What You Need to Know and What to Expect On the Day of Surgery

If you are scheduled for surgery at Prentice Women's Hospital at NMH, please review the Surgical Instructions page on their website.

Please arrive no later than the time you were given. If you are late, your surgery may be canceled, since the OR usually runs on a tight schedule. Please make sure we have a cell phone number or other way to reach you the morning of your procedure in the event that we would like you to arrive earlier or later than originally scheduled.

On arrival, you will proceed directly to the 6th floor of Prentice Women’s Hospital.
There is a check-in desk immediately after you get off the elevator. You will then be taken to your private pre-op room.

 

Before Your Surgery

A visitor may accompany you to the pre-op area. Once you are in your room, you will be given a gown to change into. You will be asked to remove all jewelry, wigs, false eyelashes, eyeglasses, contact lenses, hearing aids and dentures. Please bring appropriate storage containers. Do not bring any valuables with you. 

The nurse starts by getting basic information and confirming things that she has already been told, like your name and the specific operation for which you are scheduled. She will take your blood pressure, temperature, and pulse.

A urinalysis and pregnancy test is usually done. No matter how unlikely pregnancy may be, many hospital policies require pregnancy tests on all menstruating women prior to surgery. The nurse is also the first of many people who will ask you if you have had anything to eat or drink and if you are allergic to anything. 

The Gynecologic Resident
The next person you will meet is the gynecologic resident. The gyne resident is a licensed doctor, not a medical student. He or she has completed four years of medical school and is doing an extra four years of post-graduate training to specialize in Obstetrics and Gynecology.  As part of their training, they participate in surgery.  Many people think that residents only observe other surgeons operating.  While certainly there are many instances in which they are observers, they also function as assistants to your attending surgeon.

Patients sometimes request that they not have a resident participate in their surgery. This is usually not an option, since every surgeon needs an assistant, and at a teaching hospital the assistants are always resident doctors. In fact, insurance companies will not even cover the cost of a different assistant if a resident is available. 

Residents do a high volume of surgery and are capable surgeons.  They are not strangers to us; we operate with them every day and know them very well.

Residents are assigned to cases that are appropriate for their level of experience, and your doctor has a say as to who their assistant will be.  If they are assigned a resident and feel that they need someone more experienced, another resident will be assigned.  Your doctor stays scrubbed and in the room for the entire duration of the surgery and will be taking responsibility for everything that happens during the course of the operation.  At no time is the resident on his or her own.  

The gyne resident will introduce him or herself as the resident who will be assisting your doctor.  They will usually know a lot about you, having already spoken to your doctor and read your history.

The Medical Student
Medical students are required to rotate through all the specialties during their third year of medical school.  They usually spend a week or two on gynecologic surgery as part of their rotation in Obstetrics and Gynecology.  While they often scrub for surgery, they rarely do anything other than hold something the surgeon has asked them to hold; they are essentially observers.   They do nothing that will influence your surgery other than provide an extra pair of hands.

The Anesthesiologist
The anesthesiologist who will be taking care of you also greets you in the holding area. At the pre-op anesthesia appointment, all issues regarding anesthesia will be discussed. If a nurse anesthetist or anesthesia resident is involved in your care, they will also introduce themselves. 

The Consent Form
The next step, if it was not done in advance, is to sign consent forms.  Usually there are two forms: one for the anesthesia and another for the surgery.  The lawyers, not the doctors, design the consent form. The term "informed consent" is a legal term meaning that the patient has been informed of what the surgery will include, what potential complications might be, what alternatives are available, and what outcome the patient should expect.

There is usually a section that asks for permission to transfuse blood if necessary.  Understand that transfusions are only given in life-threatening emergencies.  No one is going to give you blood unless you really need it. If you are a Jehovah's Witness, or have another issue with this, it should be discussed with your surgeon prior to the day of surgery.

Another section of the consent asks for permission to photograph or videotape portions of the surgery. Your surgeon, as part of your medical record, may keep videotapes and photos.  If you are interested in having your own videotape as a record of your surgery, ask your doctor before hand.  

Intravenous (IV) Line
Everyone must have an IV prior to surgery since that is the way you get fluids, and ultimately the drugs that put you to sleep or provide sedation.  If you are having a regional anesthetic, you still need an IV since you need to get fluids prior to placement of your epidural or spinal.

The anesthesiologist will inject local anesthesia in the skin where the IV is to be inserted.  This burns for a few seconds.  The IV is a needle with a soft plastic catheter, which is poked through the anesthetized skin and into the vein.  Once the catheter is in the vein, the needle is removed and discarded so that only the soft catheter remains.  The IV is then hooked up to a bag filled with fluid.  When your IV is first started, no drugs are in the bag of fluid; usually it is a saline solution, which may or may not have sugar in it.  Any medication that is to go through the IV will be added later. 

You will see your attending surgeon in the holding area prior to going to the operating room.  While there will be time to answer a quick question, please call us prior to surgery if you have any major issue that you would like to discuss.

Site Marking
The last thing that will happen prior to leaving the pre-op area is either the resident or your attending doctor will "mark" the surgical site. This is required by the hospital lawyers for certain procedures to ensure that the entire team knows what part of the body the surgery is to take place on. The practice of "marking" the surgical site stems from incidents when, for example, the left knee was operated on when the right knee had the problem.  Even though you only have one uterus, your belly will be marked.

Visitors and family
Once you leave the holding area, your visitors are given an estimated time of when they should return to the waiting room to wait for the surgeon.  It’s a good idea to get there a little bit early, since sometimes surgery takes less time than expected.

The surgery may also take longer than expected, which does not mean that something went wrong. Sometimes it just takes longer. If the surgeon goes out to talk to family, and no one is there, she or he will be starting another case and may not be available to speak to them for hours.  If your family is planning on leaving the waiting area, have them give one of us a cell phone number so we can call them when the surgery is finished. Tell your surgeon exactly who will be there, whom she can talk to, and how much detail you want them to know. We ask you to do this because sometimes well-meaning friends or relatives show up to keep a visitor company and end up hearing surgery details that are none of their business.

If you are having outpatient surgery
Your visitors will be allowed to sit with you in the recovery area once you are fully awake. A nurse will come and get them from the waiting room. You will not be discharged until you are able to get out of bed, eat, drink, and urinate. Discharge instructions will be given to you at that time.

If your ride home will not be at the hospital, your nurse will be happy to call them when you are ready to be discharged. The hospital will not let you leave unaccompanied under any circumstances, so you must have someone available to take you home.

If you will be admitted to the hospital for the night
Your visitors will not be allowed to come to the recovery room. Roughly one hour after you have left the operating room, you will have a room assigned to you on the 14th floor of Prentice. If the room is ready, your visitors are welcome to wait for you in your room once they have spoken to your doctor.

What if you are not sure if you will be going home?
Sometimes, it is not certain if you will be staying overnight. For example, many laparoscopic hysterectomies are outpatient but it is always possible that a stay will be necessary.  If that is the case, you will usually be admitted to the 14th floor until later in the afternoon, when it is certain that you are able to leave. Your visitors should wait for you in the 14th floor room. This should be discussed with your doctor prior to the day of surgery.     

The Operating Room
The first thing you will notice upon entering the operating room is the temperature, which might seem to be roughly thirty below zero. The hospital is not trying to save money on the heating bill; the operating room is cold because the huge lights over the operating table generate a lot of heat. Those overhead lights are off when you enter the room, but the room is kept cool in anticipation of when they will be turned on. In addition, the surgeons and scrub nurses wear gowns, gloves, masks and hats that are quite warm.  You will be given a warm blanket within minutes.  

The operating table is extremely narrow so that the surgeons are right up against you during the surgery.  You will be asked to scoot on the table from the gurney and to put your bottom near an indentation in the table. This is so you will not need to be moved after you are asleep. There is generally no pillow, but there is a small head cushion. The table is narrow, but you will not fall off. A safety belt is placed around your hips in the event that you move around. In addition, someone is always by your side.

Frequently, one or both arms are placed on an arm board. A safety strap is often placed on your arms (loosely) to "remind" you not to help during surgery. This is especially important if you have a regional anesthetic, which means you potentially have the ability to move your arms freely. If your arm is not secure, you may inadvertently place it on your abdomen. Since your surgeon does not need an extra hand, your arms will be placed out of the way and loosely secured.

If your legs need to be in stirrups for the procedure, they generally will be positioned after you are anesthetized. Operating room stirrups are not like office stirrups. They are cushioned foot rests, which cradle your feet and the back of the calves. Obviously, no effort is needed on your part to keep your legs in the proper position.

Compression Booties
One of the risks of any operation, and gynecologic surgery in particular, is the risk that a blood clot may form in the veins of your legs. Any time that someone's legs are immobilized for a long period of time, blood can pool and occasionally form a clot. The clot in and of itself is not dangerous. If that clot travels from your leg and lands in your lung, a pulmonary embolus results, which can have serious consequences. Normally during sleep, we move our legs around, which prevents formation of clots since the muscles in the legs keep the blood in the veins moving. During surgery, there is no movement, and particularly if surgery is lengthy, blood clots may result.

Compression booties are inflatable leg wraps that are placed around your calves and sometimes thighs shortly after you arrive in the operating room. Once surgery has begun, the booties inflate and deflate so that your legs are periodically massaged.  Essentially, the booties reproduce the effect of moving muscles on the venous system of the lower extremities and prevent blood from pooling. Since the use of compression booties has become standard, deep vein thromboses are a rare complication.

Usually, the booties remain on until you are walking around. For some women, this will be a few hours after surgery; for others, it is the next day. If you are having a short procedure, such as a D&C, you will not need compression booties.

 

Recovery Room
After surgery, you will be transferred to a private post-op recovery room. Drugs that you receive during surgery cause a temporary amnesia. Those, along with whatever pain medication you receive, make the hour or two you spend in the recovery room a blur which most people have little or no recollection of.

The exception is if you had a regional anesthesia or IV sedation for a short procedure rather than a general anesthetic. In that case, you will be awake and alert almost immediately after you arrive in the recovery room.

Generally, you will see your surgeon in the recovery room before you are discharged home or to the 14th floor. In some cases, you will not see your surgeon in the recovery room since she may already be in another surgery. Your recovery room nurse will review discharge instructions with you and will give you any information about your surgery we would like you to have.