High-Risk Consent for Bilateral Ovarian Cystectomy and Adhesiolysis Under GA
A comprehensive high-risk consent form for bilateral ovarian cystectomy and adhesiolysis under general anesthesia must include detailed information about both the surgical procedure and anesthesia risks, with clear documentation of the patient's understanding and agreement to these risks.
Surgical Procedure Information
Nature and Purpose of Procedure
- Bilateral ovarian cystectomy: Removal of cysts from both ovaries
- Adhesiolysis: Breaking down of adhesions (scar tissue) that may be causing pain or other complications
- Reason for procedure: Treatment of ovarian cysts and associated adhesions
Specific Surgical Risks
Common risks:
- Post-operative pain and discomfort
- Bleeding (intra-operative and post-operative)
- Infection (wound, urinary tract, pelvic)
- Damage to surrounding structures (bladder, bowel, ureters, blood vessels)
- Formation of new adhesions 1
Serious risks:
- Need for additional procedures (including possible oophorectomy if cyst removal is not possible)
- Conversion to laparotomy if minimally invasive approach is planned
- Ovarian damage potentially affecting fertility
- Incomplete removal of cysts or adhesions requiring further surgery
- Late complications from adhesions (bowel obstruction, chronic pain, potential impact on fertility) 1
General Anesthesia Information
Nature of General Anesthesia
- Medication-induced unconsciousness
- Breathing tube insertion (intubation) or laryngeal mask
- Monitoring throughout surgery by anesthesiologist
- Post-operative recovery process 2
Anesthesia Risks
Common side effects:
Serious side effects:
Alternative Options
- Alternative surgical approaches (if applicable)
- Alternative anesthesia techniques (regional anesthesia if appropriate)
- Non-surgical management options
- Consequences of no treatment 2, 3
Patient-Specific Risk Factors
- Document any specific risk factors that increase the patient's individual risk:
Documentation Requirements
Essential Documentation Elements
- Clear record of the consent discussion
- Patient's questions and the responses provided
- Patient's agreement to proceed with both the surgical procedure and anesthesia
- Signature of patient (and witness if required by institution)
- Date and time of consent discussion 2, 3
Format Considerations
- Use institution-approved consent form
- Document discussion in patient's medical record
- Consider supplementary documentation for high-risk patients 2
Best Practices for Consent Process
Communication Approach
- Use clear, non-technical language
- Provide written information where possible
- Use professional interpreters when needed (not family members) 2
- Tailor information to the individual patient's needs and concerns 2, 3
Timing of Consent
- Obtain consent well before the procedure when possible
- Allow sufficient time for questions and consideration
- Verify consent on day of procedure 2
Special Considerations
High-Risk Elements to Emphasize
- Potential for ovarian damage and impact on fertility
- Risk of conversion to more extensive surgery
- Long-term adhesion-related complications 1
- Anesthesia risks specific to the patient's condition 2, 3
Documentation of Patient Understanding
- Record that the patient understands the nature of the procedure
- Document that risks, benefits, and alternatives have been discussed
- Note any specific concerns raised by the patient 2
Remember that the consent process is a dialogue, not just a form to be signed. The documentation should reflect that the patient has been given the opportunity to ask questions and has demonstrated understanding of the information provided 2, 3.