Lap Colectomy: failure to recognize transection of ureter (Case #118)

• Medical Probability: 10 / 10
• Medical Error Summary: Transecting a ureter is definitely an error. One of the major steps in this operation is identifying the ureters. However, this is one of the known complications of this surgery. Although it should ...
• Causation Probability: 10 / 10
• Causation Summary: Misidentifying the ureter leads to inadvertent transection of the ureter.
• Expert Summary: General surgery, colon surgery and abdominal surgery is my main practice. I have also had my own transection of a ureter and understand why this happens and how it happens and what is normal and not n...
• Similar Summary: At least once per month or twice per month I do colon surgery.

"Subclavian" port-a-cath is placed in the thoracic aorta (Case #130)

• Medical Probability: 10 / 10
• Medical Error Summary: Definitely a known error placing the catheter into the subclavian artery instead of the subclavian vein. However, I would be curious to know if the hole was in the aortic arch (extremely uncommon an...
• Causation Probability: 7 / 10
• Causation Summary: I think it comes down to if the catheter was actually placed in the aortic arch or if it was placed in the subclavian artery. If it was placed in the subclavian artery there is probably no need to h...
• Expert Summary: I've done thousands of subclavian catheter placements. I have actually put the needle in the subclavian artery a few times but not dilated the artery because I checked to see if there was a pulsatile...
• Similar Summary: I do not do these much anymore but as I said have done probably thousands. Probably less than 10 per year now, but I'm very familiar with the technique, known and unknown complications of the procedu...

Young male needs CVC for sickle cell treatment, surgeon perforates subclavian artery bedside, has multiple complications (Case #376)

• Medical Probability: 7 / 10
• Medical Error Summary: This is a known complication of CVC. Complication rate is of subclavian or common carotid artery puncture is 6-9% for internal jugular vein catheters. It would be interesting to know if this was only...
• Causation Probability: 10 / 10
• Causation Summary: This complication led to bleeding. There might be an error which led to continued bleeding and need for the thoracotomy.
• Expert Summary: I’ve done at least 500 or more CVCs. I’ve punctured the subclavian artery myself and compressed the artery manually to stop the bleeding. I’ve put in at least 500 chest tubes and have done abou...
• Similar Summary: Not often but I’ve seen a handful.

Hernia repair w/ fundoplication, later found to have esophageal perforation and also a surgical stitch in pericardium. (Case #380)

• Medical Probability: 10 / 10
• Medical Error Summary: No suture should be through the pericardium during fundoplication.
• Causation Probability: 10 / 10
• Causation Summary: Suture into the pericardium most likely was full thickness through the stomach causing gastric leak, which caused the dense adhesions between the left ventricle, pericardium and fundoplication. Also t...
• Expert Summary: I'm not the best expert for this case, I have done probably 20-30 of these but this is not a regular case that I do anymore.
• Similar Summary: I don't do these anymore.....I have not worked clinically for 3 years now. I was doing about 2-3 per year before that and had done probably 15-20 in residency.

Sigmoid diverticulitis with contained perforation and abscess. Hartmann’s procedure done and develops fistula and large wound, multiple complications. (Case #381)

• Medical Probability: 8 / 10
• Medical Error Summary: Sounds like the colon was not properly sealed at the original surgery. That is a known complication of the surgery however I think the error is not taking the patient back on POD 1 when she had perito...
• Causation Probability: 10 / 10
• Causation Summary: If the patient is taken back on POD 1 most likely she would have avoided the multiple complications and problems.
• Expert Summary: I am an OK expert. I’ve done 100s of colon and small bowel surgeries including hartmanns procedures and have also had my own patients have colonic leak and have had to manage them as well.
• Similar Summary: I have seen and managed about 10-12 really bad colonic leaks that have led to multiple complications including hernia and wound dehiscence like this one.

Injury to the aorta inferior mesenteric vein, jejunum during elective robotic assisted laparoscopic sleeve gastrectomy (Case #397)

• Medical Probability: 10 / 10
• Medical Error Summary: Any injury to an organ or blood vessel during Visiport placement is an error.
• Causation Probability: 10 / 10
• Causation Summary: The error is not identifying that the port has reached the peritoneal cavity and continuing To apply pressure to the port through the small bowel as well as the aorta.
• Expert Summary: I have placed thousands of peritoneal cavity ports for laparoscopic surgery. Approximately 25% of these are visiports.
• Similar Summary: I have not personally injured the aorta with a port however, I know of a colleague who has done that once. This is over 10 year period of practice. Personally I have had one small bowel injury, placi...

Patient with history of prior abdominal surgery, dies during laparoscopic procedure. End tidal co2 dropped immediately after a Veress needle was inserted into the peritoneum. (Case #452)

• Medical Probability: 5 / 10
• Medical Error Summary: This patient is in a cardiovascular compromised position, and most likely under-resuscitated as bowel obstruction patients usually are. The veress needle insertion either caused a gas embolism by pen...
• Causation Probability: 5 / 10
• Causation Summary: I don't think there was an error in management. I think this patient had underlying unknown CV risk that could not be appreciated pre-op. If there was Veress needle penetration of a vein causing gas ...
• Expert Summary: General, Emergency & Trauma surgeon for over 10 years. Have done thousands of laparoscopic cases. 100s w Veresss needles.
• Similar Summary: I have not had a patient die in this manner, I have had patients become unstable with insufflation of the peritoneum. I have done 100s of laparoscopic cases (at lease started) for bowel obstruction.