Laparoscope is the name given to a tool that enables doctors to perform surgery inside the body through only a small opening. This causes much less trauma to the patient and offers the promise of quicker healing.
As you can see from the illustration, after the small incision is made, the abdomen is filled with a gas to inflate it and make it easier for the surgeon to see. A TV camera is inserted into the opening as are tools that the surgeon can manipulate from outside.
Since the invention of the laparoscope, it has been adapted for use in a wide variety of surgeries. Among them are appendectomies, hysterectomies, gall bladder removal, hernia repair, gastric bypass, colon resection, fibroid removal, tubal ligation, kidney repair procedures, spleen removal, prostate procedures and many others. There are often specialized tools for use in each of these different procedures.
As with so many other advances, there are trade offs involved with laparoscopic surgery. The main one is that the surgeon does not have the same degree of vision that she or he would have with an open procedure where there is a large incision and the surgeon can have a direct view of the operative field. With the laparoscope, the surgeon is limited to what she can see on the TV screen. This occasionally leads to misidentification of structures and misidentification leads to the wrong thing being cut or removed. I have handled cases like this.
Even when the surgery is performed as an open procedure with a reasonably good view of the operative field, the surgeon may inadvertently nick a blood vessel or an organ. This can happen even with the best surgeons and is not malpractice. The nick is simply repaired and the patient is no worse for it.
The risk of an inadvertent nick is greater in laparoscopic procedures due to the more limited vision of the surgeon. In addition to an increased risk of an inadvertent nick, there is an increased risk that the surgeon will not realize a nick has occurred. This is when real trouble can happen. This is the other type of laparoscopic injury case I deal with.
Not all nicks are created equal. A small nick to a blood vessel may seal itself and no one will ever be the wiser. A larger nick, however, may bleed profusely and require a second surgery to repair the damage. An even greater problem occurs, however, when the body part that is nicked is the bowel. Even a small nick to the bowel has the potential to be fatal.
The abdominal cavity is a sterile space and needs to be kept that way. The bowel is full of nasty bacteria which would be perfectly happy to grow in the nice, warm, nutrient rich abdominal cavity. And that is exactly what they will do, if the bowel nick is not repaired and the bacteria which have escaped the bowel are not removed.
I have had a number of nicked bowel cases and they are always slightly different versions of the same theme. A surgeon performs a laparoscopic procedure and nicks the bowel. The bowel nick goes unrecognized at the time of the surgery. The patient goes home and does not do well. She gets feverish and faint. She is brought back to the hospital where the doctors evaluate her. At this point, a lot will depend on how large the nick was and how advanced is the infection. It may already be too late to save the patient’s life. If, however, the infection has not yet invaded the bloodstream and caused multi-organ failure, prompt recognition of the nature of the problem and corrective surgery can save the life of the patient.
When a patient who has had laparoscopic surgery is brought back to the hospital with abnormal vital signs and abdominal pain, the doctors evaluating that patient should have a high degree of suspicion that they are dealing with a bowel leak and act accordingly. Even though that should happen, it does not always happen. The cases I see are the ones where the problem was not promptly identified and the patient went into septic shock. In most of these cases in which I was involved, the patient died as a result of the delay in identifying the problem and beginning treatment.
As with all medical malpractice cases, the doctors do not give up easily. They argue that there were good reasons to delay repair surgery. They argue that it was not clear what the patient’s problem was. They argue that the patient came back to the hospital too late and was going to die no matter when treatment was begun. The cases are hard fought.
If you or a loved one underwent laparoscopic surgery and suffered a bowel nick that was not promptly recognized and treated, I hope it turned out OK and there was no permanent damage. If there was permanent damage or death, however, give me a call. Maybe I can help.
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