Gynecologic Surgeon Perforates Patient’s Bowel During Hysterectomy

This case involves a 62-year-old woman with a history of several prior abdominal procedures including removal of her gallbladder and a gastric bypass. She was taken for a laparoscopic robotic hysterectomy due to pelvic organ prolapse and postmenopausal bleeding. After the operation, the patient went into septic shock. It was discovered that the patient sustained injuries to her small bowel mesentery during the surgery. The patient required an emergent hemicolectomy and was hospitalized for over 2 months following the procedure. The patient suffered from ongoing incontinence as a result of the hemicolectomy, as well as disfigurement and psychiatric distress. It was alleged that the patient should never have been a candidate for laparoscopic surgery. An expert with experience in gynecologic surgery to review the matter and to opine on patient selection and preoperative clearance.

Question(s) For Expert Witness

1. How often do you perform hysterectomies?

2. What are some contraindications to performing hysterectomy via the laparoscopic/robotic route?

3. What are the alternatives to laparoscopic surgery for a patient like this one?

Expert Witness Response E-006718

I am a fellowship trained specialist in laparoscopic surgery and have been in practice since 2003. I perform approximately 200-250 laparoscopic hysterectomies per year and approximately 200 non-hysterectomy, minimally invasive procedures per year. I also lecture extensively on avoidance and management of laparoscopic complications. Adhesions from previous surgery, though not a contraindication in all cases, can be a contraindication if the adhesions are severe and put the patient at risk for bowel, bladder, or visceral injury. In these cases, the surgeon should look to alternative treatments. If surgery is the only option, the surgeon should be very vigilant for any intraoperative injury. In this case, if the post menopausal bleeding was not due to cancer, a hysterectomy was not indicated. Pelvic organ prolapse can be relieved with other options (pessary, vaginal procedures) that would not put the patient at risk of organ injury due to adhesions. I have reviewed several similar cases which involved bowel injuries at the time of laparoscopic surgery resulting in sepsis.