Inexperienced Surgeon Perforates Patient's Ureter

Case Overview

Following the birth of her second child, the patient underwent a complete robotic hysterectomy due to prolonged and heavy vaginal bleeding. During the procedure, the patient’s ureter was perforated causing her to subsequently develop urinoma as well as an abscess. It was alleged that the operating surgeon was not sufficiently experienced to perform this procedure.

Questions to the Urology expert and their responses

Please describe your background in urology.

I am a board-certified urological surgeon with 20+ years of experience practicing at top medical institutions. I formerly served as the chief of urology at a regional medical center, and I currently work as an associate professor of urological surgery at a major medical university. I have also authored 50+ publications in my field.

Are you familiar with urethral injuries caused by hysterectomy, bilateral salpingo-oophorectomy, or trans-obturator tape?

I am familiar with urethral injuries caused by hysterectomies, BSO, and TOT. The published rate in the literature of this ureteral injury caused during TAH/BSO is approximately 1%, and this rate has been relatively consistent over time. This usually occurs while trying to control the ovarian pedicle. Of course, the issue here is when was the injury recognized, how was it handled, and whether reasonable precautions were taken by the surgeon beforehand and/or during the operation. Did the surgeon have a co-surgeon, a proctor, or any supervision? Regarding the robot, could the device have failed intraoperatively? How did the hospital mobilize resources to the scene?

About the expert

This Board Certified Urological Surgeon has been practicing medicine for over 20 years at top medical institutions. He is a member of the American Urological Association, and has over 50 publications in the field of urology. He is the former Chief of Urology at the Regional Medical Center at Memphis, and currently is a Associate Professor of Urological Surgery at a major medical university.