Patient check-list before surgery
Checklist before surgery
Is the indication correct
Is the surgeon ok with this intervention
- Has my surgeon the skills, and what are his personal results?
- Did I get information about alternative surgical techniques, as is required for informed consent
- did I get information about his personal complications?
- did the surgeon know which intervention I do NOT want, e.g. ovariectomy?
Is the environment OK: i.e. the team and follow-up?
Is the preoperative planning ok?
- Video registration is a strong indication that the surgeon feels confident.
- Will you get a copy of the video?
Difficulty of gynecologic laparoscopic surgery
Basic training permits simple surgery such as ovariectomy and cystectomy.
- Level 1 permits a total laparoscopic hysterectomy (TLH) of up to 500-800 grams.
- Level 2 adds dissection and suturing and advanced knowledge of anatomy, as required for pelvic floor surgery and promontofixation.
- Level 3 is advanced laparoscopic surgery. When the anatomy is altered, and other organs such as the bowels, bladder and ureter are involved, more experience is needed. In addition, during surgery, the risk and the advantages of complete excision of endometriosis have to be balanced. This is the surgery for deep endometriosis and debulking for disseminated ovarian cancer. Another surgery at this level is surgery that is rare with obviously few experienced surgeons. Examples are hysterectomy for a uterus of more than1 a kilo, the laparoscopic Wertheim for cervical cancer and the laparoscopic para-aortic lymphadenectomy
The physics of CO2 laser surgery and of electro-surgery are depicted on the right. The minimal tissue damage and the haemostatic capacity of the laser will probably result in fewer adhesions if used well. The main indications of CO2 laser surgery are excision and/or vaporisation of superficial pelvic endometriosis. CO2 laser, however, is not suited for dissection surgery: this means that the surgeon should be skilled in both laser and electro-surgery.