There has been amazing growth in the actual performance and acceptance of laparoscopy in surgery. As with all surgical treatments, problems may appear, nevertheless, laparoscopy isn’t any exclusion. Surgeons that perform laparoscopy should not only be experienced within the technique in order to avoid as well as handle complications, however they also should completely preoperatively inform patients of the associated risks involved to produce realistic expectations and possibly avert statements of medical malpractice should injury occur.
PREOPERATIVE EVALUATION AND GUIDANCE
It behooves the surgeon just starting a laparoscopic plan to carefully choose patients and cases with regard to reasons associated with individual safety, operating room period, as well as confidence. At the start of the learning curve, doctors may encounter problems when they are not assisted or even proctored through individuals with more laparoscopic experience. Inside a medical malpractice situation, plaintiffs will ask accused doctors what percentage of a particular type of procedure they’ve performed in order to infer lack of experience.
Patients need to understand that minimally invasive is not associated with minimum risk associated with complications. A good guideline: When the patient is at risk to have an open procedure, guidelines suggest he is not a candidate for a laparoscopic one either.
Informed consent for all laparoscopic procedures must include specific mention of the potential dangers as well as complications, such as problems for vasculature, intestinal, bladder, and vital organs, as well as the need to convert to an open procedure if necessary.
PLACEMENT AND POSITIONING
Perhaps within no other laparoscopic procedure would be the placement, padding, and start from the process essential and so possibly tangled up with problems as in laparoscopy. Bone and joint and nerve-related injuries associated with patient positioning are preventable and difficult to defend. It is the surgeon’s responsibility to correctly place as well as pad the patient in order to avoid injury.
Although there are few absolute advisable limitations to laparoscopy, a good assessment of the patient’s relative risks and dialogue associated with family member contraindications are warranted. Earlier abdominal operations and adhesions increase the risk of complications.
Entry-related injuries have the effect of a significant proportion of laparoscopy-related complications resulting in claims. There continues to be substantial variation within the entry methods used in medical technique. The Veress needle as well as the first trocar can injure virtually any blood vessel, hollowed out viscera, and vital organs.
Decompression of the abdomen as well as the bladder are important to avoid entry injury. Failure to appropriately decompress may cause carbon dioxide embolus that is potentially life-threatening; if it occurs, by standard of care, the surgeon should instantly stop the insufflation, decompress the abdomen, place the patient down with right aspect upward, and have the anesthesiologist attempt to aspirate the embolus in the right coronary heart, if possible.
Laparoscopic surgeons must be able to identify as well as respond appropriately whenever something does not look or even feel right. Whenever a patient with earlier abdominal surgical treatment goes through laparoscopy, one should be ready to modify the location associated with Veress needle positioning or even make use of the opening (Hasson) way to prevent trouble. Statements stemming from injuries due to bad common sense and technique may pinpoint the surgical report and deposition of the doctor. Clear, concise, and modern explanations of the operation will help defend your actions whenever there is a claim of medical error. Badly articulated or even inaccurate surgical notes will be utilized as proof of lack of experience or inattentiveness.
Additional factors which plaintiffs’ lawyers will examine regarding entry problems are the stage when the problem first become apparent, and if the surgeon acknowledged this and acted timely and properly. Even though some laparoscopic reviews have claimed that certain trocar or technique is safer compared to another, the truth is that techniques and trocars have been associated with individual injuries. Plaintiffs’ attorneys will invariably blame the defendant’s method or instruments. It is necessary for defendant surgeons to guide their attorney about the various methods and devices and locate experts who agree with and understand their positioning.
Vascular Injuries can occur earlier and precipitously or even delayed hours postoperatively. Intraoperative blood loss must be managed in a safe and planned fashion. The doctor must recognize and manage bleeding, know when to convert to open surgery, and when to consult general surgery. All types of vascular ligation, staplers, as well as thermal power products, have had failures. Hemostasis is perhaps more essential in laparoscopy compared to open up procedures because of the requirement for a definite visual area in which to operate. Lack of experience can lead some surgeons to convert small injuries to larger ones via bad judgment as well as technique. Plaintiffs have the benefit of hindsight when reviewing problems and injuries.
Major Vessels – The aorta, inferior vena cava, iliac artery, and others can be injured throughout laparoscopic procedures. Injuring these vessels on entry is really a known danger, however will be exploited through plaintiffs as proof of a heavy hand or inexperience. Injury to the actual superior mesenteric artery, celiac axis, or contralateral renal vessels may appear if one confuses the anatomy. During laparoscopic procedures on the renal system, a continuous appreciation for the vasculature as well as ureter is vital as renovascular errors do occur. When encountering anatomy that doesn’t appear correct, cease as well as recheck the images. Confusion is responsible for most mistakes resulting in ligating the wrong vessels within laparoscopy. Digital camera alignment and centering are necessary. Be aware of your own instruments at all times and use all of them very carefully, as it is quite simple to injure any organ or vessel. Inattentiveness accounts for many errors, injuries, and claims associated with laparoscopy.
Bowel and Nerve – Bowel injury subsequent to laparoscopy might have a common or uncommon presentation and disastrous sequelae. Earlier surgical treatment and adhesions increase the probability of intestinal damage with open procedure as well as laparoscopically. Plaintiff positioning focuses on the patient did not give permission for an error caused by doctor- inattention, inexperience, or failure to provide appropriate care. Despite the actual laparoscopy-zoom, injury to large organs do occur.
Vital Organs – The spleen and pancreas can be injured upon entry or during dissection. Cautious management with dissection and retraction is pivotal to adjacent anatomy. The diaphragm can be injured while dissecting upward. All internal organs and vasculature can potentially be injured by injudicious use of energy, including monopolar as well as bipolar cautery, laser, clamps, heat and seal devices. One must not just understand how far an instrument’s energy can travel, but must also examine the instruments with every case to ensure they are working properly. Whenever there’s been inadvertent injury to a significant blood vessel, bowel or major organ, the laparoscopic surgeon must decide whether or not to repair it laparoscopically, convert to open procedure to repair it, or seek emergent intraoperative assistance from a specialist. The decision will clearly rely on the severity of injury as well as skill level of the laparoscopic surgeon. Surgeons must be sure of their skills when repairing surgical errors without seeking further assistance. In addition, improperly positioned sutures can lead to bleeding, pain, bowel damage, and herniation.
Most laparoscopic patients possess fairly uneventful recoveries; however, it is not always true that they experience less discomfort than patient’s going through exactly the same process with open procedure. Generally speaking, the postoperative laparoscopic patient should clinically improve each day. However, patients do develop an ileus with symptomatology. Patients with acute bowel injuries will present with traditional and/or nontraditional signs and symptoms, thus it is mandated for the surgeon to practice maintaining a high clinical index of suspicion for intraoperative injury with regard to laparoscopic patients who initially are doing fine and then suddenly enter clinical decline.
Laparoscopy has become a pillar within the surgical arena. Even though it is popular among physicians and patients, the risks as well as complications offer a similar experience although not identical to open procedures in regards to the same organs. Although there has not been a surge within claims related to laparoscopic methods in the literature; nevertheless, you will find multiple problems and injuries in published sequence. Laparoscopy typically results in less loss of blood and improved visual imagery due to zoom provided by the actual laparoscope. Nonetheless, complications and accidental injuries do occur throughout entry, dissection, as well as closure. Conversation, informed consent, as well as documentation are the secrets of preventing as well as defending statements of medical malpractice and wrongful death.
Kathleen A. Mary, RNC, Legal Nurse Consultant Certified is an honored medical expert and lifetime clinical scholar valued immeasurably by her plaintiff and defense attorney-clients as a time/cost-efficient asset to medical malpractice, personal injury and product liability claims. Kathleen provides flawless investigative navigation of meritorious complexities, meticulous comprehensive medical record reviews, locates trusted preeminent experts, is a recognized medical researcher and lifetime standard of care clinical consultant. For over 25 years, 100% of Kathleen’s cases (hundreds) have been positively settled without trial. Please contact Kathleen for your next medical-legal case.