This case involves a middle-aged female patient in Connecticut who underwent a robotic-assisted hysterectomy in order to treat uterine fibroids. During the procedure, the operating physician reportedly encountered no difficulties or complications and, consequently, closed the patient and sent her for recovery. After only a few hours, the patient began experiencing abdominal pain, swelling, as well as an increased heart rate. After several hours of further observation, during which the patient failed to produce any urine. After a consultation with urology was obtained the patient was sent back to surgery for emergency repair of her ureter, however the patient continues to suffer from kidney failure as a result of her injuries.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Are you familiar with urethral injuries caused by hysterectomies?
- 3. What could have been done for the patient to prevent such an outcome?
Expert Witness Response E-000249
I am a board certified Ob-Gyn with 40 years in practice. I regularly perform hysterectomies, primarily vaginal, abdominal, or laparoscopic and sometimes it is with the assistance of the DaVinci robot. Although ureteral injury is a “known complication of surgery,” it should not occur absent malignancy, severe endometriosis, infection or negligence. That is, we will occasionally, and deliberately, resect a portion of ureter involved with cancer or endometriosis, and at the same surgery reanastomose the cut edges, usually with placement of a ureteral stent. There is no excuse for terminating surgery with an undiagnosed ureteral injury. That is, when operating close to the ureter, we need to assess its integrity before closing the abdominal incisions.