FAQs – Information for Patients
SURGERY FAQs
QWhat are the risks of surgery?
ARisks of surgery include bleeding, infection, damage to internal organs (like the bladder or bowels), nerve injury, need for blood transfusion, blood clots, need for additional surgery, and extremely rarely death. The risks of surgery are minimized when your surgery is with an experienced and skilled surgeon. Thank goodness Dr. Nezhat has never had a patient death during his entire career and he wants to keep it that way.
QHow many surgeries has Dr. Nezhat performed?
ATo our knowledge, Dr. Nezhat has done more surgeries for endometriosis than any other surgeon, performing at least 15,000 surgeries. Dr. Nezhat and his team pioneered and invented many of these techniques and methods.
QIs the robot or laser used in surgery?
ADr. Nezhat has all the various instruments and devices available to him including laser, robot, electrocautery, ultrasound energy, etc and uses what he needs. He also uses various techniques including excision.
QWhat will my abdomen look like after surgery?
ABecause carbon dioxide gas is used to insufflate the abdomen to allow instruments into the abdomen, you may notice mild bloating after your surgery. Most patients will have 4 small (5-10mm incisions) on the abdomen – one in the belly button, one above the pubic bone, and one near each hip bone. In cases of removal of large masses like fibroids, you might have an incision around 2in under your bikini line. Bruising around the incisions is also to be expected and may extend to the legs and labia. The incisions are closed with a stitch under the skin. Steri-strips, which look like small bandaids, will remain on the incisions for 7-10 days. On top of that, there will be gauze and a clear adhesive.
QWhat is the most common complaint after surgery?
AMost patients experience shoulder pain after surgery. This is actually referred pain from residual gas that is used in the abdomen that is still under the diaphragm. It is not harmful but can take a few days to completely dissolve. Walking regularly after surgery can help expedite the process.
QWhen can I drive after surgery?
AYou can drive as soon as you are no longer taking narcotics and feel strong enough to push quickly on the brakes without pain in your abdomen. This takes place after one week for most patients.
QWhen can I go back to work?
AMost patients feel ready to go back to work one week after surgery. However, you can take as much time as you need to fully recover. FMLA will generally protect a 6-week leave from work following surgery.
QWill I need another surgery?
AThis depends on a multitude of factors including the reason for the surgery, the nature of the disease, the severity of pathology, the experience of the surgeon, and adherence to medical management following surgery. Fibroids and endometriosis may recur and sometimes require repeat surgeries. However, on average, 85% of Dr. Nezhat’s patients do not need a subsequent surgery.
QWhere are the incisions made and how big are they?
AThe incision for the insertion of the laparoscope in usually done at the belly button. It is 3-12mm in size (quarter to half inch). Similarly 1 to 3 more incisions may be made lower, close to the pubic bone in order to insert the operating instruments. These incisions are also very small (quarter to half inch).
QWhat exactly is Laparoscopy?
AIt’s a surgical technique in which the abdominal cavity (belly) is inflated with carbon dioxide gas (CO2) and distended. A small (3-11mm thick) telescope (resembling a long and thin tube) is then inserted through the belly button, inside the abdominal cavity.
This telescope called laparoscope has a light source at its end and a camera that allows the surgical team to watch on TV monitors, what is inside the belly under magnification and in great detail. The gas already inflated inside helps keep the walls of the abdomen and the organs separated from each other and allows excellent exposure. Additional (one to 3) 5-10mm incisions are made close to the pubic bone to insert long and thin instruments. These instruments are essentially extensions of the surgeon’s hands allowing the surgeon to use these instruments from outside the body and perform surgery inside the abdominal cavity.
QWhat are the advantages of laparoscopy?
AExcellent visualization (exposure) of organs, minimal trauma to organs, Small incisions with less chances of wound infection or/and breakdown. Significantly less adhesion formation (scar tissue inside the abdomen that may cause pain, infertility or bowel obstruction). In addition shorter hospital stay and significantly faster recovery. This means faster mobilization of the patient, that hopefully minimizes postoperative complications.
QHow long will I stay in the hospital and how soon will I recover from surgery?
AIn general most of our patients are ready to go home the same day. In cases of more extensive procedures an overnight stay is reasonable for observation but still the majority of those patients will go home the next day. Recovery is fast and most patients are able to resume their regular activities (including work) within 3-10 days, depending on the type of surgery. That is much faster than the usual 4-6 weeks of recovery after open abdominal surgery.
Q Are there any risks, disadvantages or contraindications in laparoscopy?
AAs with any medical/ surgical intervention or procedure there could be some risk associated with it. These risks are similar to those encountered with conventional open surgery (bleeding, infection trauma to adjacent organs etc…)
Extensive operative laparoscopic procedures are technically more demanding and require additional training and surgical skills from the surgeon. In the hands of experienced and trained surgeons laparoscopy is a very useful technique with minimal risks besides the ones encountered in traditional surgery and significant benefits for the short and long term well being of the patient.
Some absolute contraindications for laparoscopy are circulatory collapse (shock), and severe cardiopulmonary disease.
Q Is it possible to have my uterus, big fibroids or cysts removed through these tiny incisions? How is that possible?
AYes, even a very large uterus or fibroids the size of a large softball have been removed laparoscopically. The tissue to be removed is cut into pieces with specially designed- for this purpose-instruments. Then the pieces are removed through one of the incisions.
Q Which Health insurances does your office accept?
AOur office in Palo Alto will accept all insurances. Except the following plans: HMOs, CHAMPUS, Medi-Care or Medi-Cal. We are contracted with PPO employer based health plans through Cigna, United Health Care, Anthem Blue Cross and Blue Shield of CA.
For further information regarding your insurance, please contact our office at 650-327-8778.