Injuries during Laparoscopic Cholecystectomy: A Scoping Review of the Claims and Civil Action Judgements

Abstract

Background. To define what type of injuries are more frequently related to medicolegal claims and civil action judgments. Methods. We performed a scoping review on 14 studies and 2406 patients, analyzing medicolegal claims related to laparoscopic cholecystectomy injuries. We have focalized on three phases associated with claims: phase of care, location of injuries, type of injuries. Results. The most common phase of care associated with litigation was the improper intraoperative surgical performance (47.6% ± 28.3%), related to a “poor” visualization, and the improper post-operative management (29.3% ± 31.6%). The highest rate of defense verdicts was reported for the improper post-operative management of the injury (69.3% ± 23%). A lower rate was reported in the incorrect presurgical assessment (39.7% ± 24.4%) and in the improper intraoperative surgical performance (21.39% ± 21.09%). A defense verdict was more common in cystic duct injuries (100%), lower in hepatic bile duct (42.9%) and common bile duct (10%) injuries. Conclusions. During laparoscopic cholecystectomy, the most common cause of claims, associated with lower rate of defense verdict, was the improper intraoperative surgical performance. The decision to take legal action was determined often for poor communication after the original incident.

Educational Scoring System in Laparoscopic Cholecystectomy: Is It the Right Time to Standardize?

“…Cirocchi et al showed that in many cases of malpractice claims and civil action suits, the patients’ morbidity and mortality were related to a misperception of the CVS, and not due to the surgeon’s negligence [ 47 ]. In such cases, stopping the procedure, taking time to reorientate the anatomical landmarks, or asking for help from a more experienced colleague would be the best options available [ 47 ]. Once again, factors related to patient safety and outcomes were considered fundamental compared to previous studies.…”

Lateral dorsal infundibular approach: an alternative option for the safe completion of difficult laparoscopic cholecystectomy

“…The occurrence of BDI not only increases the length of hospitalization and the economic burden, but also means that the patient is likely to face recurrent bile duct strictures, requiring secondary hepatectomy, biliary-enteric or hepato-enteric anastomosis, eventually leading to liver transplantation or death [ 14 , 15 ]. BDI is also a common cause of medicolegal problems for surgeons [ 16 ]. Therefore, in the procedure of difficult LC, we make the following recommendations.…”

Harmonic Scalpel Versus Clips for Ligation of Cystic Duct in Laparoscopic Cholecystectomy: A Systematic Review

“…The main limitation of the use of monopolar diathermy is that there is a high risk of surrounding thermal damage. Slippage of clips off the cystic duct in relation to the gall bladder causes bile to spill into the surgical field and this invariably causes frequent instrument change which increases the risk of visceralrelated injuries [5,6].…”