October 2002 · Vol. 14, No. 10Cutting the legal risks of laparoscopy
Despite laparoscopy’s increasingly broad application, safety and efficacy data for this modality have accumulated in a piecemeal fashion. An attorney surveys the field and offers recommendations on avoiding medicolegal claims.
J.
DOUGLAS
PETERSMr. Peters is an attorney and shareholder with Charfoos & Christensen, PC, in Detroit, Mich. He also is adjunct associate professor, department of community medicine, at Wayne State University School of Medicine in Detroit and coauthor of Obstetrics/Gynecology and the Law.
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KEY POINTS
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In a recent review of medical liability claims for laparoscopy, women were claimants in 95% of cases, and most were under the age of 40. OBG was the physician specialty involved in the majority of these claims.
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Absolute contraindications to laparoscopy include hypovolemic shock, intestinal obstruction with extensive bowel distention, a large pelvic or abdominal mass, and severe cardiac decompensation.
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The most critical aspect of laparoscopy is the placement of the first trocar and sleeve through the incision near the umbilicus. For this reason, it is the most legally defensible.
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In December 1995, a 37-year-old mother of 2 entered a Michigan hospital to have her gallbladder removed. The surgeon made a small incision above the umbilicus and inserted a laparoscope to begin the operation. When he viewed the peritoneal cavity, the physician observed “a little bleeding,” which he assumed was a result of the initial trocar insertion.
The woman’s blood pressure dropped to 105/52 mm Hg from 126/66 mm Hg. Unfortunately, the anesthesiologist did not inform the surgeon of this drop or ask if there was any bleeding. When the patient’s blood pressure dropped again—to 85/50 mm Hg—and her heart rate accelerated to 120 bpm, the anesthesiologist assumed she was suffering from a pulmonary embolism. He instructed the surgeon to step away from the table so that the patient could be repositioned. During the 10 minutes spent searching for emboli, the patient bled to death.
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