Illustrative Case

A pediatric surgeon goes to a national conference and hears a presentation about a new minimally invasive operation for the correction of pectus excavatum ("funnel chest"). The operation involves the placement of a stainless steel bar behind the sternum, using two incisions, one on each side of the chest, and visualizing the bar insertion using a small thoracoscope. He is interested in trying it and subsequently attends a two-day course that is offered by the surgeon who developed the technique.

The surgeon performs the procedure on eight patients with successful results. The ninth patient to undergo the procedure has a routine preoperative evaluation, and the beginning of the operation goes uneventfully. However, when the surgeon is passing the bar behind the sternum, there is sudden onset of severe bleeding that requires the surgeon to do an emergency sternotomy. At that time the surgeon finds a laceration to the heart that he is unable to successfully repair, and the patient ultimately dies on the operating table.

During and after this event, questions arise regarding whether or not it was appropriate for the surgeon to perform this innovative operation.