Endarterectomy with Nerve Transection

Issue: Is it a departure from the standard of surgical care to completely transect the hypoglossal nerve during endarterectomy. Operative report indicates that it was inadvertently divided along with a very high facial vein and thus its distribution was described as aberrant. Primary repair was accomplished intraoperatively.

MEDQUEST EXPERT RESPONSES:

It is a departure. This is the ultimate rookie maneuver. We are trained to be aware of this. Dr RN – Vascular Surgeon

Inadvertent injuries occur during carotid surgery, but the hypoglossal nerve should be identified and protected, in general. Aberrant anatomy that could not be anticipated is one potential excuse for unintended injuries. The medical-legal argument will center on the question of whether the anatomy was unusual enough to be a reasonable excuse for the injury. This would require careful deciphering of the op note (written by the defendant-surgeon). Identifying the injury and repairing it was admirable, and certainly better than pretending that it didn’t happen or not realizing it at all. However the injury was likely caused by negligent technique. Dr MF Vascular Surgery