Robotic XI Hysterectomy, bilateral salingingectomy, bilateral ovarian cystectomy performed in hospital setting for pre-procedure diagnosis of symptomatic fibroids. Resident and APRN assisted. Pathology unremarkable discharge same day.
Return to hospital and admit 3 days later with fever and abdominal pain. CT abdomen pelvis revealed enlarged pelvic surgical bed hematoma. Follow up CT revealed increased hematoma and CT guided drainage by IR ordered. Patient left AMA a week later to present at larger regional hospital same day. Hospitalized for a week.
Followed closely with gyn practice for next 16 months. Eventually recc and performed exam under anesthesia, bilateral ureterolysis for retroperitoneal fibrosis, left oophorectomy, vaginal cuff revision and diagnostic cystoscopy. Post-op diagnosis included atrophy of left ovary and pelvic fibrosis. Surgical pathology of the vaginal cuff resection was reported as "nodular stroma, morphologically suggestive of ovarian parenchyma". Pathology of left ovary resection reported "fibrous soft tissue with chronic inflammation and evidence of hemorrhage, no definite ovarian parenchyma identified".
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Do you believe there might have been medical error?
Based on the information provided, the patient experienced postoperative bleeding, which is a known potential complication of this procedure. Day of surgery discharge is not uncommon. Percutaneous drainage of a postoperative collection or hematoma is typical. Based on the information provided, there don’t appear to be other injuries Review the operative narrative would likely assist in determining medical error, as would the initial admission hospital notes, and subsequent ED evaluation.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
As stated above, based only on the information provided, I think further determination is not possible. The patient suffered postoperative bleeding and hematoma formation, which is a known complication of the described procedure.
What makes you a good expert for this case?
I’m a gynecological oncologist who performs hysterectomy and robotic surgery.
How often do you encounter cases similar to this one in your practice?
Postoperative bleeding is uncommon, but not rare. I am very familiar with these circumstances.
Do you believe there might have been medical error?
It seems like there was a post-op bleed/hematoma which is a known complication of surgery and evaluation with CT scan and management with IR or reoperation would be correct. The thing that raises a question of possible error is the pathology of ovarian tissue on the vaginal cuff and what looks like ovary turned out to be fibrotic tissue - was an ovary inadvertently attached to the vaginal cuff during closure?
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If the ovary were sutured to the vaginal cuff, it is possible to have been the source of the hematoma, though cuff vessel or uterine artery branch bleeding are more likely culprits of post-hysterectomy bleeding
What makes you a good expert for this case?
Have been in practice as a Gynecologic oncologist for 11 years and perform robotic surgeries including hysterectomies (more than 200 hysterectomies over the past year). I have also given depositions in 2 cases as expert witness previously.
How often do you encounter cases similar to this one in your practice?
I usually have 1-4 hysterectomies every week
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Comments are accepted only from Gynecologic Oncology (Obstetrics and Gynecology) experts.