The risk of inexperience

A COROWA man died following a catastrophic bleed during a surgery at Wodonga hospital that has been described as “a risky procedure in inexperienced hands”, a court has heard.

Wodonga Coroner’s Court yesterday heard Robert Hawkins, 55, had to undergo emergency treatment when his surgeon, Albury urologist Jonathan Lewin, cut the wrong artery during a laparoscopic nephrectomy — keyhole surgery to remove the kidney.

Mr Hawkins is one of three people in Australia to die from similar complications during the procedure, which has become the standard method of treating kidney cancer.

But Royal Melbourne Hospital’s director of urology Professor Anthony Costello told the inquest he believed the change from open surgery to keyhole led to more margin for error in what was “a very difficult surgery” that should only be done by “very well-trained doctors with good back up”.

The court heard Mr Hawkins was referred to Mr Lewin on January 13, 2010, who deemed the pensioner had a tumour on his left kidney.

Mr Lewin, who was present in court yesterday, performed the surgery on February 2, 2010, about 2.30pm, but toward the end of the procedure misidentified the artery to the kidney and cut another by mistake.

Mr Hawkins’ abdomen was opened to try to stop the bleeding and general surgeon Neil Geddes was called to help, but at some point a second artery — the main blood supply to the abdominal organs — was also cut.

The surgeons stopped the bleeding and removed the kidney but did not try to revasculate the severed arteries and Mr Hawkins was returned to intensive care at Albury hospital.

He was “extremely unwell” the following morning and sent to St Vincent’s Hospital in Melbourne, where he arrived about 5pm — 24 hours after the first surgery.

Doctors tried to revascularise the bowel and other organs but Mr Hawkins died two days later from multi-system failure.

Professor Costello said St Vincent’s vascular surgeons “were asked to do something that was an impossible task”, as the bowel and other organs would have started dying within hours of the arteries being cut.

“The time to repair was then, at the time of the damage,” he said.

“It is almost uniformly fatal to sever that artery and not revasculate.

“If there’s no adequately experienced vascular surgeon (on the Border) I would recommend the patient is transferred immediately — the outcome could have been different.”

The court was told Mr Lewin had completed about 17 laparoscopic nephrectomies but Professor Costello believed this was not enough experience to perform the surgery unsupervised, even if he was technically qualified to do so.

“(Mistaking the artery) really is very rare, that’s why this is a red flag,” Professor Costello said.

Professor Costello, who has performed about 2000 laparoscopic surgeries but not nephrectomies, said only surgeons who specialised in the procedure should perform it.

He said he was “not suggesting negligent behaviour” or a lack of care from Mr Lewin, but that training processes and hospitals’ own surgeon credential requirements needed to be tougher.

Coroner Jacinta Heffey said the inquest would focus on the initial laparascopic surgery, with a second hearing in Melbourne to examine the emergency treatment.

The inquest continues.

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