1. (a) Hysterectomy (abdominal and vaginal).

   1. (1) Uncontrollable leakage of urine.
   2. (2) Injury to bladder.
   3. (3) Injury to the tube (ureter) between the kidney and the bladder.
   4. (4) Injury to the bowel and/or intestinal obstruction.
   5. (5) Need to covert to abdominal incision.

   6. (6) If laparoscopic surgery is utilized, include the following risks:

      1. (A) Damage during introduction of trocar to adjacent intra-abdominal structures and organs (e.g., bowel, bladder, blood vessels, or nerves) and potential need for additional surgery.
      2. (B) Trocar site complications (e.g., hematoma, bleeding, leakage of fluid, or hernia formation).
      3. (C) Air embolus (bubble causing heart failure or stroke).
      4. (D) Change during the procedure to an open procedure.
      5. (E) If cancer is present, may increase the risk of the spread of cancer.

2. (b) All fallopian tube and ovarian surgery with or without hysterectomy, including removal and lysis of adhesions.

   1. (1) Injury to the bowel and/or bladder.
   2. (2) Sterility.
   3. (3) Failure to obtain fertility (if applicable).
   4. (4) Failure to obtain sterility (if applicable).
   5. (5) Loss of ovarian functions or hormone production from ovary(ies).
   6. (6) If performed with hysterectomy, all associated risks under subsection (a) of this section.
   7. (7) For fallopian tube occlusion (for sterilization with or without hysterectomy), see subsection (n) of this section.

3. (c) Removing fibroids (uterine myomectomy).

   1. (1) Injury to bladder.
   2. (2) Sterility.
   3. (3) Injury to the tube (ureter) between the kidney and the bladder.
   4. (4) Injury to the bowel and/or intestinal obstruction.
   5. (5) May need to convert to hysterectomy.

   6. (6) If laparoscopic surgery is utilized, include the following risks:

      1. (A) Damage during introduction of trocar to adjacent intra-abdominal structures and organs (e.g., bowel, bladder, blood vessels, or nerves) and potential need for additional surgery.
      2. (B) Trocar site complications (e.g., hematoma, bleeding, leakage of fluid, or hernia formation).
      3. (C) Air embolus (bubble causing heart failure or stroke).
      4. (D) Change during the procedure to an open procedure.
      5. (E) If cancer is present, may increase the risk of the spread of cancer.

4. (d) Uterine suspension.

   1. (1) Uncontrollable leakage of urine.
   2. (2) Injury to bladder.
   3. (3) Injury to the tube (ureter) between the kidney and the bladder.
   4. (4) Injury to the bowel and/or intestinal obstruction.

5. (e) Removal of the nerves to the uterus (presacral neurectomy).

   1. (1) Uncontrollable leakage of urine.
   2. (2) Injury to bladder.
   3. (3) Injury to the tube (ureter) between the kidney and the bladder.
   4. (4) Injury to the bowel and/or intestinal obstruction.
   5. (5) Hemorrhage (severe bleeding).

6. (f) Removal of the cervix.

   1. (1) Uncontrollable leakage of urine.
   2. (2) Injury to bladder.
   3. (3) Sterility.
   4. (4) Injury to the tube (ureter) between the kidney and the bladder.
   5. (5) Injury to the bowel and/or intestinal obstruction.
   6. (6) Need to convert to abdominal incision.

7. (g) Repair of vaginal hernia (anterior and/or posterior colporrhaphy and/or enterocele repair).

   1. (1) Uncontrollable leakage of urine.
   2. (2) Injury to bladder.
   3. (3) Sterility.
   4. (4) Injury to the tube (ureter) between the kidney and the bladder.
   5. (5) Injury to the bowel and/or intestinal obstruction.
   6. (6) Mesh erosion (with damage to vagina and adjacent tissue).

8. (h) Abdominal suspension of the bladder (retropubic urethropexy).

   1. (1) Uncontrollable leakage of urine.
   2. (2) Injury to bladder.
   3. (3) Injury to the tube (ureter) between the kidney and the bladder.
   4. (4) Injury to the bowel and/or intestinal obstruction.

9. (i) Conization of cervix.

   1. (1) Hemorrhage (severe bleeding) which may result in hysterectomy.
   2. (2) Sterility.
   3. (3) Injury to bladder.
   4. (4) Injury to rectum.

10. (j) Dilation and curettage of uterus (diagnostic/therapeutic).

    1. (1) Possible hysterectomy.
    2. (2) Perforation (hole) created in the uterus.
    3. (3) Sterility.
    4. (4) Injury to bowel and/or bladder.
    5. (5) Abdominal incision and operation to correct injury.

11. (k) Surgical abortion/dilation and curettage/dilation and evacuation.

    1. (1) Possible hysterectomy.
    2. (2) Perforation (hole) created in the uterus.
    3. (3) Sterility.
    4. (4) Injury to the bowel and/or bladder.
    5. (5) Abdominal incision and operation to correct injury.
    6. (6) Failure to remove all products of conception.

12. (l) Medical abortion/non-surgical.

    1. (1) Hemorrhage with possible need for surgical intervention.
    2. (2) Failure to remove all products of conception.
    3. (3) Sterility.

13. (m) Selective salpingography and tubal reconstruction.

    1. (1) Perforation (hole) created in the uterus or Fallopian tube.
    2. (2) Future ectopic pregnancy (pregnancy outside of the uterus).
    3. (3) Pelvic infection.

14. (n) Fallopian tube occlusion (for sterilization with or without hysterectomy).

    1. (1) Perforation (hole) created in the uterus or Fallopian tube.
    2. (2) Future ectopic pregnancy (pregnancy outside of the uterus).
    3. (3) Pelvic infection.
    4. (4) Failure to obtain sterility.

15. (o) Hysteroscopy.

    1. (1) Perforation (hole) created in the uterus.
    2. (2) Fluid overload/electrolyte imbalance.
    3. (3) Possible hysterectomy.
    4. (4) Abdominal incision to correct injury.

Source Note:The provisions of this §602.7 adopted to be effective December 26, 2023, 48 TexReg 7985.