Laparoscopic surgery: two thirds of injuries initially missed

British Medical Journal, Sept 30, 2000 by Annabel Ferriman

A study of misadventure data relating to laparoscopic surgery shows that the injury most frequently associated with the procedure is damage to the common bile duct, followed by perforation of the small bowel and perforation of the colon. Injuries occur most often during gall bladder operations, with exploratory laparoscopy coming second.

The data are contained in a report from the Physicians Insurers Association of America, which draws on information from 19 medical insurance companies, including the Medical Defence Union, under a data sharing project. Fifteen companies are from the United States, and four are from Canada, the United Kingdom, and the Republic of Ireland.

This latest study analysed data from 535 cases, in which 163 claims were settled, with payments to the plaintiffs totalling $34m (24.3m [pounds sterling]). Payments ranged from $1500 to $925 000, with the average being $212 350.

Failure to identify the injury once it occurred was a key factor in the severity of the outcome. In over two thirds of the incidens examined, the injury was not identified until some time after the conclusion of the procedure. In some cases that delay led to serious complications, such as peritonitis and sepsis. Resulting indemnity payments averaged 10% more when fie patient's injury was not recognised before the conclusion of the procedure.

Cholecystectomy injuries were not recognised before the conclusion of the surgery in 83% of claims. Injuries that were recognised tended to be vascular in nature, whereas visceral injuries causing complications were more likely to remain unrecognised until after the end of surgery.

Difficulty in visualising the anatomical structures during laparoscopic surgery was a contributing factor to these types of adverse incident. Trocars were the most common type of device causing injury.

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