Patient’s bowel perforated during robot-assisted RP
Urologist argues that patient’s medical conditions were not contraindications to surgery
A 59-year-old Virginia man was diagnosed with prostate cancer in 2012 and assigned a Gleason score of 7. The treating urologist discussed the treatment options with the patient and, when the patient opted to explore surgical treatment, he referred the patient to another urologist.
This urologist advised the patient to undergo radiation rather than surgery, due to his complex medical history, which included diabetes, hypertension, failed gastric bypass, sarcoidosis treated with steroids, arrhythmia, diverticulitis, sleep apnea, hernia repair, and obesity. These conditions increased the risk of complications, especially the risk of bowel injury from adhesions that may have formed after his previous abdominal operations.
The patient opted for surgery and underwent robot-assisted laparoscopic prostatectomy in 2013. During the operation, the urologist repaired a bowel perforation caused by the initial trocar insertion. He also inspected the bowel for further injuries and found none.
The patient was kept in the hospital under careful monitoring for 3 days and discharged by one of the urologist's partners when he appeared clinically stable. The patient felt well until the sixth postoperative day, when his condition worsened and he returned to the emergency room. He then underwent surgery to repair another bowel perforation that was lateral to the original repair, which was healing and intact. He suffered a prolonged hospitalization, further surgeries, and a difficult postoperative course due to his multiple medical conditions and poor wound healing.
The patient sued the urologist, alleging that he should not have performed surgery on the patient, and that the second bowel perforation should have been detected and repaired during the original operation. He also claimed he should not have been discharged from the hospital in 3 days.