Understanding the Gynecologic Procedure
Do you understand what will be done? Surgery can be done via a number of routes, so how will yours be performed? The physician may toss around terms such as minimally invasive or laparotomy; ask what these mean. She may show you pictures to demonstrate the procedure or a video; if not, jot down the name and google it later. You should understand what will be removed, what are the consequences of this, and will the tissue be sent for histopathologic examination (microscopic examination to determine if there are any abnormalities which is especially important if there is cancer or a concern for cancer).
Hysterectomy, the most commonly performed surgery in non-pregnant women, is a good example. When a doctor says hysterectomy it usually means removing the uterus but there are some additional aspects to this. The cervix is a part of the uterus but can sometimes be left in place. The ovaries and tubes are sometimes removed but sometimes left in place. Understand the specifics of your surgery. The uterus can be removed through a number of different routes from a long abdominal incision, which can be transverse or vertical to small laparoscopic incisions or no incisions on the abdomen at all if it is done through the birth canal.
Once the surgery is complete, are there any long-term consequences? Again if the ovaries are removed then you will no longer be able to produce eggs, this is called a surgical menopause and the consequences are highly concerning in a young woman. If you are at the age of a normal menopause, then it is less of an issue. If the uterus is removed then you can no longer carry a pregnancy. This may seem a simple point however not everyone is at the same health literacy level.
Finally, understand the risks of the surgery and potential complications. These risks include the standard ones but also the procedure specific ones. In the case of a hysterectomy, possible injury to the bladder and ureter are procedure specific risks. Standard risks include injury to the intestines, bleeding that may require a blood transfusion, infections of the wound or other body parts and the need for additional surgery to correct mistakes or address complications. Other potential complications include the development of a venous thromboembolism, pneumonia, reaction to medication, intestinal obstruction, heart attack and stroke. These problems can happen during surgery, immediately afterwards or several weeks later. In the case of the intestinal obstruction the time line of the risk is indefinite. Finally, the risk of medical error, especially medication related also exists and this can be the source of adverse outcomes. Please understand however that the risk of any of these occurrences is quite low and the potential benefit of the surgery should outweigh any of these risks.
Making the decision to have surgery can be a huge relief, but don’t exhale yet. You have a lot more work to do. Most of this involves paying attention to the details to ensure your health care team do their job. The descriptions above are the content of a normal informed consent process and are mandated by law in most developed countries. Be an advocate for yourself or a family member and make sure you understand the surgical procedure, the potential risks and complications and the long-term consequences of the procedure.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!
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