Florida Surgeon Tuesday
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https://www.miamiherald.com/news/state/florida/article291866640.html
He died during the surgery, the law firm said in an Aug. 30 news release. Bryan’s procedure was performed by Dr. Thomas Shaknovsky, an operative report shows. >
Afterward, it was discovered that the organ Shaknovsky thought was and labeled as Bryan’s spleen was actually his liver, according to Zarzaur Law.
In a surgical pathology report written by Dr. Robert Blanchard, the pathologist noted the organ removed from Bryan’s body, which was “designated” as a spleen, was a “grossly identifiable” liver that was partly torn.
When Shaknovsky wrongly removed the liver, he tore the blood vessels that connected to the organ, “causing immediate and catastrophic blood loss resulting in death,” Zarzaur Law said in a statement.
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Poor Dr Shaknovsky, never thought that he would one day be a world famous liver surgeon.
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@jon-nyc said in Florida Surgeon Tuesday:
George - seems like this would be a case where it would be reasonable to sue the anesthesiologist too. Surely if you were there you’d have noticed that huge red thing he was removing wasn’t the spleen.
Yes and no. OR staff as well.
When you're taking an organ out, the first thing you want to do is cut off the blood supply. One you ligate the arteries/veins to the organ, then you can proceed to free it up from the surrounding tissues. However, interrupting the blood supply is a Rubicon kind of moment. You don't go back from that. It's not like, once the liver's exposed, you can just put it back.
Though, if I were at the head of the table, I would have wondered why the surgeon is working in the right upper quadrant, where the liver lives.
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From U.S. News:
Dr. Thomas J. Shaknovsky is a colon and rectal surgeon in Crestview, Florida and is affiliated with multiple hospitals in the area, including Ascension Sacred Heart Emerald Coast Hospital and Twin Cities Hospital. He received his medical degree from Chicago College of Osteopathic Medicine at Midwestern University and has been in practice between 11-20 years. Dr. Thomas J. Shaknovsky has expertise in treating colonoscopy, upper gi endoscopy, surgical removal of colon, among other conditions - see all areas of expertise. Dr. Thomas J. Shaknovsky accepts Medicare, Aetna, Humana, Cigna, Blue Cross, United Healthcare - see other insurance plans accepted. Dr. Thomas J. Shaknovsky is highly recommended by patients.
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BTW, the hospital is a 76-bedder and recognized for excellence in orthopedic surgery (mostly knees and hips. Hey, it's Florida.). Nowadays, that's not podunk. Small, but not podunk.
Patient presented with acute belly pain and cause was determined to originate from the spleen. Since the guy is in his 70's, it ain't gonna be something like spherocytosis, so most likely trauma or lymphoma? (Past my pay grade.)
So...I'm no doc, but there is a bit of difference in the size of a liver and a spleen. How does a surgeon make such a mistake unless he's under the influence of drugs or is staggering senile?
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@jon-nyc said in Florida Surgeon Tuesday:
Oh, and not to blame the victim, but who the hell gets surgery in a random village in the Florida panhandle? Four hour drive gets him to UAB or UF.
A. Four hours might be too long. Chopper.
B. Find a bed. Find a bed with the right services. Around here, it's not uncommon to board a patient in the ED for a day, until the right bed comes open somewhere. I've seen patients choppered to New Orleans, Jackson and anywhere within almost 200 miles. -
It's not too clear to me how he presented. Four hours is not an unreasonable time to wait after presentation or onset of symptoms.
And, all that said, there are two observations I want to make.
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A good surgeon can work at a bad hospital. For simple stuff (and a splenectomy is relatively simple), the size of the place is irrelevant. I worked with a lot of fine surgeons who were on the staff where Mrs. George had her negative experience back in July.
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The converse is true. I worked with more than one bozo at the university. I've seen residents have to bail these guys out.
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ill try to give my perspective on this, just to try to understand, although, no matter what, the whole story is outrageous.
so the patient had abdominal pain, left sided, and somehow this leads to surgery. I must assume that a CT was done, otherwise i truly dont understand what the indication was, there are very few situations where u rush someone to abdominal surgery without imaging and having at least a working differential diagnosis.
be that as is it may, in what i read, the intended procedure was a lap splenectomy, and so, they must have gone into the case expecting to see something wrong with spleen. so did they have a CT showing this, or maybe misinterpreted as such.
when you do a laparoscopic procedure, one of the funny quirks is, that often your eyes will see what your brain wants you to believe. sort of like a vertigo in an airplane, you interpret your instruments the way you want to.
its happened to me in a lap gall bladder where i was convinced i saw one thing, but when i gave up and opened the belly i could see i was way off....anyway, the guy saw what he thought was the spleen but was probably the left lobe of liver, which in some people, can be to the left of the midline, maybe flopping down on the stomach. and he went with that till the bitter end. i actually feel sorry for the guy. (let alone the patient)
now doing a splenecetomy is not a particularly hard thing to do, certainly in trauma ive whipped out spleens in open surgery in ten minutes. you just have to ligate the splenic vessesls (without injury to the pancreas) , and short gastrics, which are small vessels between the spleen and the stomach, and out it comes pretty easily. flimsy attachments to the rest of the abdomen.
but to take out the left lobe of the liver, i mean you are talking some pretty hard core anatomy. which is why its hard to digest that you can mistake it like that. portal vein, hepatic artery, bile ducts. this is real hard core plumbing,. life threatning plumbing i mean, you really need to screw up big big time to even get the thing out.and the craziest thing is, the guy filled out a path report writing "spleen" meaning that even after he pulled the thing out he still thought it was a spleen. it took what was probably a very befuddled pathologist to note that what was sitting on his table was a liver lobe and not a spleen.
its just too bizzarro for words. i mean, i can see very vaguely how you may get confused, vertigonous, but i think even a student or resident would be able to discern that said object was liver and not spleen.
anyway, like i said, at least for a day, he was the worlds best known liver surgeon.
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"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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@bachophile said in Florida Surgeon Tuesday:
@George-K https://www.newsweek.com/doctor-surgery-florida-liver-removed-spleen-operation-pensacola-attorney-bryan-1948035
its in the newsweek piece
Ah, OK.
So, what pathology in the spleen can cause a sudden onset of left-sided abdominal pain?
Infarct?
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yea maybe, pretty rare, but i still wonder if there was a CT.
not much going on in the left upper quadrant as far as acute diagnoses....anywhere else, ok, u can (but probably shouldn't) go with peritonitis to surgery without imaging,
Right upper-cholecystiis
Right lower, appendix
Left Lower, diverticulitis,
but left upper? very little acute pathology. -
adrenal hemorhage, also very rare. gastric torsion,all really zebras, that no one sane would go into surgery without a CT and at least a reasonable idea of what was going on...
