Gynecologic Oncology Experts Discuss Cause of Ureteral Injury During Robotic Surgery


Oncology Expert WitnessThis case involves a woman  in Arizona who underwent a robotic-assisted hysterectomy in order to treat an abnormal carcinoma of her cervix. During the procedure, she suffered injuries to both of her ureters which remained undiagnosed for over a week following the operation. In order to treat these injuries, the patient underwent ureteral stenting. After multiple attempts to insert the catheters over the next few months, she suffered a massive stroke and underwent an emergent decompression. As a result of injuries caused by the stroke, she was admitted to a long-term care facility with little hope for significant recovery. It was alleged that the initial ureter injuries suffered during her robotic-assisted hysterectomy were the cause of her eventual stroke.

Question(s) For Expert Witness

  • 1. How often do you perform robotic-assisted radical hysterectomies, and cystoscopies?
  • 2. Have you reviewed a similar care before?
  • 3. What are some causes for a bilateral ureteral injury during this type of surgery?

Expert Witness Response E-081077

I perform about 20 robotic assisted radical hysterectomies, bilateral salpingo-oophorectomies, and pelvic lymph node dissections per year, as well as another 300 or so standard robotic hysterectomies with or without lymph node sampling. I do not routinely perform cystoscopies because the injury rate is low and the procedure is not necessary. Bilateral ureteral injury during this procedure is rare. Some potential explanations include diffuse fibrosis, inflammatory reaction secondary to a tumor, or a tumor that was too large for robotic hysterectomy. I am not sure what the potential explanations might be here, but such an injury should be identified and addressed when it does occur.

Expert Witness Response E-019122

I am confident that I can help with this case as I perform robotic radical hysterectomies on a monthly basis. I have seen several cases like this before and have been an expert on several similar cases. There are several causes for ureteral injury but often it may be poor technique, lack of surgeon training, poor patient selection, or faulty equipment. I have lectured on it and am now publishing a book on surgery which includes surgical complications of this type. I am a professor of Gynecologic Oncology and Director of Minimally Invasive Surgery and Education. I have published 200+ articles and written 19 book chapters. I am also the Associate Editor of the Journal of Minimally Invasive Gynecology.

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