The Surgery: The Whole Process

This morning I got an email from HysterSisters reminding me of checkpoints to prepare for my surgery next week.  HysterSisters has been a great resource for me and I highly recommend their website for any woman who need this surgery.  I have been busy preparing for the surgery, making sure I had everything I needed at home to ensure comfortable recovery.  I have been cooking up a storm to stuff the freezer with meals as I will be unable to cook for a while.  That is one thing I will miss very much.  The past two months, cooking has been a therapeutic activity for me as I dealt with this cancer.  For most part, I am almost ready other than needing to cook a few more meals to freeze this week.  I am not emotionally or mentally ready.  It is a life-changing surgery and that terrifies me.  I also struggle with the idea I will be unable to do many normal activities for six to eight weeks.  I am a Type-A personality and always on the go.  Now I have to rest for that long.  I really do not like that idea but have come to accept that it is necessary to ensure a longer life. 

On Monday, March 30th, I will have a two-hour surgery called the da Vinci hysterectomy with sentinel lymph node resection.  Dr. Jewell will be removing my cervix, uterus, and Fallopian tubes laparoscopically assisted by a robotic system called the da Vinci system.  This is a minimally invasive surgery.  What's going to happen during the surgery?

First, they will fill my abdomen with carbon dioxide (an inert gas) to create a large space for the surgeon.   The gas applies pressure that compresses tissues.  As a result, I will experience minimal bleeding as compared to an open surgery.  The day before the surgery, I will be on a liquid, dairy-free diet to help clear my body for the gas that will fill up.  It is the gas that makes many women feel very uncomfortable after surgery. 

Next, she will make five incisions in my abdomen - the top two incisions are 10 mm wide and the bottom three 8 mm wide.  Traditionally, hysterectomies are done by cutting up the uterus into small pieces for removal through abdomen using a power morcellator.  However for women with uterine cancer, that must not be done.  They need the uterus in one piece for the pathologist to accurately stage the cancer.  Plus if the uterus was cut, there's the risk of the cancer cells being spread to another part of the body namely the vagina or the area where the uterus used to be.  This happened to a woman during her surgery:  http://www.nytimes.com/2014/04/18/health/fda-tells-doctors-to-stop-procedure-used-to-remove-uterine-fibroids.html?_r=0.

Cuts will be made to disconnect the tubes, uterus, and cervix through cutting and cauterizing.  Then she will carefully remove everything vaginally.  Next, she will do sentinel lymph node dissection.  At our last appointment, Dr. Jewell explained the latest research on lymphadenectomy.  In United States, the typical approach is to remove all of the regional lymph nodes near where the cancer was found.  In Europe, they remove only those that should be removed (sentinel lymph nodes).  Comparative studies were done and there is no difference in the cancer progression between those two approaches.  In order to reduce the risk of lymphedema which is usually the result of  removing too many lymph nodes, they will just remove some.  In order to figure out which ones to remove, insert blue radioactive dye into the pelvic area to look for lymph nodes that become stained with the color blue.  Those will then be removed.

The last step is to close the end of my vagina where the cervix once was, which will become my vaginal cuff.  The uterosacral ligaments are secured with the vaginal cuff.  The recovery of my vaginal cuff is very important.  Thus, that is why I cannot do many things for six to eight weeks to ensure full recovery, including lifting anything over six pounds or working out.  If I do not follow instructions, I run the risk of having another surgery to reconstruct the vaginal cuff.  They will use a mix of dissolvable stitches- some will dissolve in six weeks, while some will dissolve in six months.

If Dr. Jewell can see there's something wrong with my ovaries during the surgery, she will have to remove them.  We agree that the goal is to keep both or at least one ovary.  If I lose my ovaries, I have 50% overall higher risk of mortality, along with numerous health risks.  If she sees that it is too complicated to do the laparoscopy surgery, she will do an open surgery.  If all goes well, I will be in the hospital for one night and go home the next day.  If it ends up being an open surgery, I have to stay in the hospital for three to five days.  I will not be discharged from the hospital until I can urinate and can walk. 

The removed cervix, uterus, tubes, and lymph nodes will then be sent to the pathology to stage my cancer.  I will not know my stage until the follow-up appointment with Dr. Jewell on April 14th.  My post-op appointment is on May 12th to see if my vaginal cuff has recovered and to get the green light to resume all of my normal activities.

The first two weeks, I will be heavily medicated with pain medications.  I will be sleeping a lot.  But I am required to walk around a bit throughout the day.  During the third week, I can resume some normal activities again but it will be a struggle.  I have been learning a lot about the post-operation experience from other women through HysterSisters to help me prepare.  Many of them said that even a simple task of showering is so exhausting that one needs a nap after.  I will probably be napping a lot during the weeks 3 and 4.  Once Dr. Jewell gives me the green light to resume my normal activities, I will still feel tired often as my body slowly recover.  I probably will not feel completely like myself again for six to twelve months.  The way I see it, the megestrol (hormone therapy) prepared me for that because I am a lot more tired those days.

Speaking of which, I am thrilled that my last day of hormone therapy is tomorrow.  Usually, patients are advised to keep on taking megestrol until the day before surgery so it keeps the cancer at bay.  I told Dr. Jewell that I was going to run out of my month's supply of megestrol on Tuesday.  She told me not to get a refill and it's just five days without treatment.  I am happy to have a break in between treatments.