Clinical Anatomy and Medical Malpractice—A Narrative Review with Methodological Implications

Abstract

Anatomical issues are intrinsically included in medico-legal methodology, however, higher awareness would be needed about the relevance of anatomy in addressing medico–legal questions in clinical/surgical contexts. Forensic Clinical Anatomy has been defined as “the practical application of Clinical Anatomy to the ascertainment and evaluation of medico-legal problems”. The so-called individual anatomy (normal anatomy, anatomical variations, or anatomical modifications due to development, aging, para-physiological conditions, diseases, or surgery) may acquire specific relevance in medico–legal ascertainment and evaluation of cases of supposed medical malpractice. Here, we reviewed the literature on the relationships between anatomy, clinics/surgery, and legal medicine. Some methodological considerations were also proposed concerning the following issues: (1) relevant aspects of individual anatomy may arise from the application of methods of ascertainment, and they may be furtherly ascertained through specific anatomical methodology; (2) data about individual anatomy may help in the objective application of the criteria of evaluation (physio–pathological pathway, identification–evaluation of errors, causal value, damage estimation) and in final judgment about medical responsibility/liability. Awareness of the relevance of individual anatomy (risk of iatrogenic lesions, need for preoperative diagnostic procedures) should be one of the principles guiding the clinician; medico–legal analyses can also take advantage of its contribution in terms of ascertainment/evaluation.

Anatomical Ignorance Resulting in Iatrogenic Causes of Human Morbidity

“…Proper identification of the hepatocystic and Calot’s triangles, and the anatomy within and around them, is crucial for the safe execution of the procedure [ 60 , 61 ]. Normally, a single cystic artery branches off of the right hepatic artery at the superior border of the cystic triangle, posterior to the common hepatic duct [ 60 ]; however, variations in this pattern exist [ 61 ], with an estimated prevalence of more than 10% [ 62 ]. Similarly, the cystic duct, which normally branches off of the common bile duct, marking the inferior vertex of the hepatocystic and Calot’s triangles, exhibits variable anatomy in at least 4% of patients [ 61 , 62 ].…”

“…Normally, a single cystic artery branches off of the right hepatic artery at the superior border of the cystic triangle, posterior to the common hepatic duct [ 60 ]; however, variations in this pattern exist [ 61 ], with an estimated prevalence of more than 10% [ 62 ]. Similarly, the cystic duct, which normally branches off of the common bile duct, marking the inferior vertex of the hepatocystic and Calot’s triangles, exhibits variable anatomy in at least 4% of patients [ 61 , 62 ]. Ignorance of these anatomical variations can result in complications such as biliary or vascular injuries [ 61 , 62 ].…”

“…Similarly, the cystic duct, which normally branches off of the common bile duct, marking the inferior vertex of the hepatocystic and Calot’s triangles, exhibits variable anatomy in at least 4% of patients [ 61 , 62 ]. Ignorance of these anatomical variations can result in complications such as biliary or vascular injuries [ 61 , 62 ]. One analysis of surgical malpractice claims found laparoscopic cholecystectomies to account for 7% of all cases, with an emphasis on common bile duct injuries [ 58 ].…”

Enhancing Anatomy Education Through Flipped Classroom and Adaptive Learning. A Pilot Project on Liver Anatomy

“…MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions, or products referred to in the content. 2 However, in recent years, the decrease in anatomy teaching time, the reduced allocation of resources, a shortage of trained anatomists and of skilled teaching staff and conversely the increasing number of students are critically impacting both undergraduate anatomy curricula and medical formation, with significant implications in medico-legal claims [5][6][7]. This is also particularly true for anatomical dissection programs, long considered a cornerstone in developing anatomy knowledge [8].…”

Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report

“…Abnormal surgical operations and irregular operation of surgeons are the most direct causes of medical disputes, which often lead to doctor-patient conflicts before entering the judicial evaluation process. Among these cases, there are many involving postoperative bleeding caused by untight surgical suture [ 6 ]. A key goal of forensic pathology examinations in these instances is to determine if a surgical factor contributed to the subject’s death, potentially clarifying if any negligence occurred during the operation, especially the surgical suture process.…”