CONFIDENTIAL Settlement – Gallbladder Removal Medical Malpractice

Plaintiff was sent to Defendant doctor (confidential medical negligence settlement so cannot disclose name) by her primary doctor for a consultation arising from abdominal pain and gallbladder stones.  Dr. recommended an “elective cholecystectomy” and scheduled the surgery. During the laparoscopic portion of the gallbladder removal procedure (laparoscopic cholecystectomy) Dr was negligent when he clipped and then fully cut the Plaintiff’s common hepatic duct.  He was supposed to clip and cut the cystic artery and duct.  Defendant claimed that he was not negligent because he thought he clipped and cut the cystic artery but clipped and cut the common hepatic duct by mistake because it was difficult identify the anatomy because of inflammation and variations in the Plaintiff’s biliary anatomy.

Standard of care:  A surgeon has a duty to fully dissect and positively identify all the relevant anatomy before cutting or clipping, like the old carpentry saying, measure twice and cut once. The safest known laparoscopic surgical technique is called the “critical view of safety” approach.  This approach has been around for over 25 years and is considered the safest technique to positively identify the anatomy of the gallbladder and surrounding structures to avoid biliary injury.

If the critical view of safety cannot be obtained and the structures cannot be positively identified the surgeon can cancel the surgery or convert the laparoscopic surgery to an open procedure before clipping or cutting structures. Cancelling the surgery allows the doctor to place drains and treat the patient with anti-inflammatory drugs to bring down any inflammation that may be making identification of the anatomy difficult.  Additionally, it also allows the option to transfer the patient to a more qualified surgeon.  When a surgeon cannot positively identify the anatomy the other, and much more common option, is converting from a laparoscopic procedure to an open procedure (laparoscopic scopes versus and open surgical field) to make identification much easier for the surgeon as they are looking at the surgical field and anatomy directly rather than through laparoscopic rods and scopes.

Violation of the Standard of Care:

In this particular case the Dr was negligent and violated the standard of care by:

1. Carelessly clipped and cut the common hepatic duct thinking it was the cystic artery.
2. Used the infundibular approach or top-down approach rather than the critical view of safety and failed to visualize the triangle of calot.
3. Did not positively identify the structures before clipping and cutting.
4. Did not cancel the surgery or convert to an open procedure BEFORE clipping and cutting the structures.
5. performed an intraoperative cholangiogram AFTER converting to an open procedure and AFTER clipping and cutting the wrong structures.

As often happens with medical negligence cases, this Illinois medical malpractice case had to be fought hard in court in about six months before trial insurance company for the doctor settle the case for a great amount, such a good amount that they required we remain and keep it confidential that other lawyers can use it as an example for future cases.

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