The case involves a fifty-two-year-old female patient who underwent a laparoscopic left radical nephrectomy. According to the operative note, the surgeon removed much of the tissue near the wall of the aorta on the left side, along with the renal mass. Immediately after surgery, the patient complained of significant weakness and pain in her legs before her release from the hospital. One year later, and after multiple complaints of lower limb weakness, her primary care physician decided that she should be examined by a second surgeon. Vascular studies were obtained that showed significant vascular compromise to the lower extremities, most likely from the previous surgical intervention. The new surgeon corrected the vascular obstruction and found that more than 50% of the blood flow distribution had been inhibited due to the prior surgery.
Question(s) For Expert Witness
1. Is there any increased risk to performing this procedure laparoscopically?
Expert Witness Response E-004689
Overall, complication rates (9-13%) associated with laparoscopic radical nephrectomy (LRN) are comparable with those of open radical nephrectomy series. Differentiating complications that occur intraoperatively, and those that occur postoperatively, are important because the former may be managed laparoscopically or may contribute to open conversion. Several intraoperative complications of LRN are worth noting. Bowel injuries can occur either during trocar placement or during electrocautery. A small perforation can be managed with laparoscopic suturing. If the adequacy of closure is questionable, however, the surgeon should convert the procedure to an open repair. Vascular injuries can be managed with either clips or the laparoscopic stapler. If suturing is required for an extensive injury, direct pressure can be applied with an inflated Foley catheter balloon over a mandarin while the patient is being opened for repair.
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