Florida Surgeon Tuesday
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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...
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I bet what he thought was a ruptured splenic artery aneurysm was simply ripping to pieces the left hepatic artery.
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So they did do imaging and found a 12-inch spleen? That's yuge, unless the radiologist was wrong.
Splenic artery aneurysms are not all that unusual. It's when they (infrequently) rupture. A 1 cm aneurysm isn't likely to do that, amirite?
Sounds like, until they went to the OR, everything was done appropriately. Not sure if a hand-assisted lap splenectomy would be appropriate for such a large spleen, but that's not in my wheelhouse.
"Splenic laceration noted." Was that really the liver?
OK, they converted the hand-assisted lap splenectomy to an open procedure - that should have made it obvious that it was the liver, no?
The splenic artery aneurysm ruptured during dissection and all hell broke loose. If it was the splenic artery and not the left hepatic. That's probably when he lost sight of what was where and started to indiscriminately clamp vessels and....
Thoughts?
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The spleen was normall. I read that in one of the news reports. To my mind, the whole thing started with misreading the CT. I bet the radiologist is also going to be investigated. Sure the surgeon gets a lot of blame but not all of it.
The whole description of mobilizing the spleen is all nonsense because the spleen stayed in situ. What was removed was the left lobe of the liver. Which means there was no splenic hilum. Only the fissure, which is the falciform. between the left lateral lobe of the liver and the rest of the liver. If you go dissecting in there with a ligasure, , u r going to hit a portal, hepatic and biliary triad. No wonder blood came gushing out. -
License suspended.
After multiple wrong-site surgeries that resulted in permanent harm or death — including a procedure in which a patient’s liver was removed instead of his spleen — a surgeon’s license has been suspended in Florida.
The Sunshine State’s Department of Health and Surgeon General Joseph Ladapo ordered an emergency suspension of Dr. Thomas Shaknovsky’s license to practice osteopathic medicine Tuesday. The 21-page order detailed the troubling circumstances surrounding two botched surgeries — and Shaknovsky’s apparent attempts to cover up his own errors.
The order first described the case of a patient identified as “G.D.” — a 58-year-old man scheduled for surgery to remove his left adrenal gland at Ascension Sacred Heart Emerald Coast hospital. During the procedure, Shaknovsky did not remove the man’s adrenal gland at all, but rather, removed a portion of the man’s pancreas. The order noted the stark anatomical differences between the two organs: adrenal glands are small triangular glands located on the top of each kidney while the pancreas is a large gland located behind the stomach and surrounded by the gallbladder, liver, and spleen.
When Shaknovsky was alerted to the error, he claimed the adrenal gland had “migrated” to a different part of the patient’s body. The patient suffered permanent harm as a result of the surgical error.
The suspension order next detailed the case of 70-year-old William Bryan, identified in the order as W.B.,” an Alabama man who came to Ascension Sacred Heart Emerald Coast hospital for tests to assess an abnormal spleen.
After medical staff advised Bryan that immediate surgery was required to prevent serious spleen-related complications, Bryan reluctantly agreed to an emergency laparoscopic splenectomy. The operation was scheduled for 4 p.m., and per the order, “staff were concerned with it being done so late in the day because they only had a skeleton crew.”
Further, said the order, “OR staff knew splenectomies were complicated procedures that could quickly deteriorate and were not regularly performed at Ascension.”
Perhaps most damning, the order said, “OR staff had concerns that Dr. Shaknovsky did not have the skill level to safely perform this procedure.”
Ultimately, according to the order, Shaknovsky arrived at the surgery an hour late, and opted to change course for the surgery, converting a laparoscopic procedure to an open one to mitigate difficulties in visibility. The order went on to note that Shaknovsky first reported that he was able to control a ruptured aneurysm during the procedure, but later said that he had never been able to control the aneurysm.
It also said that Shaknovksy “fired a stapling device blindly” into Bryan’s abdomen, removed an organ that he “believed” was the spleen, but was so affected by the “shock and chaos of the situation” that he was unable to properly identify the organ that he actually removed.
