Surgical clips: what would you like your surgeon to do?

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oxygen18
oxygen18 Member Posts: 164
edited July 2018 in Surgery - Before, During, and After

I had an excellent surgeon who did a masterful job, and am most appreciative of her help. My surgery was years ago, but only now do I find out, thanks to a diligent radiologist, that titanium clips, dozens of them, were implanted at the time of surgery. Informed consent was not obtained, no way, I am certain of that. Also, the surgical notes mention no clips. It appears this is the standard of practice, most surgeons don't mention permanent clips nor their number. Myself, I see no excuse to not obtain consent, I see it as paternalistic and a theft of autonomy, however well intentioned it is. And well intentioned it indeed is, as some patients may find it disturbing to live with clips, though it seems essentially not harmful, is helpful to radiation oncologists, and possibly more beneficial than suturing which supposedly is more irritating.

I am interested in knowing how others feel about this, specifically:

If clips were a better solution than sutures in your case, would you rather know or not know that you have them? I.e., what do you value more, your peace of mind from not knowing about something which is unlikely to harm you, or your right to decide?

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited July 2018

    Hi there and thanks for the post. I actually had a biozorb inserted, which was fully disclosed and discussed. So no regrets.


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  • SummerAngel
    SummerAngel Member Posts: 1,006
    edited July 2018

    I found out I have clips about a month ago because of a scan. I do find it odd that most women who have breast cancer surgery end up with these permanent metal clips in their axilla and are never told about it. I'm not surprised, I have felt a strange sort of "pinched" feeling there ever since my surgery.

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  • MexicoHeather
    MexicoHeather Member Posts: 365
    edited July 2018

    Yeah, I would have agreed to it, but I didn't know until about a month ago! The clips are in the axillary area, and I have some cording.

    The clips do not prevent a person from having an MRI.

    Also there is one marker in the "good" boob, and when it was placed, it moved! So it's not pointing and the right cr*p. I always let the Mammogram people know.

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  • moth
    moth Member Posts: 4,800
    edited July 2018

    fwiw, my surgical notes mention placement of clips. I think it's odd if the surgical notes don't.

    Mine also include details of what type of suturing was done at each step too. If they include that, it seems to me they should also mention clips.

    I've had previous surgery in a different organ and there are clips left behind there too (which I've seen on subsequent ultrasounds)

    I guess I think it should be mentioned during the pre surgery talk so people aren't surprised by it later.

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  • Sandy71
    Sandy71 Member Posts: 15
    edited July 2018

    I was told about my clips for all of my biopsies and surgeries. I do not think that not mentioning the clips is a standard of practice. I think quite the opposite. Informed consent is a big deal. Maybe poor communication by your surgeon despite the masterful job she did. Did you have copies of the surgical consent paperwork to refer to?

    I think the clips are placed to mark the area in case the surgeon needs to go back in and take more tissue and to mark area for future mammograms. I personally was glad to have them to mark all of my ‘problem areas’ over the years and to help find my lesion that required intervention.

    Clips and sutures are completely different. Sutures close your wound and allow the tissue to heal. It’s not a matter of choosing between one or the other. They perform different functions.

    I suppose if you feel that strongly about having clips placed without your knowledge that you could contact your surgeon with your concerns


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  • SummerAngel
    SummerAngel Member Posts: 1,006
    edited July 2018

    The clips I have are used to control bleeding during the surgery, just like sutures.

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  • oxygen18
    oxygen18 Member Posts: 164
    edited July 2018

    Thank you all for your responses so far. If there is anyone who would rather not know that they have received permanent surgical clips, I would be interested in hearing from you too.

    It is true, these clips are used to seal off blood vessels (and lymphatics, etc.), although their other potential role is as markers for subsequent radiation tx.

    By the way, it seems to me that, at a minimum, physicians who do biopsies need to quit saying that the biopsy marker clips will come out during surgery. First of all, it is not always true, and second, we come out of surgery with more clips, not fewer, than when we went in with.

    If you were in charge of setting policy on what to say and not say to patients about the presence of surgical clips, what would you decide? Would it be any different than what you'd decide for yourself?


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  • carmstr835
    carmstr835 Member Posts: 388
    edited July 2018

    there is another option...

    https://www.sciencedaily.com/releases/2015/05/150501081742.htm

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  • Sandy71
    Sandy71 Member Posts: 15
    edited July 2018

    Sorry.....I was referring to titanium markers.... my surgeon called them clips. Different issue all together



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  • oxygen18
    oxygen18 Member Posts: 164
    edited July 2018

    Sandy, it really can be confusing, titanium clips can be used as markers, or for suturing, or for both purposes at the same time. They are of similar size, made of same material, and they do get called a variety of names (I know what I'd have liked to call them when I realized I have them, but this is a polite board).

    When one clip is to be inserted as a marker, we are always asked for our consent, but when dozens of clips are to be inserted for sealing of vessels, often no consent is requested (except in broad meaningless terms, e.g. you consent to whatever the surgeon deems medically necessary).


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  • oxygen18
    oxygen18 Member Posts: 164
    edited July 2018

    carmstr, that is a good one, and there are other reports as far back as the early 90's of dissolvable clips tested in animals, but I have not found evidence of any clinical trials on humans. Anecdotally I hear that the dissolvable ones are not as safe for suturing.

    My hope is that if more people are aware of the wide use of these permanent clips, there will be more pressure to perfect dissolvable ones.

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  • Warrior2018
    Warrior2018 Member Posts: 380
    edited July 2018

    Gosh, I didn’t see anything about clips in any report. I knew of the one from the initial biopsy but that’s it. I guess I’ll find out what I have inside meat my first screening.


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  • nat_blue
    nat_blue Member Posts: 30
    edited July 2018

    I think you must have hemaclips. They are often faster and more secure than using suture and possibly less likely to cause infection, more inert and therefore less irritating. When suture breaks down, the body reacts to it. Honestly I'm not surprised they weren't disclosed prior to surgery. I don't think it would be typical for a surgeon to discuss suture type with the patient. I can see how they could be disconcerting if you didn't realize such an option might be available--a bit of a surprise to suddenly see them on imaging.

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  • oxygen18
    oxygen18 Member Posts: 164
    edited July 2018

    Warrior18, I sure hope I emphasized these are quite harmless, NOT worth worrying, it's just that I expect my doctors to ask me first.

    Mammograms might not show them, and mammo reports might not mention them anyway. I saw mine via chest xrays, and even my first xray report post MX did not mention the clips at all.


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  • Amica
    Amica Member Posts: 488
    edited July 2018

    I didn't even know I had surgical clips on my axillary lymph nodes until it was noted on a recent ultrasound that I had, 20 years after the surgery!

    So, no one ever mentioned those clips to me. Nor do I have the surgical notes from 20 years ago, my surgeon's office has long closed and I have no idea how I would ever locate those notes if they become necessary due to my recent recurrence.

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  • Warrior2018
    Warrior2018 Member Posts: 380
    edited July 2018

    I won’t worry Just saying that if some are there, I don’t know right now, but would like to. We’ll see I guess!


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