Femoral nerve injury in gynecologic surgery: medico-legal issues for best surgical practices

Gynecological Surgery - Tập 18 Số 1 - 2021
Piergiorgio Fedeli1, Maurizio Guida2, Pasquale Giugliano3, Laura Letizia Mazzarelli2, Annalisa D’Apuzzo4, Roberto Scendoni5, Giuseppe Vacchiano4
1School of Law, Legal Medicine, University of Camerino, Camerino, Italy
2Department of Neuroscience, Reproductive Sciences and Stomatology, University Federico II, Naples, Italy
3Department of Legal Medicine, “S. Anna e S. Sebastiano” Hospital, Caserta, Italy
4Institute of Legal Medicine, University of Sannio, Benevento, Italy
5Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy

Tóm tắt

Abstract Background Femoral nerve injury following gynecologic surgery may be a postoperative complication, leading to medical malpractice claims and litigation. Methods and results A retrospective analysis was performed on data collected from 973 medico-legal reports of suspected malpractice in gynecologic surgery, filed with the Italian Court between 2000 and 2010. Twelve cases were selected for proven negligence, after a blinded investigation conducted by a gynecologist and a medico-legal expert. Surgical data included type of procedure (hysterectomy, salpingectomy, cesarean section, endometriosis excision), duration of procedure, patient position, and use of retractors. For each case, the observed neuropathy, degree of severity, and recovery time after physical therapy were described. Neuropathies were classified into three categories: neuropraxia (three cases), axonotmesis (six cases), and neurotmesis (three cases) with high sensory and motor deficits. Many particular conditions and pre-existing comorbidity were observed. Two neuropraxia cases were associated with the lithotomy position; axonotmesis cases were related to the incorrect use of self-retaining retractors and an inadequate lithotomy position. Conclusions To avoid potential malpractice lawsuits, care must be taken to accurately collect data linked to individual factors and the possible complications of a surgical procedure. A detailed description is required of the patient’s position on the surgical table, the self-retaining retractors selected, length of time they were in use, maximum tractive force exerted, and their inspection or repositioning during the operation.

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Gynecological Surgery

Tập 18 Số 1

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