The doctor who performed a surgery which resulted in injury to the patient’s bladder did nothing wrong, the Western Cape High Court has ruled.
The case, involving the patient and Dr Francois Viljoen van der Merwe, centres on a laparoscopic surgery (a minimally invasive procedure using small incisions and camera guidance) conducted on 19 April 2016, during which she underwent the removal of cystic masses surrounding her ovaries. Complications ensued, leading to a perforation in the dome of her bladder that required urgent surgical repair on 4 May 2016.
Throughout the proceedings, which stretched over several years, the core issues revolved around whether the patient’s bladder injury could be attributed to negligence on the part of Viljoen van der Merwe, a specialist gynaecologist with extensive experience. The patient first claimed damages based on a breach of duty of care during the surgical procedure, arguing that the doctor failed to exercise the standard of care expected of his profession.
During the trial, two expert witnesses for the patient, including the respected Dr Hendrik Cronje and Dr Bastiaan Pienaar, presented a rigorous critique of the defendant's use of surgical instruments, particularly the LigaSure device. They contended that the choice and method of employing the LigaSure as well as the failure to convert to an open surgery (laparotomy) were negligent actions that contributed directly to the bladder injury.
This assertion was based on the contention that a device with greater thermal spread might not have been appropriate given the delicate anatomical relations in the patient’s abdomen, further complicated by previous surgeries.
In stark contrast, the doctor’s experts, including Dr Daniel Fölscher and Dr Peter De Jong, defended the surgical technique used, highlighting that the laparoscopic approach was viable and that the LigaSure device, specifically the LigaSure Maryland variant, was suited for the operation, notably when addressing the adhesions and other complexities present.
They affirmed that unexpected complications can occur in even the most carefully conducted surgical procedures, and cited the technical challenges that accompanied the patient’s case.
In the ruling, Judge M Sher concluded that the patient had failed to demonstrate that Viljoen van der Merwe was negligent in his actions during surgery. The ruling identified that the perforation to the bladder resulted from avascular necrosis, a rare but recognised complication of such surgical procedures, rather than a direct result of the surgeon's actions.
"The perforation was an unfortunate complication, of the kind which can occur in the best of hands," stated the judgment.
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