| Patient Information:
Be
Your Own Patient Advocate
Wendy K. Winer, R.N., B.S.N., CNOR
Minimally invasive surgery and, in particular,
routine laparoscopy, have become increasingly popular over
the past decade because of the potential for lower procedure
costs, reduced risk of infection, reduced patient trauma,
faster recovery time, minimized blood loss, minimal scarring
(reduced adhesion formation), shorter length of hospital
stay and procedures often done on an outpatient basis, as
well as a quicker return to work and/or one ’s normal
routine. There are approximately 4 million laparoscopic surgeries
performed annually in the United States. Projections call
for this number to rise to five million by 2010.1 For
example, approximately 80% of gynecologic surgeries are laparoscopic
and 85% of gall bladders are removed laparoscopically.
Patients should be aware of the risks and potential post-surgical
complications for any surgery, including laparoscopy. As
with any procedure it is important to read the patient-informed
consent prior to surgery and review this with your surgeon.
When undergoing laparoscopy, there are the normal risks as
with any type of surgery when a patient undergoes general
anesthesia. Laparoscopy risks include infection, injury to
the bladder and/or bowel (including any adjacent tissue and/or
organs), the development of postoperative adhesions or scar
tissue (even though with delicate tissue handling and reduced
blood loss, postoperative adhesion formation should be reduced),
and risk of bleeding.
Various energy sources are used during laparoscopic surgery
and they can result in injury to the bladder and/or bowel.
For example, it is common for monopolar energy to be used
in any surgery. When monopolar energy is used to cut and/or
coagulate during a laparoscopy, there is the risk of stray
energy burns that could result in a laparoscopic procedure
being converted into a laparotomy or open procedure. This
also may result in a burn that is or is not recognized at
the time of surgery. Patients could develop postoperative
symptoms such as infection, pain, nausea, vomiting, and change
in bladder or bowel symptoms that could be indicative of
a problem. If any of those symptoms occur, it is important
to contact your surgeon immediately.
There are ways to protect against stray burns occurring
during surgery and AORN (Association of periOperative
Registered Nurses) Recommended Standards is annually
updated and kept in the operating room suggesting ways to
protect against electrosurgery injuries (use of active
electrode monitoring as referenced in this website is
used to protect against these types of injuries). It is strongly
recommended that the patient ask any questions prior to surgery
to ensure that guidelines such as those mentioned are followed.
This not only applies to all energy sources used in surgery
but also to things such as sterilization techniques, eye
protection depending on the energy source used and so on.
The patient has the right to know what the potential risks
are during any surgery and to review with the surgeon what
steps are taken to protect against such potential injuries
as mentioned above. This includes infection control, care
with latex allergies if that is a concern, blood loss and
the procedure followed if blood is needed, energy sources
used with appropriate protection, suturing techniques in
case a hole occurs in the bladder and/or bowel and what situations
could require a laparoscopy turning into an open procedure.
Overall, the complication rate is vastly reduced with a
laparoscopy; however, it is imperative to recognize that
there still are risks and they can be very serious. It is
always important to verify that the surgeon and operating
room staff are all properly trained in the laparoscopic procedure
to be performed. When safe techniques are used to protect
the patient, the laparoscopic procedure will most likely
be successful enabling the patient to benefit from a shorter
hospital stay, quicker recovery and reduced chances of complications
as well as the above mentioned benefits when a minimally
invasive procedure is done as with laparoscopy.
What You Can Do
- Educate Yourself – The
more involved you are in directing your own healthcare,
the less likely you are to experience a serious adverse
medical event. (See Common
Questions about Laparoscopy, Glossary
of Medical Terms, Other
Useful Information, and Quick
Facts.)
- Download a Patient Brochure
to Learn More about AEM – COMING SOON!
- Contact Your Surgeon – Ask
your surgeon if he/she uses AEM or is aware of the benefits
of the technology
- Contact Your Hospital – The
Director of Surgery or the Director of PeriOperative
Services can tell you if your hospital uses AEM.
References:
- Dennis, V. RN, CNOR, CMLSO, “Advancing Patient
Safety in Laparoscopy – The Active Electrode Monitoring
System”, Patient Safety & Quality Healthcare,
May/June 2005
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