Any surgeons about? Why wasn't I wearing knickers?

[ohwerehalfwaythere]

I had laparoscopic surgery for an ovarian cyst this morning. Went into surgery wearing disposable knickers but wasn't when I woke up. It's really bothering me. Can anyone shed any light what would have happened? I'm in England. Thank you

You used to always go down for operations with no pants , I think wearing them , then having them removed is probably more disconcerting .

If you feel concerned about it, then just ask - nurse, doc or whoever. .

If you speak to PALS they will have to "investigate" something that happens all the time and is a normal part of the surgical scene. That would be a waste of their time.

I would not have given it a second thought. Having a sterile field of operation is the priority.

Why are you concerned about it? I can understand you being curious, but concerned seems a bit OTT. I think you should simply put it out of your mind and be happy that your surgery is over and you are fine.

@Firesidefox

I had a big op last week and wasn't wearing pants when I came round. Didn't bother me for one second. They're only on at the start to make you feel better.

I don't see why you're so het up tbh.

There’s not one part of the OP’s post that suggests she is “het up”, she has made it clearly that she is curious to know why this happened as it wasn’t mentioned to her and not obvious why they would do this, so it’s perfectly reasonable for her to ask why, I would want to know why too and If there is a valid medical reason why then that’s fine. What I personally can’t understand is why anyone would come on here and make snidey comments to someone who is just asking a reasonable question.

Hi OP. I’m a gynaecologist.

You would need to have no underwear in for several reasons:

For any lower abdomen/pelvic surgery, the skin needs to be cleaned to reduce risk of infection when inserting strike equipment (camera and instruments)

Camera is usually through the umbilicus (but can be put in other sites) and other instruments for gynae procedures often include a a site which is at the top of the natural pubic hairline.
For general surgical keyhole (laparoscopic) surgery, instruments are only put in via your abdomen.
For gynae laparoscopic procedures, it’s standard to empty the bladder with an in/out catheter, which is to reduce the risk of bladder injury from other port site introduction, and improve the view- a really full bladder could stop the surgeon even seeing your ovary, never mind the cyst. The vulval and vaginal area will be cleaned and draped before this.

Usually, it’s then needed to move the uterus around, to see in front/behind it, to enable the attached structures of tubes and ovaries to be seen and operated on safely, and to see the exterior of the uterus itself.
This is done by inserting a speculum, then an instrument which goes into the uterine cavity, and clips onto the cervix. One of the assistants sits and after catheterising, will move the uterus around as needed at the surgeon’s direction as needed.

I hope that helps to explain.

I can’t fathom why (presume) a ward nurse told you not to wear your own underwear, gave you disposable knickers, but did not explain why, or that they would be removed.
The surgeon should also be clearly explaining the whole process before and at consent stage. I know I have seen colleagues not consider the vaginal/bladder aspect as anything but “prep”, and possibly not consider that a patient might feel violated or be concerned. Not acceptable, though.

Sorry you have had this experience, and have not had this explained clearly beforehand. You are absolutely right to question these things, which hopefully will ensure practice improves.

Sorry for typos!
Underwear “on” not “in”
“Strike” should be “ports”

I would suggest rather than PALS, feed back to your surgeon and ward staff. This could be really helpful for them to be aware of what patients experience (although not rocket science to put yourself in someone else’s shoes, ffs!)

This would make a very good quality improvement project for the department to carry out, with maybe a patient info leaflet, improved communication from medics and doctors, theatre staff etc. Any decent clinician should be aware that women may be concerned about this, and particularly so the the significant amount of us who have experienced sexual violence.

I hope you have a good recovery. Make sure that you phrase this carefully if you do complain. The way you’ve phrased it here could imply assault, which I don’t think is your intention.

@Hairyfriend

Where did they insert the camera? Surely if it was ovarian, then that is pelvic, so unless they inserted the camera through you foot, I'd assume the knickers came off to clean the skin and/or insert a catheter!!!

I had my ovarian cysts removed by keyhole and there were two very tiny incisions, one for the camera one for the instruments. One hole in belly button (a one-stitch repair) and the other at one side of it and a little below, which had 2 stitches.

I am pretty certain I didn't get/wear any surgical knickers OR a catheter but it was 12 years ago.

If my bladder emptied during the procedure nobody mentioned it; but I would not be surprised if that happened. The surgeon showed me all the photo series after; a fascinating tour of my innards in full colour as she tried to find a way round multiple adhesions.

I wouldn't worry about the lost knickers. Getting rid of ovarian cysts was instantly, miraculously lifechanging and I've never regretted it.

I think reporting it to PALS is a good idea. The gist needs to be:

1. You were not told beforehand that this would happen.
2. Staff need to be aware that for survivors of sexual assault/abuse this could be extremely distressing
3. For all women this could be distressing and confusing.
4. Informed consent to surgery should include not just the risks and benefits of surgery, but also the procedure used
5. What is normal to theatre/recovery staff is not know to the general public, so patients should be told everything before going to theatre

In summary, PALS should feed back to the hospital trust that communication needs to improve. They could be prompted to provide a leaflet pre-op explaining what might happen and why. They should also be able to reassure patients of the safeguarding measures in place to protect patients when they are most vulnerable (under anaesthetic).

Good luck and I hope they make some changes that will benefit people in future.

Thank you to all those with constructive abs helpful comments and good wishes, particularly those medics who gave detailed responses. I really appreciate you taking the time. Waiting for a midwife to check on the baby and then I think we can go home. Very tired and sore but okay.

For those with all the nasty and unhelpful comments, I'm not going to waste my time replying to you. Please don't spread bile on anyone else's thread either. Just go away

Mummyoflittledragon

LaBellina
Some appalling comments from some posters here, I can only hope they do not work in the medical field because they seem to have very little respect for the importance of patient dignity and consent.

OP, you’re absolutely right to be upset about this and although although I also think it’s unlikely something sinister has happened, they should have explained this could happen to you pre op. They should, frankly every woman I know would feel uncomfortable about this sudden change and it would be potentially triggering for those with a history of sexual abuse.
I would want an explanation about this and I would report it to PALS, they need to be more mindful of explaining this properly to women.
What? You’d report this to PALS? Fgs the nhs is on its knees. I’ve had a few laps and major surgeries. It would never occur to me to report people for taking care of me. 🙄

So women should just shut up and be grateful that they’re been taken care of @Mummyoflittledragon? We should have empathy for the NHS but survivors of sexual violence don’t deserve any consideration for their trauma? Because having your knickers taken off you without any warning or explanation when you’re unconscious and vulnerable is pretty triggering for a lot of women. If PALS is aware of how this makes women feel then they can do something about it and that’s my point.

@Budapestdreams

I think reporting it to PALS is a good idea. The gist needs to be:

1. You were not told beforehand that this would happen.
2. Staff need to be aware that for survivors of sexual assault/abuse this could be extremely distressing
3. For all women this could be distressing and confusing.
4. Informed consent to surgery should include not just the risks and benefits of surgery, but also the procedure used
5. What is normal to theatre/recovery staff is not know to the general public, so patients should be told everything before going to theatre

In summary, PALS should feed back to the hospital trust that communication needs to improve. They could be prompted to provide a leaflet pre-op explaining what might happen and why. They should also be able to reassure patients of the safeguarding measures in place to protect patients when they are most vulnerable (under anaesthetic).

Good luck and I hope they make some changes that will benefit people in future.

Excellent post @Budapestdreams

@ohwerehalfwaythere get well soon

I’d want to know beforehand because that’s proper consent

Plus the medical profession has a very dodgy history with anesthetised women being practiced on without consent that id always (rightly or wrongly) feel a little uneasy going under general in a hospital

I think it would be a good idea to speak to PALS so that they could possibly work towards a policy where a general leaflet for patients could be produced informing patients that these procedures (ie catheter, removal of underwear, pain killing suppositories etc) are a possibility during any surgery. Just a general information type leaflet which would cover a number of different surgeries.

Hope you are recovering well OP.

Kate luv scats I know what you’re saying about going via PALS causes more work but this is the way to make change happen, maybe they will then brief the next woman about this so the incident doesn’t repeat itself, if they have to look at their protocol and revise it for the better then that’s a good thing and in all likelihood wouldn’t happen without PALS intervention.

The problem with PAS - here at least - is that you can only make a complaint.

A fracture in my foot was missed (which has had long term consequences on my mobility) and this was totally unnecessary as I kept telling the doctors the nature and severity of the pain when I tried to walk. They fobbed me off and said it was fine. I went to PALS to say that I would like to convey to the team that listening to the patient is very important indeed and could have avoided all the trouble that I have had.

PALS said it was a complaint or nothing. Seemed daft to me.

Mischance - in my area PALS is not just about complaint , it stands for Patient Advice and Liasion Service so I suspect you may have been misadvised. Usually if a patient wants to make a more formal clinical complaint about a hospital they now go through their local CCG. Generally speaking PALS tends to be the less formal route. Patients can always complaint direct to the hospital, but if they don’t want to go via the hospital they can complain to their CCG and they will investigate. The feedback from the OP is valuable information for hospitals to capture and I would say going through PALS and giving them her feedback to pass on would be a helpful thing to do.

I had surgery 6 months ago. Cosmetic, and nothing in that area.

I said to the anaesthetist before hand that if they used a catheter I needed it removed before I was conscious because I couldn't mentally handle it.

I came round after surgery minus my nickers. They're were very neatly folded on the chair next to me. I was unreasonably embarrassed - nice knickers and considering the procedures I'd just had done, i knew they'd seen every bit of me anyway, and the nurses had to rebutton my garment after I'd had a wee.

So sympathy there from me. It is discombobulating. Especially if you weren't expecting it. Also, GA can give you the blues for a few days, so be kind to yourself and drink loads of watr x

30kg is spot on . If OP or anyone else in this situation wanted to feed back do go through the surgical team directly . We welcome feedback . If you go through PALS it creates an innominate amount of red tape. Teams are trying to catch up on waiting lists. So extra red tape not helpful. A good QI project though to raise awareness / create an information leaflet though.
Food for thought for me about our processes .

Op, so do you feel reassured now?
Do you feel you need to take it further?

If this were me, I think I’d want to be very clear that I was making an observation rather than a complaint. I’d make clear I’d woken up and was confused and concerned as things hadn’t been explained and it would help if the aspect of disposable underwear’s purpose and what would happen to it were explained in advance.
I’d also appreciate that if Inout this in writing to any organisation that it would require follow-up.
I’m not saying not to do it….as others say, it’s sometimes required to bring about change. However, I would appreciate that any kind of written comment will require follow-up and use of resources.

It depends really, if you feel now you understand what happened and are satisfied or if you think follow-up is required. Sometimes people like to follow-up very minor issues and it generates lots of work for little real gain. This is a sensitive issue though, so oerhaos it is worth following up. In all liklihood, the procedure is for patients to have this explained and it was overlooked here…not maliciously, but it was nevertheless overlooked and left you uncomfortable. To avoid that happening to others and because it’s important, you could raise it…again, not as a formal complaint but an observation…and PALS seems a good route to take.

On another note, don’t be so sensitive to people with different points of view. This is a discussion forum and there’s no point coming on here if you’re not willing to let everyone have their say. It’s the nature of it that people disagree and are free to do so. Unfortunately, by being overly sensitive to peoples responses, you give an indication that your concern about the communication before the procedure might be hyper-sensitivity too. I don’t think your concern is unreasonable, but by hitting back at people who take time to reply tO your question, you can make the issue itself seem like an over-reaction. It’s just something to bear in mind.

@olympicsrock

30kg is spot on . If OP or anyone else in this situation wanted to feed back do go through the surgical team directly . We welcome feedback . If you go through PALS it creates an innominate amount of red tape. Teams are trying to catch up on waiting lists. So extra red tape not helpful. A good QI project though to raise awareness / create an information leaflet though. Food for thought for me about our processes .

@LaBellina I didn’t say women should shut up. Those are your words. I said I wouldn’t report this to PALS as the NHS is on its knees. I would report it back to the surgical team. As per this post, which explains why putting in a formal complaint is a bad idea for those still desperately waiting for surgery.

I didn’t mention a putting in a formal complaint. I said report it. If it’s reported to PALS, possibly changes could be made in more places then just 1 department.

Could you have urinated whilst out for the count, and they removed them to clean you up

@ohwerehalfwaythere, apologies, I’d missed the post where you said you were pregnant. In that case, the uterus will not have been manipulated or instrumented, but your bladder will still certainly have been emptied with an in/out catheter.
Hope you are feeling better. Laparoscopic and GA take a while to recover from, even if you’re not pregnant!

On another note, don’t be so sensitive to people with different points of view. This is a discussion forum and there’s no point coming on here if you’re not willing to let everyone have their say. It’s the nature of it that people disagree and are free to do so. Unfortunately, by being overly sensitive to peoples responses, you give an indication that your concern about the communication before the procedure might be hyper-sensitivity too. I don’t think your concern is unreasonable, but by hitting back at people who take time to reply tO your question, you can make the issue itself seem like an over-reaction. It’s just something to bear in mind.

I really take umbrage with this ‘advice’.

There’s an extraordinarily obvious reason why someone might have felt shocked / surprised / upset / worried / much worse, on coming to from an operation and realising the underwear they had on are not there any more.

Given that reason - which is only a possible one - it’s highly likely that the OP would be ‘sensitive’ about it.

You can’t tell people not to be so sensitive. It’s extremely unhelpful.

Anyone with half a clue would read a thread like this and know that it needs a sensitive response - as most people on this thread have managed to do.