@robs477 I'm sorry I didn't barge in on this conversation sooner. I was away on vacation and I'm not someone who takes technology everywhere.
I think, at least to some extent, your surgeon in doing the CYA (cover your ass) thing. To the best of my knowledge, the only complication that is more likely with open surgery is a hernia. Not that a hernia is something to take lightly, but all the stuff on the inside is the same, and I don't even think the infection rate is higher with open surgery (just my opinion of course). It is possible that he is concerned about your particular build making lap surgery harder. It is harder to work in the upper abdomen on men than it is on women. It's related to the shape of the rib cage, not something you or the surgeon can change.
I think your idea of putting your concerns and what you will and will not accept in writing is a good one. I like Hilary's version very much. I would avoid anything that could be perceived as insulting or threatening, even if you don't intend to insult or threaten. Specifically, I would avoid saying that if you don't get the switch part done someone else will be the one doing it, even if this is a true statement. There is nothing to be gained by saying this, as I don't think this is a surgeon who is known to do the DS in two parts to get paid twice.
It is possible that something could happen after the VSG is done to make either the surgeon or the anesthesiologist insist on getting you off the OR table ASAP. If that happens, it will not be possible to take photos as things will be happening FAST and your safety must be the number one and only concern. I know you are a smart guy and I'm confident you will understand this as long as the surgeon provides you with a reasonable explanation after the dust settles. I'm just saying that you can't demand photos. Now, if on the other hand you have some abnormal anatomy that prevents the switch, he could take pictures of that. So it all depends on the situation, and you need to give your surgeon a little flexibility there.
Having surgery is scary on many levels, and one of them is that you are, for a short but crucial period of time, putting someone else in control of your life. There is no getting around this. It's great to let your surgeon know, in clear terms, what is and is not acceptable to you, but you still need to allow him to use his best judgment while he's operating. Let him know that you accept the increased risk of infection with open surgery and/or longer recovery because for you, the risk of not getting the DS is far greater than the risk of getting a wound infection - which is a real but very treatable complication. You could even point out that ALL bariatric surgery used to be done open. Between that and your (And Hilary's and everyone else's) written directive, you will have done all you can.