Litigations Involving Ureteral Injury Related to Minimally Invasive Gynecologic Surgery: Lessons Learned from a Legal Literature Review

Kim, Edward; Wu, Harold; Simpson, Khara; Patzkowsky, K.E.; Wang, Karen

doi:10.1016/j.jmig.2018.11.003

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…Moreover, failure to perform cystoscopy at the time of hysterectomy increases malpractice liability (30), and consideration of these risks would further decrease the threshold for implementation of universal cystoscopy. Our estimates may significantly underestimate the savings associated potential malpractice costs.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

Luchristt

Geynisman‐Tan

Mueller

et al. 2021

Journal of Minimally Invasive Gynecology

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

Luchristt

Geynisman‐Tan

Mueller

et al. 2021

Journal of Minimally Invasive Gynecology

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“…37 Several studies showed that a well-trained, dedicated team can reduce the time needed for docking, undocking, and robot troubleshooting issues, which consequently reduces the operating room (OR) time and overall cost. 10,32 Reusable sealing devices showed comparable efficacy, operating time, and safety when compared to more costly disposable devices. 38 Another useful strategy to decrease operative time and reduce cost is through using a surgeon preference card and a pre-operative checklist.…”

Section: Proposed Cost Containment Strategies Reducing Operative Time...mentioning

confidence: 99%

Section: Dynamics Of Minimally Invasive Gynecologic Surgery Costsmentioning

confidence: 99%

“…29 Lawsuits that follow surgical complications include inadvertent injury, lack of informed consent, and delay in diagnosing postoperative complications. 30,32 An estimated amount paid by OB/GYN's were $300,000 and $400,000, with 6% of "payouts" reaching above 1 million dollars. 30 Adequate training, obtaining informed consent and being vigilant is paramount to the learning process for surgical care; however, there is room for growth in litigation training.…”

Section: Rising Migs Costsmentioning

confidence: 99%

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Strategies for Cost Optimization in Minimally Invasive Gynecologic Surgery

Afaneh

Borahay

2022

JSLS

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Background: Cost and quality are important, complex, and intertwined surgical outcomes. Evidence suggests that major cost drivers include operating room time, length of stay, re-admission, surgical complications, and quality of pre-operative and operative care in general. Our practices shape both costs and quality of gynecologic surgery. Various factors are explored in this review article to present and identify ways to implement cost-effective change that also improve quality of patient care. Database: We searched MEDLINE and PubMed databases for relevant articles. Discussion: Clinical preferences and decisions, surgeon experience, trainee education, and defensive medicine can influence cost. In addition, an incongruent physician-administration relationship may impact decisions across the healthcare system. The accelerating adoption of minimally invasive surgery, particularly the robotic approach, presents both an opportunity and a challenge. An example of practices that improve outcomes, patient satisfaction, and cut cost is pre-operative optimization, enhanced recovery after surgery, and the growing adoption of outpatient hysterectomy. The identification of cost-drivers and finding strategies to improve them would simultaneously improve quality and patient outcomes while reducing costs in minimally invasive gynecologic surgery.

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“…They are usually repaired by open ureteral anastomosis [15]. Across the United States, ureteral injuries are one of the most common reasons for minimally invasive gynecologic surgeries (MIGS)-related litigations [16]. Thus, avoiding thermal damage to the ureter during TLH is paramount.…”

Section: Introductionmentioning

confidence: 99%

Non-Electrical Ligation of Vessels Using Hem-o-lok Clips Ensures No Electrical Ureteral Injury during Total Laparoscopic Hysterectomy

Kim¹,

Lee²,

Yoon³

2023

Clin. Exp. Obstet. Gynecol.

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Background: Ureteral injury is one of the most common anatomical complications during total laparoscopic hysterectomy (TLH). And most ureteral injuries resulted from electrosurgery and were recognized postoperatively. To avoid thermal damage to the ureter during TLH, we evaluated the feasibility and safety of vessel ligation using the Hem-o-lok clip. Methods: A retrospective analysis of 480 patients who underwent TLH. Hem-o-lok clips were used to ligate both uterine vessels. If the patient underwent unilateral or bilateral salpingo-oophorectomy, the gonadal vessels were also ligated by using Hem-o-lok clips. Clinical outcomes including perioperative and postoperative complications were evaluated. Results: Perioperative complications were reported in six patients, with four cases of stump dehiscence and two cases of bladder injury. All bladder injuries were found during the operation and repaired. None of the patients experienced ureter injury or vessel rebleeding. Conclusions: Vessel ligation by Hem-o-lok clips in TLH is a safe method for ligating vessels and avoiding unexpected ureteral injury. Prospective studies are needed to confirm the real clinical benefit of this surgical approach.

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Litigations Involving Ureteral Injury Related to Minimally Invasive Gynecologic Surgery: Lessons Learned from a Legal Literature Review

Cited by 7 publications

References 11 publications

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

Strategies for Cost Optimization in Minimally Invasive Gynecologic Surgery

Non-Electrical Ligation of Vessels Using Hem-o-lok Clips Ensures No Electrical Ureteral Injury during Total Laparoscopic Hysterectomy

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