. The initial bleeding should gradually tail off and become like a light period. If it becomes painful and / or heavy and is associated with a smelly discharge, fever or chills, you may have an infection and should contact your GP.

Stitches

Your cuts will initially be covered with a dressing, you will be able to remove this after 24 hours.

We usually use stitches that are dissolvable and do not need to be removed. If they become bothersome, please contact your GP/ practice nurse. Occasionally a special glue is applied to the wound site, this will wash away of its own accord, or you can gently wipe away the glue after 7 days using warm water and clean gauze.

Bowels

Avoid constipation and straining when opening your bowels. A good fluid intake (1.5 - 2 litres in 24 hours) and an increase in fibre in your diet will reduce the risk of constipation.

Being mobile will also help with this. We may occasionally send you home with oral laxatives to reduce the chance of constipation.

Personal Hygiene

You may shower or bath 24 hours after your surgery. It’s best to ensure someone is around when you do this for the first time per chance you feel dizzy or faint. If your scars get wet, do not worry, pat them with a separate clean towel or let them air dry. It is advisable to avoid using tampons or menstrual cups for about 6 weeks to reduce the risk of infection.

Medication

Please finish any course of any antibiotics you may have been prescribed. You should continue to take your current medication as normal unless otherwise instructed.

Sexual Intercourse

You can usually resume sexual activity when you feel comfortable. If you have had more extensive surgery, then your surgeon will be able to advise you.

Exercise

As you have had a laparoscopic or robotic-assisted surgery you should be able to return to exercise and lifting as you feel comfortable.

Travel Plans

If you are considering travelling during your recovery, it is helpful to think about:

1. The length of your journey: journeys over four hours where you are not able to move around (in a car, coach, train or plane) can increase your risk of deep vein thrombosis (DVT); this is especially so if you are travelling soon after your operation
    
2. Comfortable: How comfortable you will be during your journey, particularly if you are wearing a seatbelt
    
3. Overseas travel:
    
• Would you have access to appropriate medical advice at your destination if you were to have a problem after your operation?
   
• Does your travel insurance cover any necessary medical treatment in the event of a problem after your operation?
   

If you have concerns about your travel plans, discuss these with your surgical team or GP before travelling.

Follow Up

If there is a need for any further treatment, we will arrange a follow-up in the hospital with a member of the medical or specialist nursing team. Often, a routine follow-up visit is not needed. In these cases, we will write to your GP who will then continue with your medical care.

Women who have had surgical treatment for an ectopic pregnancy may contact the early pregnancy unit to request a post ectopic clinic consultation by ringing 01932 722662.

Risks and Complications

Whilst every effort will be taken to ensure your wellbeing, no surgery is without its risks. The risks associated with this type of surgery are listed below, with average chances of these happening. Your personal risk of these issues will depend on how complicated your surgery is, and your surgeon will be able to advise you further.

Pain

It is quite normal to experience pain or discomfort, but this can be controlled effectively with painkillers. Please let the doctor or nurse know if the pain killer isn’t controlling your pain. Shoulder tip pain is common after laparoscopy as this is caused by small amounts of gas left in the abdomen after surgery. Early mobilisation after surgery will help reduce the shoulder tip pain.

Bleeding

This can occur during or after surgery. Major bleeding requiring blood transfusion is uncommon (less than 3 in 100). You must inform a healthcare provider if your vaginal blood loss is unmanageable whilst an inpatient or once discharged from hospital.

Potential to proceed to open surgery

In certain circumstances, the surgeon may feel that it would be safter to proceed with open surgery. This will mean you will need to remain in hospital overnight and your recovery will be longer.

Infection

This can occur in the wound (15 in 100), urine or chest. If an infection occurs you will be given antibiotics.

Risk of blood clots

Having laparoscopic surgery increases your risk of blood clots in the legs (deep vein thrombosis) or lung (pulmonary embolus), with the overall risk being about 1 to 5 in 1000. This risk is higher if you have additional risk factors, including reduced mobility, being overweight, smoking, previous history of clots etc.

This risk will decrease by weight loss and smoking cessation prior to your operation, early post-op mobilisation and doing gentle exercise whilst at rest. For example: pump each foot up and down briskly for 30 seconds by moving your ankle, move each foot in a circular motion for 30 seconds, bend and straighten your legs – one leg at a time, three times for each leg.

You may be given support stockings to wear to help prevent clots and/or a blood thinning injection if you stay in hospital overnight or if you have additional risk factors for blood clots. If you need blood thinning injections on discharge, we will teach you or a relative on how to give the infection. We will tell you how long you need the injections for.

Please inform your doctor or nurse if you experience any swelling or pain in your legs or sudden shortness of breath as this may be a sign of thrombosis.

Damage to Internal Organs

The average risk of serious complications at laparoscopy is about 2 in 1000. This includes injury to the bladder, ureters (tubes that pass from the kidneys to the bladder), bowel and blood vessels. This would be dealt with and repaired when they are identified, usually at the time of operation.

However, damage may not be obvious until after the operation and in 15 out 100 cases of bowel injury, this may not be obvious at the time of surgery.

Hernia

There is about a 1 in 100 chance of a hernia developing at the site of entry (the incision sites on your abdomen).

Hormone Replacement Therapy

If your operation involves the removal of both ovaries, depending on your age, you may need to consider taking hormonal replacement therapy (HRT) to prevent your bones from becoming weak and fragile (osteoporosis) and to help control night sweats and hot flushes. The need for HRT, its benefits and risks should be discussed by your medical team prior to having surgery. It may be advisable to delay the start of HRT until a few weeks after your operation (as you may have an increased risk of developing a blood clot immediately following surgery). Your GP can also advice on the type of HRT to use and when to start this.

Transfer to St Peter’s Hospital

If your surgery is planned for Ashford hospital, there is a small risk that in the event of an unexpected complication related to your admission or procedure, you may require ambulance transfer to St Peter’s Hospital for further investigation and treatment. Your surgical team will discuss this with you if this is required.

Useful Telephone Numbers