Patient Suffers Permanent Nerve Damage From Surgical Positioning

This case involves a female patient who on underwent a total hysterectomy to resect uterine cancer. The surgery was lengthy, as the surgeon was sending slides to pathology as the procedure progressed, until he eventually decided on total hysterectomy. The patient was in dorsal lithotomy position for for an extended period of time, beyond the length of the surgery itself. The operative report makes no note of position changes or the use of positioning devices such as wedges. Immediately upon awakening, the patient could not feel her right leg. EMG and other studies confirmed severe femoral nerve palsy. Despite some inprovement in her condition, she continues to suffer from impaired mobility as a result of her injuries.

Question(s) For Expert Witness

1. Do you routinely perform hysterectomies?

2. What measures should be taken to prevent nerve injuries to patients during this procedure?

Expert Witness Response E-006830

I routinely perform hysterectomies, both open and laparoscopic. Depending on the positioning of the patient, and the route of hysterectomy (was patient in dorso-lithotomy position? were sidewall self retaining retractors used?, etc), femoral nerve could be, and should, protected with intermittent releasing of hyperflexion of the hip (in dorso-lithotomy position) or releasing pressure on the sidewall retractor paddles during open hysterectomy. I never had this outcome in my patients. I am fellowship-trained minimally invasive gynecologic surgeon with 8 years of academic experience. I teach residents and medical students how to prevent this particular type of injury, and act as invited international speaker for many conferences, including topics on intra-operative and post-operative complications.