Operative Hysteroscopy Consent Form

OPERATIVE HYSTEROSCOPY - PATIENT INFORMATION AND CONSENT FORM

A. What Is Hysteroscopy?

A hysteroscopy is a procedure in which a thin telescope is inserted through the vagina and cervix into the uterus.
An operative hysteroscopy involves treating conditions such as Müllerian anomalies (congenital developmental abnormalities of the uterus including septum / sub-septum), Myomectomy (removal of fibroids), adhesiolysis (removal of intra-uterine scarring), and benign endometrial lesions (polyps).

B. Anaesthesia

This procedure is performed under General Anaesthetic (GA) only. You will be asleep throughout.

C. Benefits

• Improved menstrual symptoms
• Improved fertility or reduced miscarriage risk
• Removal of fibroids, adhesions, septa, or abnormal tissue
• Outpatient/same day discharge

D. How the Procedure Is Performed

A hysteroscope is inserted through the cervix, fluid distends the uterus, and instruments remove abnormal tissue. There are no abdominal incisions.

E. Risks and Complications

1. Anaesthetic Risks

Common: nausea, sore throat. Serious complications are very rare (<1 in 10,000).

2. Uterine Perforation

Approx. 1-3% in operative hysteroscopy.

3. Fluid Overload

Occurs in <1% overall; severe cases <0.1%.

4. Bleeding

Usually light; heavy bleeding uncommon (<1%).

5. Infection

1-3% in published series.

6. Pain or Cramping

Mild cramping common.

7. Adhesion Formation

Myomectomy adhesion rates vary (up to 15-30%); adhesiolysis recurrence may reach 20-40% depending on severity.

8. Incomplete Procedure

Occurs in 1-5%.

F. Aftercare

Light bleeding and cramps expected. Seek help for heavy bleeding, fever, severe pain, difficulty breathing.

G. Consent Statement

I confirm that I understand the procedure, risks, benefits, and alternatives.

I consent to operative hysteroscopy and any additional procedures deemed necessary during the surgery by my treating doctor.

I have viewed the Vitalab online patient information regarding hysteroscopic Surgery.

I have had sufficient opportunity to discuss any concerns and questions with my treating doctor.

I have considered the alternatives to surgical management, including no surgery and I am convinced of my choice.

This is an elective surgery, which is chosen after careful consideration of the explained risks and benefits.

Patient Consent:

Post-Operative Expectations

Normal Findings

• Mild-moderate abdominal pain or cramping for several days.
• Shoulder or chest-tip pain due to $CO_{2}$ gas (common for 48-72 hours).
• Incisional soreness and mild bruising.
• Fatigue lasting 3-7 days or longer depending on procedure.
• Bloating or abdominal distention for several days up to 1-2 weeks.
• Light vaginal spotting (for gynaecologic procedures).
• Nausea related to anaesthesia or pain medications.
• Mild redness around incisions without drainage.
• Temporary constipation or mild bowel habit changes.

Abnormal Findings - Seek Medical Advice

• Fever $\ge38^{\circ}C$ (100.4°F) after the first postoperative day.
• Increasing redness, swelling, pain, or foul-smelling drainage from incisions.
• Heavy vaginal bleeding (e.g., soaking a pad in <2 hours).
• Severe or worsening abdominal pain not relieved by medication.
• Persistent vomiting or inability to tolerate fluids.
• Inability to pass gas or have a bowel movement after several days, especially with pain.
• Difficulty urinating or significantly reduced urine output.
• Shortness of breath, chest pain, or signs of a blood clot.

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