Hysterectomy, the surgical removal of the uterus, is an effective option when various treatments for conditions such as uterine fibroids, endometriosis, cancer, and others, fail. Especially for working women, this surgery is a boon. With the conventional open surgical approach, a patient needs to stay in the hospital for 3-5 days after the surgery; but with fast track hysterectomy, they can be discharged within 24 hours! However, one shouldn’t consider it to be a minor surgery just because the patient is home early.
Firstly, while using the anaesthesia techniques, the post-operative pain and nausea management and the technique of minimal access laparoscopic or robotic hysterectomy involving smaller incisions and less blood loss, cause less pain and heals faster in fast track hysterectomy. Moreover, pre-surgery counselling and detailed discussions help the patients to set clear expectations. This advanced form of robotic surgery with keyhole method in complex situations involving the large uterus, severe adhesions such as endometriosis or multiple previous surgeries, is a preferred option.
Moreover, the need to convert a laparoscopic surgery into an open surgery while the operation is on is reduced. Thus there is no surprise to the patient when she wakes up from anaesthesia that her hysterectomy, which started as laparoscopy, was turned into open surgery. Since the blood loss is minimal in robotic surgery, the need for blood transfusion is also reduced. This is also an important factor that leads to a quick discharge of the patient as the time required for blood transfusion requires the patient to stay in the hospital for a longer time. Post the surgery, the patient also doesn’t feel weakness or fatigue.
Today, surgeons no longer use an enema or mechanical bowel preparation which is often unpleasant for patients before surgery. A low residue diet a day prior to the procedure is sufficient and patients are allowed to take clear liquids up to four hours before the operation. This prevents dehydration without increasing aspiration risks.
They start by giving oral liquids within 3 hours after surgery and solid food after 5-6 hours. Women are encouraged to mobilise in bed soon after and can walk out of bed by 10-12 hours post the surgery. They are gently weaned off to oral diet and medications after 8-12 hours.
These patients show less postoperative symptoms, fast recovery and the treatment is also easy on one’s pockets. The involvement of the entire surgical and anaesthesia team, as well as nursing staff, is important in order to obtain the optimum advantages of fast track hysterectomy.
Surgeries often come with a number of apprehensions. Especially for a working woman, they bring a lot of questions such as – how many days of bed-rest she would need post-surgery, when would she be able to get back to work, who’ll take care of the family in the interim and so on.
Dr Rooma Sinha, MD, DNB
Sr. Consultant Gynaecologist, Laparoscopic & Robotic Surgeon,
Apollo Health City, Jubilee Hills,