Published on AAGL listserv

Date: Mon, 29 Nov 2010 20:59:15 -0500
From: “Philippe R. Koninckx and Anastasia Ussia”
Subject:Informed consent and medicolegal exposure .

Reading the last exchange of ideas, it seems important not to mix several issues.
1. Open hysterectomy versus laparoscopic hysterectomy. This is difficult to understand, given the legal obligation to obtain informed consent, which implies explaining the intervention and the alternatives. In Belgium, the latter
moreover is obligatory. With the available evidence today, it seems highly unlikely, that any patient being explained the pro’s and cons will choose for open hysterectomy. If the alternatives were not explained and performs an open hysterectomy, the surgeon exposes himself to medico-legal action.
2. Robotic surgery. For a debate at the ESGE in Barcelone this year we reviewed the literature. Today there is no proven benefit in gynaecology, nor to the best of our knowledge in other disciplines. The increased costs associated with robotic surgery, however are obvious.
3. Tubal sterilisation. Important in this discussion is the often forgotten aspect of maintaining the possibility of reversal eg with Yoon ring or clips

Philippe R. Koninckx and Anastasia Ussia
Universities of Leuven, Belgium, Oxford UK and Rome Italy
Gruppo Italo Belga, Rome Italy.