consent advice 2017 rcog
Diagnostic Laparoscopy
CONSENT FORM
- Name of proposed procedure or course of treatment
Diagnostic laparoscopy,with or without minor treatment of problems that may be expected given the presenting problem. This includes documentation of the findings that may include photographs or video that will be retained as part of the patient records. - The proposed procedure
Describe the nature of laparoscopy. Explain the procedure as described in the patient information. This involves the insertion of a laparoscope through a small incision on the abdominal wall to view the peritoneal cavity and
pelvic organs specifically in order to identify a cause for the patient’s symptoms. This involves the use of additional
small incisions to allow the use of instruments to move structure within the abdomen to allow a thorough inspection and possible treatment if agreed in advance.
Potential minor treatments,such as dye hydrotubation, excision of mild superficial endometriosis, division of filmy adhesions (bands of tissue) or tissue biopsy, should be discussed with the patient prior to surgery and
documented in the patient record and/or consent form.
Other procedures that might be anticipated (such as treatment of ovarian cysts, treatment of more severe
forms of endometriosis,thick or vascular adhesions) must be discussed and additional consent obtained specifically with associated additional (risk of delayed presentation with the use of energy devices) risks discussed.
There is a possibility of finding conditions that require more extensive surgery.Therefore, an indirect risk is
establishing the need for more major gynaecological surgery at a later date once the patient has been able to
consider the consequences of that more major surgery. In these circumstances,small samples of tissue may be
taken for biopsy and analysis, but no disease modifying or curative surgery will be attempted. - Significant and frequently occurring risks6–8
It is recommended that clinicians make every effort to separate serious from frequently occurring risks.Women
who are obese or very thin; who have significant pathology; who have had previous surgery; or who have preexisting medical conditions must understand that the quoted risks for serious or frequent complications will
be increased. The risk of serious complications at laparoscopy also increases if an additional therapeutic
procedure is performed.Women should also be advised that laparoscopy may not identify an obvious cause for
her presenting complaint.
4.1 Serious risks
These include:
● The overall risk of serious complications from diagnostic laparoscopy is approximately 2 in 1000 women
(uncommon).This includes damage to the bowel, bladder, ureters, uterus or major blood vessels which would require immediate repair by laparoscopy or laparotomy (2/3 chance) (open surgery is uncommon). However, up to 15% of bowel injuries might not be diagnosed at the time of laparoscopy.
● Failure to gain entry to the abdominal cavity and to complete the intended procedure.
● Hernia at site of entry (less than 1 in 100; uncommon).
● Thromboembolic complications (rare or very rare).
● Death; 3–8 in 100 000 women (very rare) undergoing laparoscopy may die as a result of complications.
4.2 Frequent risks
Frequent risks are usually mild and self-limiting. They may include:
● bruising
● shoulder-tip pain
● wound gaping
● infection. - Any extra procedures which may become necessary during the procedure
These may include:
● laparotomy
● repair of damage to the bowel (including the possibility of a stoma), bladder, uterus or blood vessels
● blood transfusion. - Intended and potential benefits
To find the cause of the woman’s presenting symptoms. As this is a diagnostic procedure, it is unlikely to alter symptoms. Occasionally, a minor laparoscopic procedure is appropriate to treat some of the identified causes or relieve the symptoms. It might fail to achieve a diagnosis for the woman’s symptoms. It may not be appropriate
to perform more advanced surgery at the time of diagnostic laparoscopy as the patient may require time to consider all further options depending on the findings of this test. - What the procedure is likely to involve, the benefits and risks of any available
alternative treatments, including no treatment
Insertion of a laparoscope through a small incision on the abdominal wall to view the peritoneal cavity and the
pelvic organs specifically to try and identify the cause of the woman’s symptoms.The role of prior diagnostic
imaging must be discussed, together with the option of no investigation. - Statement of patient: procedures which should not be carried out without further
discussion Other procedures which may be appropriate but not essential at the time should be discussed and the woman’s wishes recorded. - Preoperative information
A record should be made of any sources of information (such as RCOG or locally produced information leaflets.
Doctors must enter into a dialogue with patients and be even more careful to give and document:
● Clear and accurate advice on the risks and benefits of a procedure, and the alternatives.
● Health service organizations should amend consent to treatment policies to reflect this development and provide training to ensure that clinicians are aware of and follow the law.
● Existing information sheets for procedures need to be reviewed to ensure they reflect the new position and doctors should not rely solely on these when consenting patients. - Anesthesia
Where relevant,the woman must be made aware of the form of anaesthesia planned and be given an opportunity to discuss this in detail with the anesthetist before surgery. It should be noted that for women who are obese,
there are increased surgical and anaesthetic risks
Do as consented do not do more except
- life saving- ectopic
- minimal intervention to relieve symptoms – detorsion
- if hemodynamically unstable that haemorrhage will affect her life as in case of ectopic
- stable patients leave it for another appointment
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