Thoracic Surgery On-Line

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Presentation transcript:

Thoracic Surgery On-Line Part 3 Explanations and Consent for Surgery

Explanations and Consent for Surgery All surgery is done for a reason so explanations must incorporate discussion of both the surgical aspect of the treatment as well as the outcome of the surgery. Eg For Lung Cancer,explanations must centre around the surgery and its problems,as well as the expected outcome in terms of the Cancer being treated.

Explanations and Consent for Surgery Eg Right Upper Lobectomy for Lung Cancer. 1.Surgical Method 2.Expected outcome of the Cancer.

Explanations and Consent for Surgery Surgical Method. Explanation involves the incision – where it will be, if a rib will be removed or not How long it will be Pain from intercostal neuralgia post op. Importance of mobility and exercise after surgery to minimise long term pain.

Explanations and Consent for Surgery Surgical Method The Lobe will be removed – explanation of “lobes” – 3 on right,2 on left. Junctions between the lobes often isn’t complete – requires stapling to separate the lobes. Drain tubes – which need to be on the floor at all times,with water in them – the tubing goes under the water to stop air being sucked back into the chest.

Explanations and Consent for Surgery Surgical Method Pain relief needing morphine or similar Physiotherapy for mobilisation to prevent chest infections and Deep Vein Thrombosis. Antibiotics Stay in hospital 7-10 days. Go home when No temperature/complication Oral pain meds Able to go to bathroom by themselves and be independent.

Explanations and Consent for Surgery Surgical Method Complications:best to use a visual indicator and ask if any questions,as well as did they understand? Ask accompanying person if any questions? Best method is to use hands:

Explanations and Consent for Surgery Complications from: Bleeding Infections Air Leak/windpipe leak DVT Atrial Fibrillation Special:nerve/ oesophageal/thoracic duct damage Death from: Myocardial Infarct Pulmonary Embolus ARDS

Explanations and Consent for Surgery Cancer Component of the Treatment. Summarise discussion: “You had a cough which was investigated with a chest X Ray.There was a shadow and a CT was done which showed where it was exactly in the lung.A needle biopsy was done which confirmed this is a Primary Lung Cancer.A PET scan was done which showed no spread of the cancer…….

Explanations and Consent for Surgery Cancer Component “..As you’re medically fit with good breathing tests and echo of the heart,we feel that the risks of surgery to remove this cancer are low but the benefits are great,so we are recommending you have this removed. With the evidence we have we think there is the potential to cure you of the cancer.”