This case involves a middle aged female patient who developed complications following an adrenalectomy procedure to remove a tumor from his right adrenal gland. The patient originally went into the defending hospital to have a tumor removed from her right adrenal gland. She was released about a week later, but she was in excruciating pain, and she returned to the hospital some time following discharge. It was revealed that she had a large quantity of urine in her abdomen. It was subsequently discovered that, during the initial surgery, the surgeon severed her right ureter while removing the tumor. As a result, the patient had to have her right kidney removed.
Question(s) For Expert Witness
- 1. How often do you perform this procedure?
- 2. What measures should be taken to protect the ureters during surgery?
Expert Witness Response E-005320
I do adrenalectomies routinely in my practice and was previously the highest volume adrenal surgeon at a state university academic center. This is an unusual complication. The ureter would typically only be at risk during colon mobilization portion of the procedure. Unless the adrenal tumor was gigantic, the patient had had prior retroperitoneal surgery or the kidney was malrotated, the ureter should not be at risk for an iatrogenic injury and this does raise a question of surgeon experience and standard of care.