This case involves a sixty-five-year-old male patient who had a new onset prostate cancer and underwent a robotic assisted prostatectomy that was met with significant complication. The patient had a prior history of an exploratory laparotomy with extensive gastrointestinal manipulation and resection of bowel tissue with a holmium laser enucleation. During the prostatectomy, the surgical note detailed great difficulty maneuvering within the abdomen due to adhesions and problems placing the patient in a standard prostatectomy position. There was also mention of proper insufflation issues that prevented a proper window into the surgical workspace. Ultimately, due to the robotic surgery, the patient sustained a perforation to the small bowel that needed to be resected with a reanastomosis required during a corrective exploratory laparotomy procedure. The patient suffered from complications linked to a very large surgical wound that would not heal for an extended time period.
Question(s) For Expert Witness
- 1. What is the most common complication related to laparoscopic prostatectomy procedures?
Expert Witness Response E-005320
Obtaining access to the intraperitoneal or extraperitoneal space for LRP or RALP is associated with specific risks based on the type of trocars used, the location of access, patient anatomy, and prior abdominal surgery. In LRP or RALP, initial access is typically in the periumbilical location and is based on surgeon preference. Bleeding related to trocar placement is the most common access-related complication. The majority of bleeding resulting from trocar placement is due to injury of small subcutaneous veins. Most of these injuries are immediately recognized upon trocar insertion or removal, and are easily controlled with the use of electrocautery. Less frequently, larger intra-abdominal or pelvic vessels can be injured during laparoscopic access. Careful attention to proper laparoscopic technique can help prevent these injuries.