Medicolegal Issues

Blood vessels injured during trocar insertion: $8.7M verdict


 

Blood vessels injured during trocar insertion: $8.7M verdict

A 26-year-old woman went to the emergency department with periodic pelvic pain. The attending ObGyn ordered exploratory laparoscopic surgery. When a resident physician inserted the trocar, the right common iliac artery and vein were injured. The patient started hemorrhaging and required a laparotomy to repair the injury. Postsurgery, the patient's bowel began to swell; the wound was kept open for drainage, requiring an additional procedure for closure. She remained in the intensive care unit for several weeks. She has a large abdominal scar and reports chronic abdominal pain. She is at risk for further complications, including bowel obstruction, because of abdominal adhesive disease. She lost her job and struggles to maintain her daily life.

PATIENT’S CLAIM:

The resident was negligent in performing trocar insertion during laparoscopic surgery by inserting the trocar too far into the abdomen. The attending ObGyn did not supervise the resident properly. There is nothing in the patient's medical records to indicate that she had abnormal anatomy. The woman's life is in turmoil after what was supposed to be a routine procedure.

DEFENDANTS' DEFENSE:

There was no negligence. The patient's anatomy was abnormal, making the risk of surgery higher. The injury is a known complication of laparoscopic surgery.

VERDICT:

An $8,718,848 Illinois verdict was returned.

Related article:
How to avoid major vessel injury during gynecologic laparoscopy

Wrong fallopian tube transected: $1.8M award

A 28-year-old woman underwent an appendectomy. During the operation, the surgeon saw an abscess on the patient's right fallopian tube and called in an ObGyn to remove the abscess. While doing so, the ObGyn transected the left fallopian tube. Both fallopian tubes were removed.

PATIENT’S CLAIM:

The surgeon did not tell the ObGyn which fallopian tube was abscessed and therefore the ObGyn operated on the wrong tube. In addition, the surgeon failed to obtain informed consent for bilateral salpingectomy. The patient is now unable to conceive without assisted reproductive treatment.

PHYSICIAN’S DEFENSE:

The surgeon admitted his mistakes but disputed the informed consent claim. The patient probably would not have been able to conceive naturally due to the infection.

VERDICT:

A $1.8 million Connecticut verdict was returned.

Related article:
Elective laparoscopic appendectomy in gynecologic surgery: When, why, and how

Complications after vaginal hysterectomy

A woman underwent laparoscopic vaginal hysterectomy and bilateral salpingo-oophorectomy with anterior and posterior repair using mesh in August 2010. Shortly after surgery, the patient reported vaginal discharge with pain and bleeding. She was treated with antibiotics. Results of a CT scan identified the cause of her symptoms as vaginal cuff granulations.

Her pain continued and in June 2011, she underwent vaginal tissue biopsy. After testing revealed the presence of fecal matter, a small-bowel vaginal fistula was identified. She underwent laparoscopic enterectomy, urethral lysis, an omental pedicle flap, and cystoscopy. The mesh had perforated several loops of the small bowel.

In August 2011, the patient reported spinal pain. Magnetic resonance imaging (MRI) revealed a new fluid abscess in a disc extending through the tract anterior to the soft tissue of the pelvis. She underwent intensive antibiotic therapy.

PATIENT’S CLAIM:

The gynecologic surgeon fell below the standard of care in his treatment of her conditions.

PHYSICIAN’S DEFENSE:

The surgeon denied allegations.

VERDICT:

A Nevada defense verdict was returned.

Related article:
Vaginal hysterectomy with basic instrumentation

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

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