Patient is Severely Injured During Laparoscopic Hysterectomy

This case takes place in Delaware and involves a middle aged patient who suffered a rectal injury as a result of a laparoscopic surgery. The patient initially presented to her ob/gyn with severe pain and excessive bleeding during her menstrual cycle. The ob/gyn placed the woman on Yasmin contraceptive pills to control the symptoms and later implanted an IUD. The physician removed the IUD one year later and performed a vaginal ultrasound. The patient was told that the vaginal ultrasound revealed a cyst on one of her ovaries. The following year, her ob/gyn recommended a hysterectomy for the cyst.

The patient was informed that the hysterectomy would be performed laparoscopically and, if a problem developed, they would switch to an open procedure. The assisting surgeon documented that, during the laparoscopic surgery, there was a significant injury to the rectum with multiple areas of deserosalization, including anteriorly and laterally both locations. Therefore, the procedure was converted to open, and she completed her portion of the procedure with over-sewing of the vaginal cuff. Because of the extensive damage to the rectum, the assisting surgeon performed an ileostomy. Immediately after the surgery, while in the recovery room, the patient was informed that the hysterectomy did not go as planned, and was told that they encountered Stage IV endometriosis. As a result, the surgeon had “nicked” the rectum. The patient was informed that she had to use an ileostomy bag, which was eventually reversed. Since then, the patient has continued to experience very limited control over her bowels and relates that she empties her bowels 10 times per day. She has difficulty eating raw vegetables and fruits and says that she experiences excruciating pain from what she assumes is a bowel blockage. The patient was informed that she had scar tissue at the site of the anastomosis, and that she had developed a hernia. She will require additional surgery to correct these additional complications.

Question(s) For Expert Witness

1. Do you have extensive experience performing laparoscopic hysterectomies?

2. Do you have knowledge of the complications that may arise when continuing the surgery after seeing a dense adhesion?

Expert Witness Response E-004027

I have extensive experience in laparoscopic hysterectomy surgery as well as endometriosis of all stages. I also have knowledge of the potential complications of such surgery in the field with dense adhesions and endometriosis. I have had many cases that sound similar to the findings at the time of the start of this case. Although, this is an extreme set of complications and repairs for these complications it is not unheard of. Most important to me here will be how the physician counseled the patient prior to surgery about the potential complication of this surgery and the potential risks and expected outcomes of these risks. I would also be interested in knowing who the assistant surgeon was. It sounds like a general surgeon or colorectal surgeon. Was he/she there for the entire case or only after the noted rectal injuries? Also, I would like to know the thought process for determining that a hysterectomy was necessary for an ovarian cyst. Was it due to the bleeding issues or something else?