Description of Event or Problem · 1
A (B)(6), FEMALE, ADMITTED ON (B)(6) 2011, FOR ELECTIVE DAVINCI ROBOTIC ASSISTED HYSTERECTOMY. UPON INSERTION OF TROCAR BY RESIDENT, BLOOD NOTED IN ABDOMINAL CAVITY. IV'S OPENED, GENERAL SURGEON CALLED IN FOR ASSISTANCE. PT UNSTABLE WITHOUT MEASURABLE BP DURING CERTAIN PERIODS OF CASE. MASSIVE TRANSFUSION (18 UNITS PRBC'S, 700 CC CELL SAVER, 4 U FFP, PLATELETS AND 13 LITERS OF CRYSTALLOID GIVEN). TREATED WITH EPI, NEOSYNEPHRINE, EPHEDRINE AS NECESSARY TO SUSTAIN BP. PT PLACED ON VENT AND TRANSPORTED TO CVICU. FOUND TO HAVE SUSTAINED AORTIC INJURY WITH RETROPERITONEAL BLEEDING. CASE ABORTED. PT RETURNED TO SURGERY 2 DAY LATER ((B)(6) 2011), FOR SUPRACERVICAL HYSTERECTOMY. DETAILS OF INITIAL SURGERY: THE PT WAS TAKEN TO THE OPERATING ROOM, PREPPED AND DRAPED IN NORMAL, STERILE FASHION. EXAM UNDER ANESTHESIA REVEALED APPROX 20 WEEKS' SIZE ENLARGED UTERUS. WEIGHTED-SPECULUM WAS PLACED IN THE VAGINA. CERVIX WAS GRASPED WITH SINGLE-TOOTH TENACULUM GENTLY, SYMMETRICALLY DILATED TO APPROX 14. UPON DILATION TO APPROX 14, A SINGLE-TOOTH TENACULUM WAS PLACED THROUGH THE POSTERIOR LIP OF THE CERVIX PRIOR TO DILATATION. A STITCH OF 0-VICRYL WAS THEN PLACED AT THE 6 O'CLOCK POSITION FOR TRACTION ON THE UTERUS AND TO HELP WITH VAGINAL DELIVERY OF THE FIBROID. THIS SUTURE WAS THEN PLACED THRU THE V-CARE UTERINE MANIPULATOR AND THIS MANIPULATOR WAS PLACED WITHOUT DIFFICULTY AND GOOD MOBILITY OF THE UTERUS WAS NOTED. A 15CC OF AIR WAS PLACED INTO THE V-CARE BALLOON PRIOR TO ADVANCING THE CUPS. FOLEY CATHETER WAS THEN PLACED AND FROM ABOVE, APPROX 10 CM ABOVE THE TOP OF THE UTERUS, A 12 MM MARK WAS MADE USING A CLEAR VIEW TROCAR. AT THIS POINT, CAMERA WAS WHITE BALANCE. A TROCAR WAS PLACED IN A TRAUMATIC FASHION THROUGH THE FASCIA AT THE LEVEL OF THE PERITONEUM. AT THIS TIME, THE CAMERA WAS REMOVED AND IT WAS APPARENT THAT WE WERE RIGHT ABOUT AT THE EDGE OF THE PERITONEUM. SCOPE WAS THEN PLACED AND THE TROCAR WENT INTO A LARGE ARTERIAL VESSEL. AT THIS TIME NOTICING THIS, THE TROCAR WAS REPLACED INTO THE POT AND LEFT IN TO TAMPONADE THE BLEEDING. AT THIS TIME, ANESTHESIA WAS NOTED AS WELL AS THE REST OF THE OPERATION ROOM STAFF. BLOOD WAS ORDERED. TRANSFUSION SERVICE WAS AGAIN TO BE NOTIFIED PER ANESTHESIA. THE OPERATING ROOM STAFF KNEW AS WELL AND VASCULAR SURGERY WAS CALLED. AT THIS TIME, THE TROCAR WAS LEFT IN PLACE TO TAMPONADE BLOOD LOSS. AT THAT TIME, THE PT'S VITAL SIGNS REMAINED STABLE AS PRESSURE AND AT THIS TIME, A VERTICAL INCISION WAS MADE WITH THE SCALPEL SHARPLY ENTERING THE FASCIA. THE DEEP FASCIA WAS INCISED AND EXTENDED WITHOUT DIFFICULTY USING CAUTERY. UPON ENTRY DR (B)(6) WAS PRESENT. PLEASE SEE DR (B)(6) DICTATION. AT THIS TIME, IT WAS NOTED THAT INITIALLY THE BLEEDING WAS THOUGHT TO BE IN THE OMENTAL VESSELS SO THE TROCAR WAS REMOVED AT THIS POINT. IT WAS THEN LATER NOTIFIED THAT THE TROCAR WAS INTRODUCED PROBABLY AT THE LEVEL OF THE AOTA. THE PT WAS SENT TO ICU AFTER SURGERY. AGAIN, PLEASE SEE DR (B)(6) DICTATION. THE BLEEDING WAS STABILIZED AND THE PT WAS LEFT WITH HER ABDOMEN OPEN AND WAS TRANSFERRED TO THE ICU.