Laparoscopic Surgery – Some Things You May Not Hear From Your Doctor
Disclaimer: This article is written for informational purposes only and should not be relied upon as legal advice. In each case, specific legal advice should be obtained which will be responsive to the circumstances of the individual requiring it (Copyright and Disclosure).
Laparoscopic surgery is popular with patients and insurance companies. The absence of an incision is cosmetically appealing and the immediate post-operative course is smoother. It also allows for a shorter stay in hospital and an early return to normal function. But is it safe? The procedure is surgically demanding and introduces risks not associated with open surgery such as an open cholecystectomy (a procedure to remove gallstones).
The veress needle and trocar are unique to laparoscopic surgery. Both are inserted blindly and can easily cause bowel or vascular injuries. These injuries are less likely to occur in an open procedure, but if they do occur, are recognized immediately and dealt with. They are not as easy to recognize in laparoscopic surgery, and may not be recognized until the patient is in shock.
In a recent survey conducted by the New York State Department of Health, the risk of injury to the bile ducts was fifteen times higher in a laparoscopic cholecystectomy as opposed to an open procedure. The risk of injury to major vessels or bowel perforation was almost six times higher in a laparoscopic procedure. Also, studies have shown that complication rates were lower in centres specializing in laparoscopic surgery. The more experience the surgeon had in doing this procedure, the lower the risk of complications.
Laparoscopic surgery begins by placing a specialized needle, the veress needle, into the abdominal cavity and filling the cavity with gas, usually CO2, to extend this area. This is followed by the insertion of a sharp metal cylinder called the trochar. It is through this instrument that a camera is subsequently introduced to visualize the abdominal cavity, allowing a second and third trocar to be inserted to perform the required procedures.
Another complication of vascular injury is gas embolization. CO2 gas can enter the heart through a tear or injury to the blood vessels. This can result in death. CO2 gas is not a factor in open procedures.
The most feared complication in laparascopic cholecystectomy is damage to the bile duct. The New York study reported a fifteen fold increase in bile duct injury in a laparoscopic procedure as compared to an open procedure.
In summary, if you are facing the prospect of this surgery, you should make sure your doctor discusses all your options, and you should find out about your doctor’s experience in doing these procedures.
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