Urology Expert Discusses Severe Internal Bleeding Following Robotic Kidney Surgery

Joseph O'Neill

Written by
— Updated on October 2, 2017

Urology Expert Witness This case involves a middle-aged male who underwent a robotic procedure to remove one of his kidneys. The surgeon reported the surgery to be uneventful, and the patient was noted to tolerate the procedure well. The patient was transported to the PACU. While there, the anesthesiologist noted the patient was unable to move both lower extremities, and that he appeared to be very pale. The patient was hypotensive after a few hours in the PACU, and the patient was brought to the ICU. After he continued to deteriorate in the ICU, the patient was taken back to the operating room with a diagnosis of intra-abdominal bleed. The surgeon noted that there were large amounts of blood within the abdomen. The surgeon performed a splenectomy but injured one of the patient’s major arteries in the process, requiring a vascular surgeon to come repair it. The patient survived, but required an extensive hospital stay and suffered permanent injuries from his ordeal.

Question(s) For Expert Witness

  • 1. Do you have experience performing robotic nephrectomy?
  • 2. Is lower extremity weakness a known complication of robotic nephrectomy?
  • 3. What is the most common site of postoperative bleeding following robotic nephrectomy and what steps can be taken to prevent it?

Expert Witness Response E-085515

I have extensive experience with robotic, single-site laparoscopic, and laparoscopic nephrectomy and partial as that is my sub-specialty area of expertise. I perform well over 50 of these types of cases annually. This is a tragic complication. Splenic and pleural injuries are not uncommon and in exceedingly challenging nephrectomies, an aortic injury is certainly possible. However, one should tread lightly and be able to respond quickly should this happen for rapid and definitive control. I couldn’t comment on splenectomy complications as I am a urologist and this would be a general surgery question. Certainly the renal hilar bed and, on the left side, the spleen are very common places for post op bleeding following nephrectomy but also the adrenal gland bed is another. Lower extremity weakness wouldn’t be a typical complication from nephrectomy unless secondary to a catastrophic injury to the nerves or blood supply.

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