Inexperienced Surgeon Perforates Patient’s Ureter

Urology ExpertThis case involves a 38-year-old woman with a medical history of two natural births and a family history of ovarian cancer. 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.

Question(s) For Expert Witness

  • 1. Please describe your background in urology.
  • 2. Are you familiar with urethral injuries caused by hysterectomy, bilateral salpingo-oophorectomy, or trans-obturator tape?

Expert Witness Response E-008891

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. 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?

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