Patient Suffers Permanent Nerve Damage From Surgical Positioning

Case Overview

This case involves a female patient who on underwent a total hysterectomy to resect uterine cancer. The surgery was lengthy, as the surgeon was sending slides to pathology as the procedure progressed, until he eventually decided on total hysterectomy. The patient was in dorsal lithotomy position for for an extended period of time, beyond the length of the surgery itself. The operative report makes no note of position changes or the use of positioning devices such as wedges. Immediately upon awakening, the patient could not feel her right leg. EMG and other studies confirmed severe femoral nerve palsy. Despite some inprovement in her condition, she continues to suffer from impaired mobility as a result of her injuries.

Questions to the Gynecology expert and their responses

Do you routinely perform hysterectomies?

I routinely perform hysterectomies, both open and laparoscopic.

What measures should be taken to prevent nerve injuries to patients during this procedure?

Depending on the positioning of the patient, and the route of hysterectomy (was patient in dorso-lithotomy position? were sidewall self retaining retractors used?, etc), femoral nerve could be, and should, protected with intermittent releasing of hyperflexion of the hip (in dorso-lithotomy position) or releasing pressure on the sidewall retractor paddles during open hysterectomy. I never had this outcome in my patients.

About the expert

This highly qualified and board-certified OB/GYN received his M.D. from SUNY Upstate Medical University, College of Medicine. He completed residency training in Obstetrics and Gynecology at Albert Einstein College of Medicine and Fellowship training in Gynecologic Endoscopy & Minimally Invasive Gynecology at Nezhat Medical center. He is a member of several professional organizations including the Society of Reproductive Surgeons, American Society for Reproductive Medicine, and the American College of Obstetricians and Gynecologists. He serves on the editorial board for the Journal of Gynecology and is a reviewer for several peer-reviewed publications including Journal of Minimally Invasive Gynecology, Journal of Systems Biology in Reproductive Medicine, and Journal of Assisted Reproduction and Genetics. Currently, this expert is an Assistant Professor in Obstetrics and Gynecology at a major medical university.

E-006830

Specialties:

Gynecology