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Wed Jul 29 19:12:29 BST 2009

Had the chance to repair injured iliac vessels (artery and vein) in a 25 yo woman who was on a cholecystectomy by a colleague using the open (Hasson) method to access peritoneal cavity.  Then learned of two more similar cases.  After some inquiring I found out the mechanism: The so-called laparoscopic surgeons implicated on the cases (the 2 other were inguinal hernia repairs) use the S-shaped retractor or similar to expose the fascia, problem is some of them feel confident to incise the fascia with small No. 15 or 11 blade at this moment (instead of grasping the fascia and pulling it up with Allis or similar) being not aware that when you are pushing the tissues down with the retractors you are actually leaning on the retroperitoneum... so I guess the lesson to younger colleagues use either open (Hasson) or Veress method BUT ALWAYS grasp fascia and pull it up before opening or puncturing it.

Ruy Cabello-Pasini, MD

--- On Tue, 7/28/09, Jean-Pierre Arsenault <jparseno at yahoo.com> wrote:

> From: Jean-Pierre Arsenault <jparseno at yahoo.com>
> Subject: Re : Airman Loses Legs in Botched Gallbladder Surgery,
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Date: Tuesday, July 28, 2009, 9:15 PM
> 
> Pretty obvious, besides the aortic VALVE statement which is
> obviously wrong, sounds like a Veress in the aorta and then
> catastrophic consequences from air insufflation/embolism in
> the aorta and/or and/or too much time before they noticed
> what was wrong and/or hesitation to open the abdomen when
> diagnosis was made and do the right thing.  If you're
> doing this kind of surgery, you should be able to fix the
> complications.
> 
> Another argument against the Veress needle...this is much
> harder to do with a Hasson approach...
> 
> 
> -----Original Message-----
> From: Richard Wigle MD FACS <rlwigle at yahoo.com>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Tue, Jul 21, 2009 10:08 am
> Subject: Re: Airman Loses Legs in Botched Gallbladder
> Surgery,
> 
> 
> 
> True, but doesn't explain legs but no arms
> 
> I think Norman is exactly right, Trochar or insufflation
> needle in Aorta and 
> then inability to deal with it
> 
> R Wigle MD FACS
> 
> 
> 
> On Tue, Jul 21, 2009 at 1:12 AM, Lorick Fox, PA-C <Lorick at lorick.org>
> wrote:
> 
> >? I admit this isn't exactly trauma, but I am not clear
> how you get into
> > the AO from gallbladder
> >
> >? http://www.foxnews.com/story/0,2933,534050,00.html
> >
> >
> > *A Texas Airman stationed at an Air Force Base near
> Sacrament
> o, Calif. has
> > lost both legs after surgeons reportedly botched a
> routine surgery to remove
> > his gallbladder.
> >
> > *Colton Read, 20, underwent laproscopic surgery last
> week at David Grant
> > Medical Center at Travis Air Force Base near
> Sacramento. Laproscopic surgery
> > is a minimally invasive procedure that involves making
> a tiny incision to
> > minimize pain and speed recovery time.
> >
> > About an hour into the surgery, something went wrong.
> Read's wife Jessica
> > told CBS11TV.com.
> >
> > "A nurse runs out, 'we need blood now' and she rounds
> the corner and my gut
> > feelings is 'oh my God, is that my husband?'" Jessica
> Read said. Read's wife
> > said an Air Force general surgeon mistakenly cut her
> husband's aortic valve,
> > which supplies blood to the heart, but waited hours to
> transport Colton Read
> > to a state hospital with a vascular surgeon.
> >
> > Read, who is still in intensive care, lost both legs
> as a result of the
> > blood loss. Meanwhile, his gallbladder still has not
> been removed. Jessica
> > Read said the doctor admitted his mistake, but under
> federal law the Reads
> > cannot sue.
> >
> > The future of Colton Read's career is now uncertain,
> FOX 40 in Sacramento
> > reported<http://www.fox40.com/news/headlines/ktxl-news-airman,0,4446243.story>
> > .
> >
> > Jessica Read told FOX 40 she is appalled that the Air
> Force is even
> > considering medical retirement or medical discharge
> while Airman Read is
> > incapable of making any type of decision. She said he
> is not 100 percent
> > lucid and is still heavily medicated.
> >
> > The Air Force is conducting a review of the case using
> outside experts.
> >
> >? *Lorick
> >
> > *
> > Lorick Fox, MPAS, PA-C
> > SEAVIN/Peace Vector IV
> > Gianaclis Egyptian Airbase
> > Gianaclis, Egypt
> > (cell) +20-18-230-4448
> > (landline) +20-45-240-9450
> > www.lorick.org
> >
> > --
> org/index.php?/community/
> 
> 
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Airman Loses Legs in Botched Gallbladder Surgery,