Robotic Surgery Expert Opines on Patient Death from Internal Bleeding

This case involves a male patient in Washington who underwent a robotic procedure and then suffered post-operative bleeding leading to his death. The patient underwent a procedure to remove part of his prostate, which concluded without incident. Immediately after the procedure, the patient’s hemoglobin was measured, and over the next few hours was noted to have dropped. Doctors continued to monitor his hemoglobin, which eventually stabilized. A few hours later, the patient began to complain of chest pain and weakness and coded shortly afterwards. It was later revealed that the man had been bleeding internally.

Question(s) For Expert Witness

1. Are you familiar with patients like the one described above?

2. Have you had a patient develop this complication?

Expert Witness Response E-009659

I am very familiar with this procedure, I have performed about 500 robotic prostatectomies. I have treated a patient with this complication, and it was recognized and the patient recovered. I have published on this topic - I authored the American Urologic Association Update Series on post-prostatectomy complications. This is a rare but well documented case of delayed bleeding after radical prostatectomy. At the end of surgery, there was likely no active bleeding that could be identified. However, postoperative bleeding from various potential areas - like the dorsal venous complex of iliac branch - can occur. That is why hemoglobin levels are monitored postoperatively, and, depending on these numbers and the patient's status, the decision of whether to take the patient back to the Operating Room is made.