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Tips offered on reducing bowel injuries during laparoscopy. (Lowering Liability Risk).
WINNIPEG, MAN. -- Litigation for laparoscopic injury frequently centers around problems with the initial entry into the peritoneum as well as delayed recognition of the injury, according to Dr. George Vilos.
"Laparoscopy is the only surgical procedure where half of all complications arise before the surgery has even begun," he said at the annual meeting of the Society of Obstetricians and Gynaecologists of Canada.
Dr. Vilos reviewed 40 Canadian litigated cases of laparoscopic bowel injuries.
The legal outcome was favorable to the physician in 75% of cases, and the clinical outcome of the patients was uncomplicated in 85% of patients (J. Obstet. Gynaecol. Can. 24[3]:224-30, 2002).
A total of 55% of the injuries were related to entry into the peritoneal cavity, with 17 being caused by the primary trocar, 1 by the Veress needle, 1 by the scalpel, and 1 by a suture. In two of the cases, the causes were unknown, said Dr. Vilos, professor of obstetrics and gynecology at the University of Western Ontario, London.
"Blind insertions of secondary trocars are difficult to defend because they should be under direct vision, whereas primary trocar injuries are easier to defend because the entry is blind," he said.
There was delayed recognition of the injury in 45% of cases, and these cases were associated with 67% of the settlements, he said.
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Source: HighBeam Research, Tips offered on reducing bowel injuries during laparoscopy. (Lowering...