Medicolegal Perspectives on Laparoscopic Surgery

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.