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Having Surgery



Specialized Surgical Procedures:   da Vinci®   |   NovaSure®   |   Essure© Permanent Contraception
Pre-Operative Information   |   Bowel Prep Information   |   Post-Operative Information



Specialized Surgical Procedures



da Vinci® Surgery
If you have just been diagnosed with a condition requiring surgery, until very recently your options included traditional surgery with a large open incision or laparoscopy, which uses small incisions but is typically limited to very simple procedures.

Thanks to a breakthrough surgical technology, there is a new category of minimally invasive surgery for which you may be a candidate. It is a minimally invasive alternative to both open surgery and laparoscopy. Through the use of the da Vinci® Surgical System, we are able to offer a minimally invasive option for complex surgical procedures.

It is important to know that surgery with da Vinci® does not place a robot at the controls; your surgeon is controlling every aspect of the surgery with the assistance of the da Vinci® robotic platform.

da Vinci® will change how you experience surgery. Drs. Miller and Heitmann have been using the da Vinci® system since 2009 and Dr. Parker since 2010. We look forward to talking with you about how this technology can help you heal.

NovaSure® Endometrial Ablation
For women with heavy menstrual bleeding, NovaSure® is a quick, safe, and simple procedure to lighten or stop your periods, without the side effects of hormones or the risks of hysterectomy. For 90% of women, menstrual bleeding is dramatically reduced or stopped. NovaSure is a one-time, five-minute procedure.

All of our physicians are pleased to offer NovaSure® in the comfort of our office.

Essure© Permanent Birth Control
Permanent contraception, or permanent birth control, is any procedure that prevents pregnancy for the rest of your life. Traditional procedures for permanent contraception are tubal ligation (or "having your tubes tied") for women, and vasectomy for men. Both of these procedures require surgical incisions.

The next generation of permanent contraception involves a minimally invasive procedure to prevent pregnancy. This means that it does not require any incisions, or cutting of the skin, to perform. Essure Permanent Birth Control is a simple, safe, minimally invasive procedure that permanently prevents pregnancy. It works by stimulating your body's own tissue to grow in and around small, flexible inserts that are placed inside your fallopian tubes through a hysteroscopic procedure.

All of our physicians are pleased to offer Essure permanent contraception in the comfort of our office.

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Pre-Operative Information


In anticipation of your upcoming surgical procedure, there are several items we would like you to keep in mind in order to optimize your surgical outcome. Our goal is to make your surgical experience as pleasant as possible. Please follow these simple instructions:
  1. There are medications and herbal supplements that can increase your risk of bleeding. Please discontinue the following medications at least 10 days prior to surgery: aspirin, ibuprofen (Motrin, Advil), naprosyn (Aleve), Plavix, most anti-inflammatory (arthritis) medications, Ginkgo Biloba, Ginseng, Vitamin E and any dietary supplements containing Ephedra. If you have pain, you can take acetaminophen (Tylenol). If you are taking a prescribed anticoagulant medicine (such as Warfarin/Coumadin) you must inform us so that it can be discontinued in a controlled fashion in consultation with the physician prescribing it.
  2. Intact skin is your best protection against surgical site infection. Please do not shave the skin anywhere near where your surgical incision will be made.
  3. If you have any significant medical problems that have changed since your last visit, please let us know. If you are having any cardiac complaints such as chest pain or shortness of breath, please contact us immediately so that a preoperative evaluation can be done.
  4. Do not eat or drink anything after midnight the night prior to surgery. Ask your physician what medications should be taken (with a sip of water) the morning of surgery. Continue contraception until the day prior to surgery unless otherwise instructed.
  5. Constipation is common post-operatively due to anesthesia and pain medications. Please ensure that you are having regular bowel movements in the days before surgery. If assistance is needed, you can try docusate (Colace)-a stool softener, Miralax-a gentle laxative that is mixed in with juice of your choice, or Milk of Magnesia-good for occasional relief of constipation.

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Bowel Prep Information


The goal of the bowel prep is to prepare your bowels so that stool will not be present that could compromise your scheduled surgery. Please follow all of these instructions. Call us with any questions.

You must purchase from a pharmacy:
  • Magnesium Citrate
  • Fleet's Enema

Instructions

Day prior to surgery:
  • Eat a light breakfast and lunch. Consume a Clear Liquid Diet (see below) beginning after lunch. Drink LOTS of fluids WITH CALORIES!
  • Drink 1 bottle of Magnesium Citrate no later than 5:00 p.m. You may want to do this early in the day as it will give you diarrhea.
  • Nothing to eat or drink after midnight. (The only exception is if your physician has instructed you to take medications the morning of surgery with a sip of water)

Day of surgery:
  • If your stool is not completely clear, please use a Fleet's enema at least 1 hour before leaving your house.

Clear Liquid Diet

These items are ALLOWED:
  • Water
  • Clear broths -- chicken broth, beef broth, vegetable broth
  • Juices -- apple juice, prune juice, grape juice, cranberry juice, lemonade, Kool Aid
  • Clear beverages -- sodas (7-Up, Sprite, Ginger Ale), tea, coffee, Gatorade
  • Ices/Jello -- clear Jell-O, popsicles without fruit, Italian ices

These Items are NOT ALLOWED
  • Milk or Cream
  • Milkshakes
  • Orange Juice
  • Tomato Juice
  • Cream Soups
  • Oatmeal
  • Cream of Wheat

Please note: You may drink unlimited amounts of clear liquids prior to midnight and are encouraged to drink as much as possible to prevent dehydration from the laxatives.

Problems:
  1. If you are experiencing indigestion, cramps, nausea, or vomiting lie down and rest. Continue to drink fluids, but not coffee. Do Not Smoke. You may take 1 to 2 teaspoons of Maalox or Mylanta.
  2. If you vomit more than twice please call according to the instructions below.
  3. If you have severe diarrhea and feel weak, continue to take liquids.
  4. If you are not having bowel movements use a fleets enema at 8:00 p.m.

If you continue to experience problems please call us at our office 239.513.0053 or, after hours, at 239.498.3227.

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Post-Operative Information


The following are general guidelines to help as you recover. If you have additional questions, please call us at the office 239.513.0053. If you need a physician after hours, please call us at 239.498.3227.
  1. Pain Medication: Take your prescription ("narcotic") pain medication as directed on the bottle. Many narcotics also contain Tylenol (acetaminophen). Do not take more than 650 mg of Tylenol every 4 hours (a total of 4000mg/24 hours). If you need additional pain medication, you can take Ibuprofen (Motrin) up to 600mg every 6 hours. Consider alternating 2 medications (the narcotic and ibuprofen) so that every 3 hours you take alternating medications. As your pain improves, substitute Tylenol for the narcotic pain medication, using the narcotics only as needed.
  2. Food/Constipation: Eat as tolerated. You may want to start with a soft, bland diet. Drink plenty of fluids. Both surgery and narcotic pain medication can cause constipation. Consider starting a stool softener (Colace, Docusate, Senokot). You can also use a gentle laxative such as Miralax. IF YOU ARE NOT PASSING ANY GAS FROM BELOW (FLATUS) OR STOOL, PLEASE CALL US.
  3. Activity: Slowly increase your activity as you start to feel better. Walking is allowed but no intense exercise until cleared by your physician. No swimming or sexual intercourse until cleared by your physician. For all hysterectomy patients (including da Vinci®), absolutely no sexual intercourse for a full 6 weeks after surgery.
  4. Returning to Work: For all in-office procedures and most outpatient surgeries (D&C, Hysteroscopy, Diagnostic Laparoscopy), you can return to work the following day. You may need 3-5 days to return to full employment duties. For da Vinci® procedures, many patients are ready to return to work (on light duty), after 10-14 days. For any procedure requiring an abdominal incision (including cesarean section), 6-8 weeks off of work will be necessary.
  5. Driving: Do not drive if you are taking pain medication or if you are unable to physically perform all the necessary physical requirements of driving. For major procedures (such as hysterectomy) this should be 7-14 days after surgery.
  6. Caring for your incisions: Most of our incisions (including all da Vinci® incisions) are closed with dissolvable sutures and surgical glue. The glue will make you incisions waterproof and it will peel off (like a scab) in about 2 weeks. If you have staples, call the office to arrange to have them removed 5-7 days after the surgery was performed.
  7. When to contact us:
    a. Pain not relieved with medication.
    b. Fever (temp > 100.6 degrees)
    c. Heavy bleeding
    d. Redness around or drainage from the incision site
    e. If you are concerned about anything!

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