• Reference Number: HEY600-2024
• Departments: Gynaecology, Oncology (Cancer Services)
• Last Updated: 1 February 2024

Introduction

This leaflet has been produced to provide you with general information about your operation.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a hysterectomy?

A hysterectomy is a commonly performed and generally safe surgical procedure. This can be carried out in a number of ways and your surgeon will discuss the most appropriate type of hysterectomy for you.

The different procedures are:

• Total abdominal hysterectomy and bilateral salpingo-oopherectomy (BSO). This is when the womb (uterus), neck of the womb and both fallopian tubes and ovaries are removed. This operation may be performed through either a bikini style incision or through an up and down cut in the tummy.
• Laparoscopic assisted vaginal hysterectomy (LAVH) and BSO. This operation is carried out through three or four tiny ‘keyhole’ incisions in your abdomen to help remove the uterus, tubes and ovaries through the vagina.
• Robotic assisted hysterectomy and BSO.  This operation uses a de Vinci robot operated by the surgeon.  This is carried out through five tiny ‘keyhole’ incisions in your abdomen and the uterus, tubes and ovaries are removed through the vagina.  The robot is used for more intricate surgery and aims for quicker recovery time.

The end result of these approaches is the same (the removal of your womb, ovaries and fallopian tubes). It is just a question of which method is most suitable for you.

Why do I need a hysterectomy?

You have been diagnosed with cancer of the womb. The most common cancer of the womb is known as endometrial cancer, this is in the lining of the womb. There are other types of womb cancer that affect the muscle of the womb these are known as sarcomas.

The aim of the operation is to remove all of the cancer. If there is any evidence that the cancer has spread, or if the results of the operation suggest that you may be at an increased risk of recurrence of the cancer (your cancer returning), you may be offered further treatment such as radiotherapy and/or chemotherapy. This will be discussed with you when all your results are available.

Are there any alternatives to surgery?

There are alternatives to surgery but these vary from patient to patient. The treatment options will depend on the stage of your disease. The medical team will discuss this with you. Surgery is the best way of treating the cancer but you may be offered radiotherapy /chemotherapy.

What happens if I have no treatment?

Your wishes about treatment will be respected at all times by your medical team. If you choose not to have treatment, your cancer will progress and your health is likely to deteriorate. At this time you may wish for us to transfer your care to the Palliative Care Team, who will discuss with you what will happen next and help you to manage your symptoms and support you.

Whatever you may be feeling try talking about it with someone who specialises in dealing with this condition, such as your consultant or the Gynaecological Clinical Nurse Specialist. They will listen, answer any questions you may have and can put you in touch with other professionals or support agencies if you wish. Some useful contact numbers are also listed within this leaflet.

Can there be any complications or risks?

All surgical procedures carry with them a small chance of complications. The potential complications are very similar to hysterectomy regardless of the method used. Every care will be taken to minimise the risks.

The potential complications include:

• Infection – The risk of this is reduced by giving antibiotics around the time of the surgery. The infection may occur in the pelvis, bladder, chest or in the incision site. Any more extensive infection is usually easily treated with antibiotics. Occasionally an abscess may form which may require surgical drainage under anaesthetic.
• Bleeding – This may occur during the operation or rarely afterwards and may be sufficient to require a transfusion or another operation. Occasionally, if blood collects in the pelvis it may need to be drained surgically under anaesthetic. Slight vaginal bleeding/discharge should be expected up to one to two weeks after    surgery.  Sometimes if the bleeding does not settle it may be that you are doing too much.  Please contact your GP or specialist nurse for advice if you are concerned.
• Deep vein thrombosis (DVT) and pulmonary embolism – In association with hysterectomy, it is possible for clots of blood to form in the deep veins of the legs and pelvis. If this does occur a deep vein thrombosis is diagnosed. It may cause pain and swelling in the legs and can be treated with drugs. However, in rare cases, it is possible for this clot to break away and be deposited in the lungs or heart causing a pulmonary embolus or heart attack. The risk of developing a DVT is low as precautions are taken to help minimise the risk. Moving around as soon as possible after your operation can help to prevent this. We will give you special surgical stockings (known as ‘TEDS’) to wear whilst you are in hospital, and injections to thin the blood.

Further treatment may be needed such as:

• Returning to theatre to stop bleeding to the bladder or bowel.
• Antibiotics to treat an infection.
• A blood transfusion to replace lost blood.

If any further treatments are needed this will be explained to you by the medical team looking after you.

How do I prepare for the hysterectomy?

Please read this information leaflet and also the Gynaecology Oncology Enhanced Recovery patient information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this operation.

What happens afterwards?

For more information on afterwards read the Gynaecology Oncology Enhanced Recovery information for patients.

When can I have sex?

After a hysterectomy or vaginal surgery you may not feel physically or emotionally ready to start having sex again for a while. We normally advise women not to have sexual intercourse for six weeks until you have had a follow up appointment at the hospital or with your doctor.

Follow up

You will be reviewed in outpatients about three weeks following your surgery when the consultant should be able to give you the results from your surgery. This may be done at your local hospital.

Useful contacts and support agencies

Macmillan Cancer Support

Specialist advice and support through Macmillan nurses and doctors and financial grants for people with cancer and their families. For answers, support or just a chat call 0808 808 00 00 Monday – Friday, 9am – 8pm. www.macmillan.org.uk.

The Daisy Network

They provide a support network for women who experienced a premature menopause.

PO Box 71432 London SW6 9HJ

General enquiries:  info@daisynetwork.org.uk

https://www.daisynetwork.org.uk/

Womb Cancer Support

We offer online advice and support for women with womb cancer and their families. Contact us directly at ask­_wci@outlook.com wombcancersupportuk.wix.com/home.

The Lymphoedema Support Network

St. Luke’s Crypt, Sydney Street, London, SW3 6NH.

020 7351 4480 Monday to Friday, from 9.30am until 4.30pm www.lymphoedema.org.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact: Gynaecology Clinical Nurse Specialists, who are happy to speak to you at any time. If they are not there, an answer phone is available – 01482624033.

If you need to speak to someone urgently, the staff on Ward 14 at Castle Hill Hospital will be happy to help – 01482623014.

Other useful telephone numbers:

• Gynaecology Outpatients, Women and Children’s Hospital – 01482607829.
• Women’s Health Outpatients, Castle Hill Hospital – 01482624045.
• Oncology/Haematology Department, Entrance 1, Castle Hill Hospital – 01482461060.

Northern Lincolnshire and Goole Hospitals NHS Trust, Gynaecology Clinical Nurse Specialist – 01724282282.  Page through the switch board or ask for extension 5904.

Scarborough Hospital, Gynaecology Clinical Nurse Specialist: page through the switch board – 01723368111.
Office – 01723385290.

Information on Gynaecology Services at Hull University Teaching Hospitals NHS Trust: www.hey.nhs.uk/gynaecology.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.