Lawrence Gobetz: Before You Sign Consent for a Hysteroscopy, Ask These Questions
Lawrence Gobetz, Founder and Medical Director of Vitalab Fertility Clinic, shared on LinkedIn։
“Before you sign consent for a hysteroscopy, ask these questions.
Hysteroscopy is the camera operation used to remove fibroids, polyps, scar tissue or retained pregnancy tissue from inside the womb. In trained hands, it is one of the gentlest and safest procedures in gynaecology. It has almost entirely replaced the old blind scrape, and most women go home the same day.
But it is only as safe as the person performing it, and there is one risk most patients have never heard of.
To see inside the uterus, the surgeon has to fill it with fluid under pressure. Some of that fluid is absorbed into the bloodstream through the open vessels of the uterine wall. In a short, straightforward case this is trivial. In a long or difficult one it is not. Too much absorbed fluid dilutes the blood, floods the lungs and swells the brain, and it can be fatal.
It is also almost entirely preventable, because it is measurable. The fluid going in and the fluid coming out must be balanced continuously, out loud, throughout the operation, and there is a number at which the surgeon stops, finished or not.
A specialist registration tells you that a doctor is a gynaecologist. It does not tell you how many of these particular operations they do, or whether they have a protocol for that number.
So ask. A good surgeon will not mind:
- How many of these do you do in a year? How many of my particular type?
- Who measures the fluid balance during the operation, and how often is it called out?
- What is your stopping point, and would you stage the operation over two sittings rather than push on?
- What distension fluid do you use, and why that one?
- Will an anaesthetist be present and monitoring throughout?
And if you are uncertain, ask for a second opinion from a doctor who sub-specialises in this work. It is not rude, it is not disloyal, and no competent surgeon is offended by it. Read about your condition. Ask your questions. Then decide.
Informed consent means informed. The signature at the bottom of the form is the least important part of it.”
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