dVH/RALH: Upcoming hysterectomy 10/25: Getting nervous! Body Positioning During Surgery?

My surgery is coming up on 10/25. Less than three weeks away. I am scheduled for Da Vinci robotic supracervical hysterectomy (leaving ovaries and cervix, taking uterus and tubes), sacrocolpopexy, pubovaginal sling for bladder/urethra, LEEP to remove a section of my cervix, and likely both A&P repairs. I was told I will be positioned with my feet well above my head and I am very nervous about being in this position for so long (about 4 hour surgery is estimated if everything goes smoothly. Longer if there are any surprises). I am about 40-45 lbs. overweight with a very large chest. I think breathing is going to be quite difficult with my boobs all up in my face. LOL Anyone have any feedback on how sore they were or how difficult it was after being sort of upside down for so long? I know I can't wear a bra during surgery. I have already met with the surgeon multiple times and with an anesthesiologist. Neither have mentioned anything about my size being an issue at all but I've been googling and hearing otherwise. All they mentioned is to make sure I stretch a few weeks before surgery to lessen leg muscle pain. I just want to be as prepared as possible and know what to expect. Won't mucous buildup in my nose and throat be an issue too? Ugh too much worrying!

Also, regarding the LEEP procedure and the A&P repairs - My surgeon told me she thinks these will be the most painful things to recover from. Advice other than using the preemie diaper ice packs? Is there a pain relief cream or anything I can use? My surgeon seems to think I should be able to manage just fine with a few Advil every few hours after having all this done but I am doubtful. She does not like to give stronger pain meds because they can constipate and that is a big no no after all this work.

Perhaps you might contact your dr regardi g your positioning concerns because you have the right to know the answer to your questions. I had body positioning questions due to a bad back but had laporoscopic surgery. I demanded answers! I even asked them in the OR before they placed me under anaesthesia.

Hi sms814 -

I can answer some of your questions.

Regarding the position during surgery. You are talking about the Trendelenburg position, where you are flat on your back and your head is slightly tilted toward the floor. Here is an article on Position during Hysterectomy

I am sure that the doctors have dealt with all types of body sizes and will make sure you can breath - I do not think breast size will be a problem. The anesthesiologist will make sure that you are breathing and stable - that is their job and they are very good at it. Keep in mind that they have done many, many of these surgeries. But do talk to your anesthesiologist and surgeon before your surgery to get all of your questions answered. Here is an article that may help:
Anesthesia | Talking to the Anesthesiologist before Your Hysterectomy

We do have lots of ladies on this site. Hopefully other women can respond to your repair questions.

Hello, regarding the AP repairs. In addition to ice packs (I used sanitary pads) I would have wet wipes, a peri bottle and some numbing spray for the perineum. I had to take percocet and ibuprofen alternating during the first two weeks. I would insist on a rx for pain meds as needed. I also suggest you take stool softeners twice per day for at least one month to avoid constipation.

You will have a breathing tube in place and the anesthesiologist will be in charge of your breathing, so breast size will not interfere with your breathing. But be sure to ask about all your concerns, to ease your mind, it's the unknown that often stresses us the most.

Thank you for all the replies. I am researching the steep Trendelenburg position and see this in multiple places - steep Trendelenburg position for more than 3 hours may predispose a patient to potential brachial plexus injury, corneal abrasions, laryngeal edema, cerebral edema, and posterior ischemic optic neuropathy. The etiology of these potential intraoperative complications is unclear. It is believed, however, that prolonged steep Trendelenburg position may be a contributing factor, particularly in patients with a body mass index greater than 30.

I know they've done this surgery many, many times but I'm freaking out that I may be setting myself up for issues I didn't have going in... This anxiety is killing me. The surgeon will not call in Xanax for me. She said to speak with my primary care physician about getting it. I may have to. I'm making myself nuts over here. LOL Next week cannot get here soon enough!

I was in the “45 degrees, head down” position for my DaVinci complete hysterectomy. As another poster said, they will be breathing for you, so your breast won’t be a specific issue. I’m well over 100 lbs overweight and had no trouble. However, one thing they warned me about at my pre-op, anastheia appointment was limb numbness from being in one, restrictive position for a long time. My surgery was on the 13th and I still have numbness in my left forearm (not my IV arm). I also have some bruising under my jaw, presumably from the breathing tubes going in or coming out.

Good luck with your surgery.

Thank you for replying. I am also nervous about the limb numbness and such. We heavier gals have more to hold down with the straps and such in that position for so long so I am sure there is more injury than there would be with someone lighter. I really hope your numbness subsides soon! I spoke with someone else who also had the jaw and face bruising and pain. She was not sure what that was from either. I'm trying hard to think positively but at the same time trying to go in as prepared as possible so all this feedback is very helpful.

I had a da Vinci and the idea of being head down is weird, disconcerting. But it’s not like you’re standing on your head

It’s all very nerve wracking. I never considered I’d have a breathing tube. D’uh. But I never thought about it I guess.
My anesthesiologist told me I could have a swollen itchy face, and temptation to rub/scratch my face and eyes, from the head down position. That was bizarre to me, and I have anxiety so I actually sat on my hands when he was telling me that, and we addressed my basic anxiety . It was helpful to have an in person meeting with him. A clue someone would not see on the phone.

None of these things happened - no swollen or itchy face.

Talk to the appropriate person before your surgery about everything you are worried about, just for peace of mind.
Nothing I was worried about happened, if that helps

Thank you. I already met with the anesthesiologist and of course am finding all this about the position after the fact. I will ask at the hospital before I go in or call them if it's really bugging me. Thanks!