Consenso informato ed isterectomia

consenso informato ed isterectomia A laparoscopic hysterectomy should always be preferred unless the uterus is more than 1 kgr. A bigger uterus can be operated by laparoscopy but this is technically more difficult. The biggest we operated was 1850 gram (in Oxford) There is a serious problem concerning informed consent for hysterectomy. Informed consent should inform the patient also about all alternative treatments, including those not performed by the gynecologist. Yet the incidence of total laparoscopic hysterectomies (TLH) is less than 10% in Belgium and in most counties of this world. Subtotal laparoscopic hysterectomy (SLH) is performed in less than 5%. Even if LAVH (laparoscopic assisted vaginal hysterectomy ) is considered a laparoscopic hysterectomy the incidence is less than 25%. Why is a laparoscopic hysterectomy better ? The advantages of a TLH for the patient are less pain, less scar, faster recovery and less adhesions. Without disadvantages. It is clear that the complication rate of a TLH is comparable or less provided the surgeon is an experienced laparoscopist. If accidents occur videoregistration is useful. Without videoregistration the technique might be blamed. Conversions ( start by laparoscopy and end by laparotomy) are extremely rare. Personally we never did a conversion. If more than 5% conversions occur , as often indicated in the literature, there must be a problem of indication and or skills of the surgeons. Again videoregistration is necessary to prove this. TLH cause less adhesions. Adhesions decrease further if the duration of surgery is short and associated with little bleeding. ” a better surgeon causes less adhesions” Training thus becomes a problem knowing that during training duration of...

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