Get Consent for The Unexpected


ST. LOUIS — Physicians need to obtain comprehensive patient consent before surgery to help guide their approach to unexpected findings during the procedure, according to Ira Horowitz, M.D.

In a presentation at the 15th International Pelvic Reconstructive and Vaginal Surgery Conference, Dr. Horowitz looked at several hypothetical cases. “It is imperative that we discuss various scenarios with the patient prior to surgery,” said Dr. Horowitz, the Willaford Ransom Leach Professor and vice chairman and director of the division of gynecologic oncology in the department of gynecology and obstetrics at Emory University, Atlanta.

In one hypothetical case, a malpractice lawyer with a mucinous cystadenoma had signed a consent form to remove only the mass. The physician is permitted to remove the uterus and contralateral ovary if a carcinoma is present. “You have a suspicion of cancer. What do you do?” Dr. Horowitz asked.

“The answer might be to do nothing, because the patient has limited your ability to act independently with the consent signed,” he said.

Pelvic surgeons would be wise to have a gynecologic oncologist available if cancer is suspected. A seasoned pathologist also should be present to perform a frozen section. “There is an increased survival rate when a gynecologic oncologist assists in staging and debulking of the patient with ovarian carcinoma,” he said.

“A mucinous borderline tumor is frequently reread as invasive carcinoma,” Dr. Horowitz said. “The challenge to the gynecologists and the gynecologic oncologist is when to do staging without a definite diagnosis of cancer. This is why it is so important to discuss these options and possibilities with the patient prior to surgery. If you discuss this before the patient is put to sleep, you won't allow yourself to be put in this position,” he said.

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