Hysterectomy via Da Vinci Robotic Surgery Causes Severe Postoperative Issues

This case involves a forty-five-year-old woman, status post hysterectomy. This patient presented to her OBGYN physician for a partial hysterectomy via Da Vinci robotic approach. During the procedure suing the surgical technology, one of the blades fractured from one of the trocars, and was lost inside the patient’s abdomen. As a result, the operation had to be converted to an exploratory laparotomy to total abdominal hysterectomy and find the surgical blade. The operative report states that the blade was recovered prior to closing the incision. Her postoperative course was complicated by a supravaginal abscess, which required a percutaneous tube for drainage. This instance required an extended hospital stay and IV antibiotics. She now suffers from multiple issues such as abdominal pain, abdominal muscular wall weakness, and vaginal dryness.

Question(s) For Expert Witness

1. What are the likely complications of robotic surgery?

Expert Witness Response

A surgical robot is a computer-controlled device that can be programmed to aid the positioning and manipulation of surgical instruments. Surgical robotics is typically used in laparoscopy rather than open surgical approaches. Training and credentialing standards have not yet been established for robotic surgeons. Robotic training programs have become part of many surgical residency programs, but it is not standardized across the board. Currently, there are no guidelines or standard requirements for robot-assisted laparoscopy training in residencies, although a committee has been set up by the device industry to develop criteria for a training curriculum. Some residents and fellows will be trained as part of this curriculum and it is at the discretion of the residency or fellowship director whether the trainee is competent or not. There are no standardized criteria in hospitals across the United States to discern whether a surgeon coming out of training or from another institution should receive robotic privileges. The time is fast approaching that newly introduced procedures in a resident’s or fellow’s training may be performed using robot-assisted laparoscopy rather than laparotomy. Hence, complications arising from the robotic approach typically stems from inexperience and/or inadequate training from the robotic approach.