Gynecologist Fails To Remove Patient’s Cervix During Hysterectomy

Wendy Ketner, M.D.

Written by
— Updated on April 11, 2019

Gynecology Expert Witness

This case involves a 36-year-old female patient with a past medical history of a supracervical hysterectomy who developed pelvic pain and abnormal bleeding. The patient underwent a robotic trachelectomy to remove her cervix with no complications reported. Following the operation, the patient presented with complaints of vaginal bleeding, pain, and foul-smelling vaginal discharge. Several months later, the patient sought treatment with a second OBGYN who performed a carbon dioxide laser of what he described as a vaginal lesion. The op report stated that the vaginal cuff was inspected very carefully. There were no abnormalities noted at the vaginal cuff, but there was a posterior vaginal wall lesion starting immediately below the vaginal cuff. It was raised, irritated, and red. Biopsies of this tissue were obtained and the carbon dioxide laser was used to successfully remove the area in the vagina. In spite of the procedure, the patient’s symptoms continued with worsening pain. A subsequent pelvic ultrasound revealed what appeared to be the cervix. The patient then underwent a second robotically-assisted trachelectomy. During the procedure, a residual lesion was discovered. Pathology later confirmed it to be a retained cervix. There were severe adhesions overlying the cervical area and vaginal cuff area, which involved the bladder as well.

Question(s) For Expert Witness

  • 1. How frequently do you perform trachelectomy?
  • 2. Is retention of the cervix a common complication of this procedure and what can be done to ensure complete removal? Please explain.

Expert Witness Response E-195619

I am an expert on laparoscopic hysterectomy, including removal of the cervix. I have lectured extensively on laparoscopic hysterectomy, including video presentations at national and international meetings. I have also chaired the laparoscopic hysterectomy course at an annual congress for gynecologic laparoscopists. Trachelectomy is a rare procedure as most hysterectomies are total hysterectomies with removal of the cervix at the time of the hysterectomy. The risk of continued cyclic vaginal bleeding and pelvic pain has been estimated to be in the 10% to 15% range, and some of these are treated medically, while others require surgical removal of the cervix or trachelectomy. I have had to do a few over the years but it’s not a frequent procedure in any practice. Retention of the cervix at the time of trachelectomy is not a common complication, and it reflects the difficulty of the procedure and/or the surgical technique used. There are special techniques that are used to ensure complete removal of the cervix without injury to the bladder, the ureters or the uterine vasculature. If it happens due to extreme surgical difficulty, it should be clear to the surgeon and the patient should be made aware that the procedure was not completed successfully and referred appropriately.

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