Robotic Hysterectomy Results in Bowel Perforation

This case involves a woman who elected to undergo a laparoscopic hysterectomy using robotic myomectomy. She presented to her OBGYN with abdominal pain related to adhesions from a previous colectomy. The original OBGYN who was consulted elected to use the traditional laparotomy due to complications associated with previous surgeries. Hence, this physician felt that using robotic or laparoscopic approaches would place this patient at a high risk for surgical complications. The plaintiff was referred to another OBGYN who performed a robotic hysterectomy with the Da Vinci instrument. Intraoperatively, a bowel perforation occurred, it was corrected and the hysterectomy was carried out. Postoperatively, the patient complained of intense pain. Her symptomology worsened in the upcoming days. Seven days later, an MRI showed small bowel perforation and peritonitis. The hospital course was complicated with severe sepsis; the patient came very close to expiring on several occasions.

Question(s) For Expert Witness

1. What are the complications of robotic surgery over traditional approaches?

Expert Witness Response

The robot-assisted laparoscopic hysterectomy has become popular mode of minimally invasive surgery. The steep learning curve of laparoscopy is circumvented with the limited training requirements of robotics. Although there is a loss of tactile feedback with robotics, this is overcome in most surgeons by the superior visual input. Also, the instrumentation allows for increased degrees of freedom mimicking the motions of the human. Robot-assisted hysterectomy seems to be associated with an increased risk of vaginal cuff dehiscence as compared to laparoscopic hysterectomy. It is also not recommended in patients with previous abdominal surgeries in the region of the uterus, hence, a colectomy. A laparotomy would have been a safer alternative in the above matter.