Guidance on Informed Consent for
Hysteroscopy & Endometrial Ablation
1. Purpose of the Procedure / Intended Benefits
The aim of the procedure is to inspect the uterine cavity and then treat the endometrium (lining of the womb) with heat to relief heavy menstrual blood loss. Treatment will involve the use of Novasure.
2. The Procedure
It is performed as a day case under general anaesthesia. This involves a lithotomy position and may involve bladder catheterisation. At the start of the procedure the cervix is grasped with a volsellum (sharp-toothed instrument) and the cervical canal is dilated up to 8mm. A telescope is introduced through the cervix and, to keep the uterine walls separated, saline infusion is used under pressure. Additional procedures may be endometrial biopsy, polypectomy, removal of a coil, or insertion of a Mirena coil if it is not possible to complete the ablation procedure. The procedure cannot be completed if the Novasure machine does not pass safety checks, which are there to minimise the risk of injury to inside organs.
Common side-effects are: pain following the procedure, which usually lasts for 2-3 days. Most women will experience some watery discharge, or some bleeding like a period, which may last for up to 5-6 weeks, but this is normal and is simply due to the lining of the womb coming away.
It is important for the patient to understand that once the procedure has been successfully performed, the process cannot be reversed (i.e. periods cannot be brought back again).
3. Serious or Frequently Occurring Risks
- Uterine perforation (0.76%)
- Thermal injury to bowel
- Pelvic infection
- Failure to visualise the uterine cavity
- Trauma to the cervix
These complications are more likely to occur in women who have had previous caesarean section(s) or myomectomy, or cervical surgery such as a cone biopsy. They may require a laparotomy (open operation), longer stay in hospital, and antibiotics. Any operation involving a general anaesthetic carries a very small risk of death.
- Vaginal bleeding and discharge
- Pain – pelvic or shoulder
4. Extra Procedures That May Become Necessary
- Laparoscopy, in the event of perforation of the uterus (a hole in the womb). In the event of any complication that necessitates opening the abdomen there is always the risk of accidental damage to the bladder, bowel or blood vessels – very rare (less than 0.1%)
- Blood transfusion – very rare (less than 0.1%)
5. Length of Hospital Stay
The procedure is performed as a day case (same day admission and discharge home), unless complications occur or the patient has other complicating medical conditions that require an overnight stay for observation.
GUIDANCE ON INFORMED CONSENT FOR
HYSTEROSCOPY & ENDOMETRIAL ABLATION – contd.
6. Failure Rate
In some women the procedure may not be effective. This will have been discussed in the outpatient clinic.
OTHER IMPORTANT INFORMATION YOU SHOULD KNOW
On the day of your surgery:
On the day of the operation you will come across members of the theatre team that you have not met before. These members of staff are essential for the smooth running of both the theatres and the surgical procedure itself. These include: the anaesthetist, nursing staff, anaesthetic assistant, operating department practitioner, care assistants, porter staff, consultant(s) and/or trainee(s) that you have not met before, medical student(s) and, occasionally, theatre equipment manufacturing company representatives. The last group are there to bring and demonstrate new theatre equipment.
Before you are discharged home from hospital:
Whether you are having a day-case operation (i.e. you are going home on the same day as your surgery) or you are an inpatient (i.e. you remain in hospital after the surgery), you must have someone who can collect you from the hospital and take you home. This can be a friend or relative, but you will not be allowed to travel home unaccompanied.
** I confirm that I have been given a copy of this document to take away and have read it.