This case involves a middle-aged female patient who underwent a laparoscopic partial hysterectomy in order to treat fibroids. During the procedure, doctors accidentally caused a bladder wall injury that was identified and repaired during the operation. Nevertheless, the patient went on to develop urinary incontinence following the procedure. The patient eventually underwent a revision surgery in order to treat her incontinence, however it was not successful. As a result the patient continues to suffer from permanent urinary incontinence as well as heavy menstrual bleeding.
Question(s) For Expert Witness
- 1. How often do you perform laparoscopic hysterectomies?
- 2. What are the common complications of a laparoscopic hysterectomy?
- 3. What are the steps taken to avoid a bladder injury during a laparoscopic hysterectomy?
Expert Witness Response E-033733
I perform laparoscopic hysterectomies on a regular basis – more or less 2 per month. I perform other routes of hysterectomy frequently as well. I have additional expertise in advanced laparoscopy (beyond a standard hysterectomy) and serve as a resource for others with complicated cases. Complications overall are not common with a laparoscopic hysterectomy – but standard complications that patient should be informed of can include (but are not limited to) bladder injury, bleeding, ureteral injury, pain, bowel injury or need for an open incision. Careful dissection of the bladder off of the uterus – sometimes with aid of backfilling the bladder with fluid to better delineate planes – can help avoid injury. Experience and appropriate case selection is also important. If there is any question of a bladder injury during the case intra-operative diagnosis is important. Possible use of a cystoscopy can aid in this process as well.