About Modesty During Gallbladder Removal Surgery
Doctors may recommend gallbladder removal surgery
if you have pain or other symptoms from gallstones or your gallbladder
is not working normally (biliary dyskinesia). Gallbladder removal
surgery is often done under general anesthesia.
The good news is there are some alternatives to gallbladder
removal surgery that you can look into before consenting to
surgery. There are some natural treatments that can relieve
you of gallstones. Also, changing your diet could help to resolve
your gallbladder problems. Do research and check out Gallbladder
Procedures for ensuring a patient’s dignity and modesty
vary greatly across hospitals for gallbladder removal surgery
(also known as cholecystectomy) . Some hospitals demand that
you be fully nude under your gown which is unnecessary for gallbladder
removal surgery. The chest and abdomen have to be exposed for
this type of surgery, but a patient should be allowed to wear
surgery shorts and 100% cotton underwear. There is no reason
for urinary catheter to be inserted since gallbladder removal
surgery only takes 1 hour long. Look under general anesthesia
section of Unnecessary
Urinary Catheterizations and Lack of Informed Consent. Some
medical facilities continue to allow unnecessary urinary catheters
to be inserted in gallbladder surgery patients. The other issue
is that prior to surgery and then for a period of time after,
some patients are heavily sedated leaving them unable to either
advocate for themselves or recall what happened or who provided
care. For many patients, this is quite disconcerting.
Before you consent to surgery, there are two
principles that should guide your discussions with your providers:
1) communicate your all your wishes and concerns to
everyone involved in your surgery—even if you think they
are obvious and 2) get the agreements you make
with your doctor and surgery department at the hospital in writing.
There are three domains around which
you should have careful conversations and record all your agreements:
Types of gallbladder removal surgery:
a) Laparoscopic gallbladder removal
- surgery to remove the gallbladder using a medical device
called a laparoscope. This is the most common way to remove
the gallbladder. This surgery is done under general anesthesia.
Most people go home on the same day or the next day.
- The surgeon will make three to four small cuts in your
belly below the breasts.
- The laparoscope will be inserted through one of the cuts.
- Other medical instruments will be inserted through the
- Gas will be pumped into your belly to expand it. This
gives the surgeon more space to work.
b) Open gallbladder removal -
surgery to remove the gallbladder that uses an open surgical
cut instead of a scope. In open gallbladder removal surgery,
a surgeon makes a large surgical cut in your belly to open
it up and see the area. The surgeon then removes your gallbladder
by reaching in through the cut, separating it from other organs,
and gently lifting it out. Surgery is done while you are under
general anesthesia . The surgeon will make a 5- to 7-inch
cut in the upper right part of your belly, just below your
ribs. The surgeon will cut the bile duct and blood vessels
that lead to the gallbladder. Then your gallbladder will be
removed. This type of surgery takes 1 hour. Most patients
with this type of surgery stay in the hospital for 1 to 4
days. This is rare, but it is sometimes planned. Or, it may
become necessary during a laparoscopic procedure that goes
badly. If your doctor plans to do this in advance, find out
why. Then, get a second opinion before you agree to it. However,
it MIGHT change in the middle of the surgery. You may agree
to the change in surgery if the doctor feels it's necessary,
or you may decline until you can be consulted, or you can
have a medical power of attorney for another person to make
that decision for you.
There is no getting around the fact that you
will be exposed to a number of people for the procedure if you
are a woman and/or if you take off your underwear. It is the
job of doctors and their assistants to make you feel as comfortable
as possible. In that effort, they are likely to either skip
over details of what they will be doing, or they will try to
make it sound as clinical as possible. The basic truth is that
once you are in the operating room your gown will then be removed
because they must have access to your chest and belly for the
surgery. If you do not have surgery shorts and/or underwear
on under your gown, your genitals will be exposed.
If you were anesthetized you will be “awakened”
and likely given more sedation, then you will be taken to the
PACU where they will care for you.
If a male patient is allowed to keep his shorts and/ or underwear
on, there would be no modesty concerns since only his chest
and belly would have to be exposed. Male patients still need
to take precautions to make sure that their underwear and shorts
are never removed and that urinary catheter is not inserted.
Unfortunately, it is impossible for a female patient to wear
a bra to cover her breasts for the surgery since gallbladder
is located so close to the breasts. A female patient
who does not want any men to see her breasts will need to select
a female general surgeon, a female anesthesiologist or nurse
anesthetist, female scrub technicians, and female nurses.
The description above is very general and may be different
for your doctor or hospital, but the purpose is to give you
a frame for asking questions. For example, you might ask if
you will be covered while your doctor examines you in the Operating
Room or you might ask to be awake for the exam. Also, be sure
to ask about the windows in the Operating Room. In some hospitals,
there are windows everywhere so that people can watch procedures.
People Who Will Be Involved in Your
Patients rarely consider the fact that there
are a number of people in and out of an Operating Room before
and during a surgery. Your doctor will have an assistant to
help with the procedure. Generally the doctor selects his/her
assistant. The hospital will assign several medical personnel
for the operation including nurses, anesthesiologist or nurse
anesthetist, surgical scrub technicians, and a scrub/circulating
nurse. The job of a scrub / circulating nurse is to make sure
all the tools are ready for the doctor, bring you into the OR,
prep your body for surgery, and record information about your
preparation. Generally, you only meet anesthesiologist or nurse
anesthetist just before the surgery. There will also likely
be 2 other surgical scrub technicians involved. Their job is
to bring things to the scrub nurse, doctors or assistants, clean
up discarded items and assist in any other way they are asked.
You should be aware that nurses can take breaks in the middle
of surgeries. When this happens, a team comes in to relieve
them. This means that they could bring in male nurses to replace
the female nurses during their breaks and this is a concern
for female patients whose breasts will be exposed.
Some hospitals allow medical students to participate in gallbladder
removal surgeries. Keep in mind that some hospitals especially
teaching hospitals still allow medical students to practice
genital, pelvic, and rectal exams on surgery patients without
their consent. See more information on non-consensual
genital and pelvic exams.
Questions you might
1.) Who is going to assist
the surgeon? Do not assume you know this. A doctor will often
have someone in her office that does most of the surgeries
with her/him. If that person is unavailable, the doctor will
call someone else and usually not bother to tell you unless
you ask. If you want to have an all-female team, you must
tell her that you only accept a female assistant.
2.) Who will the scrub/ circulating nurse
3.) Who will be the anesthesiologist?
4.) Who will be the surgical scrub technicians?
5.) Who will be the PACU nurse?
6.) Is there any chance that medical students
will be present? If so, what role will they play?
7.) Can someone such as my husband, friend,
or family member be present with me for the surgery?
8.) Is there any chance that someone else
such as an equipment representative, hospital quality assurance
person or medical device representative will be in the operating
room? If so, you may refuse consent for such people.
9.) Is there any chance that any of the
nurses could take breaks during my surgery and be replaced
with other nurses?
This is the area that perhaps is the most ignored by patients.
Many patients genuinely do not want to know what is happening
and want to be sedated for as long as possible—that is
absolutely their right. However, if you wish to be aware of
what is happening, you need to make your wishes clear to your
doctor and thoroughly ask your anesthesiologist or nurse anesthetist
about his/her plan.
First of all, be aware that “awake” to a doctor
is different than “awake” to a layperson. Patients
are often given Versed
or other sedatives prior to entering the Operating Room to alleviate
stress and help you to relax. While Versed
is an anti-anxiety medication, it also has a powerful amnesia
effect. It can have other lasting effects, including effects
on behavior and memory for months or years afterwards. Versed
is also known as a date-rape drug. It is used to make a person
compliant and induces conscious sedation. It causes
a person to not remember. It's a dangerous drug which is not
in the best interest of patients. Many patients will not be
able to remember anything while under its influence. If you’re
given Versed prior to being brought into the Operating Room,
you will likely not remember who is in the room, being placed
on the OR table or being prepared for anesthesia. So while the
doctor may say you will be “awake,” be sure to clarify
what that means. Further, once surgery is over, you will likely
be give few more doses of Versed, again that means you will
likely not remember being in the PACU.
You should not consent to Versed
because you are no longer able to advocate for yourself once
you are given Versed
because it causes you to have a powerful amnesia effect. Versed
gives medical personnel the opportunities to do many things
without your consent. Versed also legally invalidates
any patient testimony regarding their treatment.
There is no reason for you to be given Versed.
You should write on your consent form that you do not give consent
for Versed to be administered at all. There may be other benzodiazepines
that can substitute for Versed.
is a brand name for Midazolam. If somebody
just refuses “Versed”, they can still give them
the generic. To play it safe, mention that you do not consent
Midazolam, or any other benzodiazepine.
All three of these areas are vital to your care and
your concerns about modesty. Remember that a conversation
is not enough. Once you have come to an agreement with your
doctor about the issues above, you need to be sure that you
write those directives on your consent form.
Important Tips For Patients Concerned
About Modesty During Cholecystectomy:
1.) You should write a list of expectations that you and
your doctor sign. Make several copies of the list. Then when
you sign your hospital consent forms and any other form you
are asked to sign, note by your signature that you have a
list of expectations that are attached and have the person
witnessing your signature initial that note.
Your list of expectations should be
clear and direct. For example:
- I withhold consent for any sedation until after I have
been brought to the OR.
- Women - I withhold consent for any male
medical personnel or medical students being present during
my surgery or observing my surgery.
- Women - If my wishes cannot be accommodated
for an all-female team, the surgery must be cancelled or
- I withhold consent for a urinary catheter.
- I withhold consent for genital, pelvic, and rectal exams.
- My underwear and shorts may not be removed at all.
2.) Try to get all consent forms prior to the day of surgery
and read them carefully. Write in any changes or requests
3.) Visit the hospital you will be having the surgery at
and ask to speak to the nursing supervisor and/or manager
of the surgery dept. Discuss your wishes about who you want
to be present. If you are a woman, make sure you indicate
if you don't wish for even female medical students to be there.
Some women who want an all-female team are open to female
medical students observing their surgery.
4.) Insist that they do not give you an IV until you have
been prepped for surgery.
5.) It is prudent to have an advocate not employed by the
hospital such as your husband present the whole time for pre-op,
surgery, and post-op to make sure that your wishes are honored.
This is the only way you can have a guarantee that your wishes
will be honored. Remember that someone else could come in
middle of your surgery including a sales representative, a
janitor, or other nurses. Check out Why
You Should Have a Personal Advocate For Surgery?
6.) Walk out and cancel the surgery if you see that
your wishes will not be honored for an all-female
medical team (if you are a woman) or other requests such as
leaving underwear on. Patients need to stand up to show medical
professionals that they are not willing to compromise.
7.) Find another doctor if she/he is not willing to work
to accommodate your wishes.
8.) Find another medical facility if they are not willing
to work to accommodate your wishes.
Female surgeons are much harder to find than
female gynecologists. You usually can find several female general
surgeons in big cities. This is a big challenge for women who
may live 200 miles or more away from a big city. You may have
to drive a long distance, but it is worth it.
Other Related Articles:
For Female Patients To Prevent Sexual Abuse In Medical Settings
Do Chaperones Really Protect Patients?
What You Should Know About Sedation and
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