Medicolegal Perspectives on Laparoscopic Surgery

  • Kenneth A. Kern

Abstract

Although the frequency of medical negligence litigation in general surgery remains stable, the development of minimally invasive surgical techniques has led to an explosive growth in litigation related to laparoscopic surgery. For example, since the widespread adoption of laparoscopic cholecystectomy by surgeons in 1990, litigation surrounding bile duct injury alone has surpassed similar litigation for open cholecystectomy by over 20-fold [1, 2•3,4,5••]. In this regard, the Physician Insurers Association of America (PIAA), a trade association of malpractice insurance carriers, recently tabulated claims for laparoscopic cholecystectomy from 31 member companies who insure approximately 65,000 surgeons. Between 1990 and 1993, the PIAA recorded almost 331 claims for laparoscopic cholecystectomy, with 189 cases of bile duct injury (57%); of these, the mortality rate was 11% (21 deaths) [1,2•3,4,5••]. By comparison, in the 5 years between 1985 and 1990, only 35 cases of bile duct injury from open cholecystectomy were reported by member companies of the PIAA.

Keywords

Explosive Perforation Peritonitis Chole Preven 

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References and Recommended Reading

  1. 1.
    Kern KA: Risk management goals involving injury to the common bile ducts during laparoscopic cholecystectomy. Am J Surg 1992, 163:551–552.PubMedCrossRefGoogle Scholar
  2. 2.
    Kern KA: Medicolegal analysis of bile duct injury during open cholecystectomy and abdominal surgery. Am J Surg 1994, 168:217–222.PubMedCrossRefGoogle Scholar
  3. 3.
    Kern KA: Medicolegal perspectives in laparoscopic bile duct injuries. Surg Clin North Am 1994, 74:979–984.PubMedGoogle Scholar
  4. 4.
    Kern KA: The anatomy of surgical malpractice claims: an overview of 711 general surgery liability cases. Bull Am Coll Surg 1995, 80:35–49.Google Scholar
  5. 5.
    Kern KA: Malpractice litigation involving laparoscopic cholecystectomy: cost, cause, and consequences. Arch Surg 1997, 132:392–398.PubMedCrossRefGoogle Scholar
  6. 6.
    Halley MM, Fowks RJ, Ryan DL: Medical Malpractice Solutions. Springfield, IL: Charles C. Thomas; 1989:40–41.Google Scholar
  7. 7.
    Weiler PC, Hiatt HH, Newhouse JP, et al.: Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient Compensation. Cambridge, MA: Harvard University Press; 1993:5–6.Google Scholar
  8. 8.
    Localio AR, Lawthers AG, Brennan TA, et al.: Relation between malpractice claims and adverse events due to negligence: results of the Harvard Practice Study III. N Engl J Med 1991, 325:245–251.PubMedCrossRefGoogle Scholar
  9. 9.
    Rossi RL, Schirmer WJ, Braasch JW, et al.: Laparoscopic bile duct injuries: risk factors, recognition, and repair. Arch Surg 1992, 127:596–602.PubMedCrossRefGoogle Scholar
  10. 10.
    Altman LK: Surgical injuries lead to new rule. The New York Times 1992 (June 14): 1 (L47).Google Scholar
  11. 11.
    Deziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4, 292 hospitals and an analysis of 77, 064 cases. Am J Surg 1993, 165:9–14.PubMedCrossRefGoogle Scholar
  12. 12.
    Wherry DC, Rob CG, Marohn MR, Rich NM: An external audit of laparoscopic cholecystectomy performed in medical treatment facilities of the Department of the Defense. Ann Surg 1994, 220:626–634.PubMedCrossRefGoogle Scholar
  13. 13.
    Larson GM, Vitale GC, Casey J, et al.: Multipractice analysis of laparoscopic cholecystectomy in 1, 983 patients. Am J Surg 1992, 163:221–226.PubMedCrossRefGoogle Scholar
  14. 14.
    Barton JR, Russell RCG, Hatfield ARW: Management of bile leaks after laparoscopic cholecystectomy. Br J Surg 1995, 82:980–984.PubMedCrossRefGoogle Scholar
  15. 15.
    Schol FPG, Go PM, Gouma J: Risk factors for bile duct injury in laparoscopic cholecystectomy: analysis of 49 cases. Br J Surg 1994, 81:1786–1788.PubMedCrossRefGoogle Scholar
  16. 16.
    Trondsen E, Ruud TE, Nilsen BH, et al.: Complications during the introduction of laparoscopic cholecystectomy in Norway. Eur J Surg 1994, 160:145–151.PubMedGoogle Scholar
  17. 17.
    Lee VS, Chari RS, Cucchiaro G, Meyers WC: Complications of laparoscopic cholecystectomy. Am J Surg 1993, 165:527–532.PubMedCrossRefGoogle Scholar
  18. 18.
    Asbun HJ, Rossi RL, Lowell JA, Munson JL: Bile duct injury during laparoscopic cholecystectomy: mechanism of injury, prevention, and management. World J Surg 1993, 17:547–552.PubMedCrossRefGoogle Scholar
  19. 19.
    Physician Insurers Association of America (PIAA): Laparoscopic Procedure Study, May 1994. Physician Insurers Association of America: Washington, DC; 1994.Google Scholar
  20. 20.
    Soper NJ, Flye MW, Brunt LM, et al. Diagnosis and management of biliary complications of laparoscopic cholecystectomy. Am J Surg 1993, 165:663–669.PubMedCrossRefGoogle Scholar
  21. 21.
    Hebebrand D: Small-bowel necrosis following laparoscopic cholecystectomy: a clinically relevant complication? Endoscopy 1995, 27:281.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • Kenneth A. Kern

There are no affiliations available

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