An innovative pathway established at UHSussex has seen nearly 250 patients undergo same day total laparoscopic hysterectomy – the most in the South East.
A total laparoscopic hysterectomy allows the surgeon to remove the uterus using a keyhole technique to see into the pelvis and avoids a large cut to the lower abdomen.
This less invasive procedure has a much quicker and less painful recovery. Previously, patients would stay at least one night in hospital following this type of procedure.
Following treatment for breast cancer, Paula Hawkins, 56, from Chichester, experienced persistent abnormal bleeding and was advised that a hysterectomy was a good option due to her medical history. She was offered laparoscopic surgery at St Richard’s Hospital that allowed her to go home on the same day.
Paula said: “Having stayed overnight after my mastectomy, I found I didn’t rest at all due to noise and disturbance and felt that home comforts and familiar surroundings would be so much nicer.”
Miss Melanie Tipples, Consultant Gynaecology Surgeon at St Richard’s Hospital, said: “Being able to offer a day case hysterectomy to patients means that the procedure is not dependant on patients being able to stay in hospital. This means, surgery is less likely to be cancelled, ensuring patients can receive treatment quickly, particularly if the surgery is to treat cancer. We also know from the evidence that day case surgery reduces the risk of catching hospital infections and blood clots.”
In the wake of the Covid pandemic, colleagues developed a day case hysterectomy pathway as a response to the growing waiting lists and lack of beds that had become a crisis.
Having examined data for laparoscopic hysterectomies performed previously, the team identified that most patients were going home less than 24 hours later and those staying in hospital overnight were not accessing any care that they couldn’t receive at home.
This led to a multi-disciplinary team of surgery, anaesthesia, pre-operative, recovery, and pharmacy colleagues to develop a care pathway that supported patients to go home the same day as surgery if they were medically fit.
This same day pathway involves the selection of suitable patients, a 90-minute operation, a specific anaesthetic technique, and a combination of medications for when the patient leaves hospital, which all supports a quicker recovery.
Patients can typically go home six hours after their operation, following a review by the surgical and recovery team who determine if it is safe, and they are well enough.
Paula explains: “After my surgery, I woke up and was totally pain free. Within an hour of coming out of theatre I was sitting up and having a cup of tea. I remained pain free and was monitored by the nurses on a regular basis and I was seen by the surgeon, anaesthetist, physiotherapist, pharmacist, and surgical care practitioner, and was ready to go home by 4.30pm that day.”
Patients are sent home with the contact details for the team and a robust plan to return to the hospital should they have concerns.
Paula said: “My recovery at home was very good. Being in my own home, around familiar surroundings and home comforts was the best choice for me and I felt well prepared by the team for being there.”
As well as significantly shortening the patient’s journey and improving their experience, this pathway has also reduced waiting times for surgery and demand on inpatient care.
Miss Tipples said: “Before, due to pressures there were surgery cancellations on the day because there weren’t enough beds and that’s the most difficult thing for the patient who might have waited some time already to have their surgery, it was very disappointing.
“This pathway means most of our patients don’t need to be admitted and the small number that do, we can arrange a bed. Having now been successful in sending most patients home the same day, the pathway has now become seamless.”
Our teams are proud of their fantastic achievement both in the region and nationally and are dedicated to being able to offer this same day pathway to more patients.
At UHSussex, the same day pathway was first established by St Richard’s Hospital, who perform the most procedures using this method, which has since been implemented at our Princess Royal and Worthing hospitals.
Dr Bronwyn Middleton, Consultant Gynaecologist and Obstetrician and NHS England South East Lead for Gynaecology Recovery, said: “The gynaecology and theatre teams at St Richard’s have been instrumental in launching this fantastic British Association Day Surgery (BADS) and Getting It Right First Time (GIRFT) approved pathway which allows patients to return home safely on the same day as their surgery.
“To be able to offer this innovative pathway to patients at our other hospitals and seeing the growing number of people benefitting from just how efficient it is – is remarkable. With laparoscopic and vaginal hysterectomies being safely performed as day case procedures, there are minimal post-op complications and we’re ensuring the comfort and satisfaction of our patients.”
The NHS England programme Getting It Right First Time (GIRFT) has developed a best practice day case hysterectomy delivery guide and resources, which Miss Tipples and Sam Roberts, Surgical Care Practitioner, have contributed to.
The guide has been shared nationally to support other hospitals in setting up their own day case hysterectomy service.