Patient Suffers Permanent Nerve Damage From Surgical Positioning

ByJoseph O'Neill

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Updated onJune 1, 2016

Patient Suffers Permanent Nerve Damage From Surgical Positioning

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.

Question(s) For Expert Witness

1. Do you routinely perform hysterectomies?

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

Expert Witness Response E-006830

inline imageI routinely perform hysterectomies, both open and laparoscopic. 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. I am fellowship-trained minimally invasive gynecologic surgeon with 8 years of academic experience. I teach residents and medical students how to prevent this particular type of injury, and act as invited international speaker for many conferences, including topics on intra-operative and post-operative complications.

About the author

Joseph O'Neill

Joseph O'Neill

Joe has extensive experience in online journalism and technical writing across a range of legal topics, including personal injury, meidcal malpractice, mass torts, consumer litigation, commercial litigation, and more. Joe spent close to six years working at Expert Institute, finishing up his role here as Director of Marketing. He has considerable knowledge across an array of legal topics pertaining to expert witnesses. Currently, Joe servces as Owner and Demand Generation Consultant at LightSail Consulting.

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