Laparoscopic surgery: Minimally invasive, but what about the risk?

Laparoscopic or minimally invasive surgeries are now well established in hospital and ambulatory surgery center operating rooms (OR) all over America.

What are the basics of laparoscopic surgery?

Unlike conventional open-approach abdominal surgeries that require one or more large incisions, the hallmark of laparoscopic surgery is small incisions. The small incisions are why laparoscopic surgeries are often described as being minimally invasive.

In all abdominal laparoscopic procedures, there is a primary incision of around one-half an inch near the belly button. After making the small incision, the surgeon inserts a tube through the incision site to insufflate, or blow up, the abdomen with carbon dioxide gas. Expanding the abdominal cavity with gas allows the surgeon to visualize the vital organs and abdominal structures more clearly.

After the abdomen is insufflated with gas, next up for the surgeon is to insert a surgical device, called a laparoscope, through the tube. The laparoscope has camera equipment that broadcasts to a monitor in the operating room. The surgeon and OR watch the monitor to see what’s going on during the surgical procedure.

In an exploratory procedure, there may only be that one small incision. If there is a surgery to remove something, such as an appendectomy (appendix) or cholecystectomy (gallbladder) the surgeon will need to make some additional small incisions to insert surgical instruments.

What are the risks of laparoscopic surgery?

No surgery is risk free, and laparoscopic procedures aren’t an exception to that rule. Although laparoscopic surgery is generally felt to be safe, there are well-known complications.

Was a laparoscopic approach warranted? When we are analyzing potential medical malpractice claims involving laparoscopic surgery, the first thing we discuss with our surgical experts is whether a laparoscopic approach was indicated. In other words, was it appropriate to attempt laparoscopic surgery for a particular patient, as opposed to a more conventional open approach.

When patients have a significant prior history of abdominal surgeries, surgeons should expect to encounter adhesions and scarring. Depending on the surgical and patient history, these factors may make laparoscopic surgery too risky because it makes the operative field difficult to see, which puts vital organs at risk of being accidentally punctured.

In some situations, the standard of care requires a surgeon to use an open approach for surgery. In others, the standard of care requires a surgeon to convert a laparoscopic procedure to open one when encountering an operative field too dense with adhesions and scar tissue.

Accidental perforations are an issue. In our experience, the biggest risk of laparoscopic surgery is from accidental perforations of vital organs or blood vessels. These iatrogenic, or healthcare-acquired injuries, are more difficult to recognize in laparoscopic surgeries as opposed to open procedures.

Medical literature reflects that the majority of abdominal injuries during laparoscopic surgery occurred during the placement of the laparoscopic equipment, including the tube and trocars, rather than during the surgery itself.

In most situations, it’s not a deviation from the standard of care for an accidental perforation to occur. This means that the surgeon and OR team may not have been negligent even if a patient’s bowel, stomach, liver, or spleen was accidentally perforated during surgery. Instead from a medical liability perspective, the focus is on whether the accidental injury was timely and appropriately diagnosed and repaired.

The failure to recognize and repair an intraoperative injury can cause serious problems in impairment for patients. One of the most dreaded laparoscopic complications is an unrecognized  bowel perforation, where bowel contents leak into the abdomen, leading to a smoldering infection and sepsis.

In case after case that we’ve handled, surgical experts have told us those accidental bowel perforations could have been easily repaired if the surgeon or team had taken adequate time to look for the potential injury. The longer perforations go unnoticed and untreated, the more likely patients will require multiple subsequent surgeries to clean out an infected abdomen and cut out or resect significant sections of bowel.

In the worst cases, patients will lose such significant sections of their bowel that they won’t be left with a functioning gastrointestinal system. That means they’ll receive their nutrition through an IV (intravenous) line called total parenteral nutrition (TPN) and may require a permanent colostomy bag for removal of their solid waste.

When these types of injuries are caused by inattentiveness and medical negligence, a medical malpractice lawsuit can seek recovery of financial compensation to cover the expenses for future medical and healthcare as well as lost wages.

If you’ve been seriously injured because of poor surgical care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.