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    Did surgeon inexperience result in iatrogenic injury?


    Andrew I. Kaplan, Esq, is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP in New York City, specializing in medical malpractice defense and healthcare litigation. He welcomes feedback on this column via email to [email protected].

     

    Facts

    On July 29, 2010, a 46-year-old obese primarily Spanish-speaking patient was admitted to a hospital by her private ob/gyn Dr. A for a total laparoscopic hysterectomy (TLH) and/or laparoscopically assisted vaginal hysterectomy (LAVH) that day. Dr. A was new to the facility, not yet board-eligible, and had never performed the procedure as primary surgeon.

    The patient and Dr. A. signed a consent (in English) for the TLH and/or LAVH with removal of tubes and ovaries bilaterally, possible vaginal assistance, possible laparotomy and all related procedures. According to the pre-procedure history and physical examination authored by Dr. A, the patient was seeking surgical management of her fibroid uterus and menometrorrhagia after failed medical treatment with birth control pills. The risks, benefits, and alternatives of LAVH, TAH, and total vaginal hysterectomy (TVH) were discussed with the patient.

    Dr. A believed that a laparoscopic approach was the best option because of the patient’s obesity, but she documented the possibility that the procedure might not be totally accomplished laparoscopically, and a vaginal approach or conversion to an open abdominal procedure was also possible.

    The patient’s surgery was originally scheduled for 1:45 pm but did not start until 6:42 pm because of operating room (OR) back-ups; it ended at 3 am.

    Dr. B, a fellow attending, observed the procedure at Dr. A’s request but did not scrub in. Dr. A and the chief resident were operating the equipment and Dr. B was watching on the screen. Dr. A had difficulty visualizing the right uterine artery because of the patient’s body habitus, which required them to tilt the patient back further in Trendelenburg to lift her bowels and omentum out of the area. When they did so, however, the anesthesiologist had difficulty adequately ventilating her in that position; therefore, the decision was made to attempt a vaginal approach.

     

    Andrew I. Kaplan, Esq
    Mr. Kaplan is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP, specializing in medical malpractice defense and healthcare ...

    2 Comments

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    • Anonymous
      I am confused by the statement "Dr. A was new to the facility, not yet board-eligible, and had never performed the procedure as primary surgeon." If this means that Dr. A's recently completed residency program had the attending on service listed as primary surgeon while the chief resident was indeed the primary surgeon, that is one thing. However, if Dr. A. had never done an LAVH as primary surgeon, I would question the accreditation of her residency program.
    • JenniferBienstock Cohen
      This article is an excellent reminder to even experienced physicians to seek out support from more seasoned physicians. Avoiding mishaps in the OR is better than litigating them for years afterwards.

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