Gynecologist Fails To Remove Patient’s Cervix During Hysterectomy

ByWendy Ketner, M.D.

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Updated onApril 11, 2019

Gynecologist Fails To Remove Patient’s Cervix During Hysterectomy

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

inline imageI 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.

About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

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.

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