Gynecologic Surgeon Perforates Patient's Bowel During Hysterectomy

Case Overview

This case involves a 62-year-old woman with a history of several prior abdominal procedures including removal of her gallbladder and a gastric bypass. She was taken for a laparoscopic robotic hysterectomy due to pelvic organ prolapse and postmenopausal bleeding. After the operation, the patient went into septic shock. It was discovered that the patient sustained injuries to her small bowel mesentery during the surgery. The patient required an emergent hemicolectomy and was hospitalized for over 2 months following the procedure. The patient suffered from ongoing incontinence as a result of the hemicolectomy, as well as disfigurement and psychiatric distress. It was alleged that the patient should never have been a candidate for laparoscopic surgery. An expert with experience in gynecologic surgery to review the matter and to opine on patient selection and preoperative clearance.

Questions to the Gynecology expert and their responses

How often do you perform hysterectomies?

I perform approximately 200-250 laparoscopic hysterectomies per year and approximately 200 non-hysterectomy, minimally invasive procedures per year.

What are some contraindications to performing hysterectomy via the laparoscopic/robotic route?

Adhesions from previous surgery, though not a contraindication in all cases, can be a contraindication if the adhesions are severe and put the patient at risk for bowel, bladder, or visceral injury. In these cases, the surgeon should look to alternative treatments. If surgery is the only option, the surgeon should be very vigilant for any intraoperative injury.

What are the alternatives to laparoscopic surgery for a patient like this one?

If the post menopausal bleeding was not due to cancer, a hysterectomy was not indicated. Pelvic organ prolapse can be relieved with other options (pessary, vaginal procedures) that would not put the patient at risk of organ injury due to adhesions.

About the expert

This expert has over 15 years of experience in the field of minimally invasive gynecologic surgery. He earned his BS in biology from the University of Miami and his MD from the University of Miami School of Medicine. He then completed a residency in obstetrics and gynecology and a fellowship in minimally invasive surgery at the University of Pittsburgh. Today, this expert is board certified in obstetrics and gynecology and is a member of several professional organizations, including the Society of Laparoendoscopic Surgeons, the American Society for Reproductive Medicine, and the American Association of Gynecologic Laparoscopists. He stays very active in academia, having published over 40 peer-reviewed articles and 7 textbook chapters on topics related to obstetrics, gynecology, and gynecologic surgery. He has also received over a dozen research grants and specializes in the treatment of pelvic pain, endometriosis, fibroids, heavy bleeding, cysts, and other minimally invasive procedures. This expert previously served as an assistant professor of obstetrics and gynecology and as the minimally invasive gynecologic surgery fellowship coordinator at the University of Pittsburgh. Currently, he serves as an associate professor of obstetrics and gynecology and as the associate director of minimally invasive gynecologic surgery at a major medical school as well as a staff member at a university-affiliated medical center in Pennsylvania.

E-006718

Specialties:

Gynecology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

Gynecologic Surgeon Perforates Patient’s Bowel During Hysterectomy