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

2. 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.

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

4. 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.

5. 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.

6. 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.

7. 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:

8. 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

9. 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…….

10. 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.”