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Tuesday 20 February 2018
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Patient Perspective: Experiencing a robotic surgery

by Justina Hurley

da-vinci-xi-surgical-arms-72dpi

Preparing for a robotic surgery

The thought of surgery is never pleasant but if you’ve been told that your option is a robotic surgery then you are at least facing a minimally invasive procedure that is a lot easier on the body than an open surgery.

If you don’t know much about robotic surgery, then first read this article on robotic surgery.

I had a radical hysterectomy and so will just run through the steps here to help anyone else out there who is facing a similar hysterectomy and who will be having it done by a surgeon who uses the DaVinci Robot assisted surgical system.

First steps:

The decision.

My advice to anyone facing a hysterectomy is to choose your surgeon, if that is possible, and to let the surgeon then choose the best procedure for you. Even though hysterectomy is a very common operation, it is still quite a complicated surgery and even more so if it is a radical hysterectomy, so it’s much more important to be really happy with your surgeon and then let him or her decide on the type of surgery.

Attitude

Eliminate fear completely. I can’t emphasise this enough. The less fear that you are feeling the easier it is for your body to prepare for and then recover from surgery.

I know it sounds trite but is is vitally important. It’s easy to forget when you are the one facing surgery that this is something that your surgeon is doing all day long every day.

It’s a bit like fear of flying. If you’re on that plane, being terrified is not going to make any difference if something goes wrong. All you can do is choose a good airline and then trust that the pilot knows what he is doing and doesn’t want to die either, then sit back and enjoy the flight! Can something go wrong? The honest answer is yes. But what can you do about that – absolutely nothing!

So you have a choice, sit there with white knuckles gripping the seat and flooding your body with stress or just hand over and trust that all will be well and that there is no point in imagining worst case scenarios.

It’s the same with surgery. No surgeon wants to damage you so they will be doing the best job they can. They have to tell you beforehand that things can go wrong and even outline all the things that can possibly happen. Try not to focus on that and focus instead on how for you it will all go according to plan.

I meditate and in the weeks leading up to my surgery I meditated a lot and visualised it all going really well on the day of my surgery and saw myself afterwards having no side effects or problems. If you need help with managing fear around surgery, then see our article here on Preparing for Hysterectomy – Meditation & Relaxation

Physical Preparation

Depending on how much time you have, begin to exercise. I’m not a gym person but I like to walk so I just upped the walking every day. Fresh air is the best and a walk by the sea or any water is a great way to de-stress. And remember that a good trot around a shopping mall is still a walk!

Also I began bladder / pelvic floor exercises just as Professor Basford recommends in her article here. This was to help to strengthen the bladder. She also gave a very good tip which is when you go to the loo, at the end bend forward leaning over towards your knees as this helps the bladder to drain the last drops and helps to prevent stagnant urine building up.

Eat healthily and stop drinking and smoking if you do either. If you find it hard to stop, then at least cut down.

Diet

I was having surgery for cervical cancer so I went on an anti cancer regime. I actually knew I had cancer before it was officially diagnosed so I began my regime two months before surgery, even though the diagnosis to surgery part was a four week period.

My regime was:

  • 6 salvestrol platinum tablets per day
  • 2 Patrick Halford Immune C
  • 2 Patrick Halford Niotin
  • 2 tumeric capsules
  • Barley Grass drinks
  • Fish Oils
  • Cut out all sugar
  • No alcohol
  • No fizzy drinks
  • No bread
  • Extra chilli, ginger and turmeric in cooking

The salvestrols boosted my system so much that I began to feel better than I had in years. I believe that they also had the knock on effect of somehow sorting a thyroid problem I had, so just before the surgery I was almost off thyroxine.

I don’t know if the salvestrols had any effect on my cancer as I only had four weeks from diagnosis to surgery but they absolutely changed my whole system and I felt really happy and energised.

I generally eat pretty well, and always use a lot of spices, ginger, turmeric and chilli so I just used them more than usual. But in the previous two years I had been busy and had begun to eat a little red meat and take away food and so I cut these completely.

Before Surgery

In the week before surgery it’s important to rest and to get sleep.

hibiscrubAlso for that week shower morning and evening using Hibe scrub (the anti MRSA scrub) so that you are not carrying MRSA, as if you are it could delay your surgery.

The last two days before surgery I took half a tranquiliser (2.5mg) just to make sure that I went to sleep early as I am a bit of a night owl and also weirdly enough the only thing that was making me a little nervous was the idea of being practically upside down for four hours!

For a DaVinci surgery you have to be in what is called the Trendelenburg position which is a steep angle with the head down towards the floor. As much as I visualised that bit and told myself that it didn’t it matter as I’d be out cold, I still found the idea a bit strange.

The two days before surgery eat lightly so that you won’t need an enema. Some surgeons have you do a bowel prep, mine didn’t, but an enema was threatened if needed. I kept my food intake light, just soups and salad and ate as little as possible the day before, so I didn’t need to have an enema or bowel prep.

What to bring to hospital

  • Peppermint tea and peppermint oil and crackers. (I’ll explain this later)
  • A top to sleep in, you won’t be able for Pjs so just a nightdress or long teeshirt is best
  • Toiletries – the usual stuff
  • Face wipes
  • An ipod with relaxing music and a guided relaxation or meditation.

The night before

Pre surgery checks will be done as well as MRSA testing.

For this swabs will be taken from your nose, underarm and groin

Bloods will be taken and then forms signed.

You will be fitted for and then given thigh length stockings which you will put on the next morning. These are really tight, but lovely and warm and are worn during surgery to help circulation in the legs.

At this point I chatted to my room mate and then listened to my guided visualisations and music on my ipod.

The morning of surgery

After a shower, a nurse helped me to get the thigh length super tight anti clot stocking on and then the standard hospital gown.

I went down early, after meeting my surgeon, then met the anaesthetist who went through a health check and discussed the anaesthetic procedure.

I was lucky to have a friend on the nursing staff who came in to be with me and who kept me distracted and entertained until I was called in.

The anaesthetic is given in a room outside the operating theatre so that’s that last I knew until I woke up four and a half hours later in the recovery unit.

Afterwards

In recovery you basically drift in and out of sleep. I was thirsty and the recovery nurse was great and regularly gave me little drops of water from a sponge type tool, just to wet my lips and freshen my mouth. At that stage it’s still too early to be allowed to swallow fluids.

I woke up to no pain as was given some thing, probably morphine, while in the recovery area. That lasts for 24 hours, I’d say, as I had no pain at all that day or night.

At about 4pm I was taken back to my room. I was very awake, very happy, totally drugged up and basically texted everyone I knew!

I felt really dizzy for a while, no doubt from the time spent in the head down position and then further time lying down in recovery so I took my time sitting up, just raising myself a little at a time and then allowing myself to readjust at each stage.

On my tummy I had 5 small bandages covering the five tiny puncture wounds. I had a catheter in and that had to stay for 7 days.

At some stage I ate tea and toast. I say some stage as basically the pain meds have surrounded the rest of that day in a happy blur.

Day 2

Eating was a mistake and this is where the peppermint tea and peppermint oil capsules come in. The only pain I had was gas pain. For this kind of surgery your abdomen is filled with carbon dioxide gas and afterwards while this is being reabsorbed by your body it can create bad gas pain. For some people this pain can radiate to the shoulder. I didn’t have that, the pain was only in my tummy

I don’t know when exactly the gas pain started but on day 2 the gas pain began to kick in sometime after breakfast. I was given a painkiller that made it even worse. I was finally given peppermint tea and peppermint oil capsules that afternoon and they really worked so my advice  is to bring your own with you and have that after surgery with some dry crackers if you can, rather than hospital food, as that will begin to help with the gas straight away.

The hardest part that day was getting the stockings off. I did it on my own but should have asked a nurse to help so if you have these stockings, ask for help as I nearly fell off the bed trying to get mine off.  Then I had a shower and was able to walk around. The heat of the shower did make me feel nauseous and a bit faint though, so it would be better to take your shower when someone is around. I did it on my own and that was also a mistake.

It’s good to keep in mind that you still have a lot of medication in your system and that basically you’re in a state that for me was like being extremely drunk and extremely sober at exactly the same time, which in fact means that you are super clear that totally bonkers ideas are completely normal and doable.

I should have gone home that day, but because the gas pain and stocking and shower scenario really weakened me, my family refused to take me home in case I wouldn’t have been able to climb the stairs!!

I did get a notion at some stage that I would get a taxi home but I couldn’t figure out how to get my stuff from the locker into my bags and then get the bags to the lift. The effort of trying to think through the whole escape scenario then tired me out so much I fell asleep. See what I mean about the bonkers ideas!!

Day 3

I woke early and practised my catheter technique i.e. learning how to empty it myself.

I was told that as my ovaries were now gone that I could have a first hot flush pretty soon and sure enough they began that day.

After breakfast I was able to go home.  To get to the car involved a bit of a walk and two elevators and I was able to walk in a slightly hunched over way as it was a bit too sore to stand fully upright. Being driven was the sorest part, as the movement of the car created a wobble effect in my tummy that caused a little discomfort.

I say sore because that is how I felt, not in pain at all. Other than the morning after the surgery, the only pain medication I took was a panadol actifast morning and evening.

At my home there are a lot of stairs to my room and I was able to do them without a problem, but did do it one step at a time, slowly, as that is what I was advised to do.

Following weeks

The next day was fine but I really did not like the feeling of the catheter. Also now that I was drinking water the anaesthetic started to clear and for me that was the worst part. I felt really nauseous all the time and the smell was awful. That smell comes out through your pores and goes on for days. I think that went on for almost a week.

Your body also has to let out the stress and shock of surgery and I was prepared for that so when the shivvering and crying started I went with it and let it all out. It lasted for a few hours and once that was over I felt very settled. The nausea lasted though and went on for about four days and was pretty severe.

Going to sleep was a bit of a sore time as I was inclined to turn on my side when I slept. This didn’t cause pain as such but more a strange sensation of my internal organs being in the wrong place and rubbing against something sore inside. I solved that by lying on my back and propping a cushion on both sides to stop me turning.

I was dreading my first bowel motion but it was OK! A bit of a strong pre-pain but nothing as bad as the pain I used to have pre surgery with endemetriosis.

On the 7th day, (that sounds biblical) I had the catheter taken out and my bladder operated perfectly so that was good.

I also had a check up with my surgeon at two weeks and I was walking then almost normally and by that time was only taking a paracetomol at night.

Overall, if I didn’t know that I had surgery I wouldn’t have thought that I had. I would have thought that maybe I had had something done to my bowel, like a colonoscopy, as it felt like it had been moved around a bit, but in no way did it feel like I had the major surgery that I had.

It is major surgery though, so even though you don’t feel pain and you are able to move around very quickly afterwards, your internal organs do know something has happened and the body needs to have time to heal and repair. For me, the main way this manifested was in tiredness. It’s the kind of bone tiredness that is only relieved by lying on a bed. I’d get up in the afternoon for a while but would have to go back to bed after a few hours. Every day I could stay up for longer though and by sixth week I was able to get up as normal, but I’d still crave my bed by 10pm.

I was lucky in that I could take my time and didn’t have to be up to take care of children etc. However, if I had had to do all that I could have managed it physically by the sixth week but I’m really glad I didn’t have to, as really you are not fully recovered at six weeks.

All soreness was gone by six weeks, but the body is still repairing and readjusting so the tiredness did continue and I needed extra rest for the first three months. Even now nine months on I can still get tired days.

Dealing with recovery period

Give in to it totally!

It might not be the same for everyone but the anaesthetic really affected me and my brain was in a total fog for the first two months and began to slowly recover from the third month.

During that first few weeks I did very little. I’d go out for the odd coffee or walk around but I basically watched 9 series of Grey’s Anatomy and couldn’t concentrate on anything else. I couldn’t read or write anything for that whole time as my concentration was zero.

My tummy scars healed very well and I had no swelling. I do know that some people can have what is called a ‘swelly belly’, but I didn’t have that.

Hormonal reaction

The night sweats and hot flushes really began to kick in from week one and thankfully a friend sent me a chillow pillow which really helped me to deal with the night time flushes.

I had no mood swings or any other symptoms but did have what I’d call sensations of hormone rushes. Like as if my system would suddenly flood with something and then die down again.

At around the third month I woke up one morning and it was like hitting a brick wall of utter blackness. It reminded me of this Fast Show scene

Yes it was all so, so black! I thought to myself ‘oestrogen has left the building’! For a whole day I felt really low and the next day also. Then just as suddenly that was gone and I was back to feeling good.

My salvestrol regime was now at four per day and I think they somehow helped my system to adjust.

The other unusual post surgery reaction I had was I suddenly developed a liking for fruit. Before this I couldn’t tolerate fruit as I’d react badly to the sugar and all fruit made my mouth sting. Now out of the blue I was an apple and berry fan. And that has continued with the addition of apricots! Very strange…

Downside

I got a kidney infection, most likely due to the irritation of the catheter, but didn’t know, as between flushing, flashing, cold chills and general sweating it was impossible to distinguish between ‘normal’ menopausal stuff and fever. It turned out that the cold chills were actually kidney chills and that I had a nicely embedded infection as I had let it go on too long.

Because I hadn’t noticed this developing, it took ages to clear and recurred twice. Apparently the oestrogen drop adds to the kidney infection as it makes the bladder more sensitive. So as well as pure cranberry juice I still take a maintenance low dose antibiotic on and off to clear that completely from the system.

The oestrogen drop also affected my thyroid so I had to go back on thyroxine for a few months. Now this is levelling out again and once more I am cutting down on this.

Upside

Month nine is where I am now and the flushing is beginning to die down a bit or at least has become a lot less noticeable and is more manageable.

My energy is almost at 100%. I am continuing on two salvestrol platinum per day and will continue this for the foreseeable future.

Having a radical hysterectomy means that you will go straight into menopause so in some ways this is better as there is no gradual onset of symptoms or confusion as to what is happening to your body. I wasn’t menopausal beforehand, so it’s sudden, immediate, physically intense and exhausting for the first few months, but then it begins to die down, as, without ovaries there are no surges or hormonal fluctuations, once it clears the system it’s gone. Other than that one bad day/two days I had no mood swings at all.  The physical symptoms take managing though and I’ll write about that in another article.

I realise that so far I’ve been very lucky and have had no complications from the surgery. As I also had endometriosis I realise I am doubly lucky as I did have bad adhesions which meant that parts of my uterus were stuck to my bowel. A radical hysterectomy coupled with adhesions makes for a very difficult surgery so I’m very grateful to have had such a skilled surgeon.

The lady I shared my room with in hospital had also had a radical hysterectomy but hers had been an open abdominal surgery. From that I really saw how much easier it is to have the robotic option if that is possible. She is going to write about her experience, but basically she was in hospital for 10 days and was on a morphine drip for a lot of that time. She was really very ill and in pain and it was a huge trauma to her body.

In contrast I was in hospital for two days and other than the post surgery morphine in the recovery room, I only needed panadol.

In the long term we both experienced the same tiredness and surgical menopause issues, and at this stage we are equally recovered. However, because I didn’t have to deal with the physical trauma she experienced I didn’t have the same hit to my emotional system and I am aware that my whole post operative experience was 100% less stressful than hers. So for me it’s team robot all the way!

 

 

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