Risks of Laparoscopic Surgery

Early reference to a form of endoscopy dates back to the time of Hippocrates. It wasn’t, however, until the turn of the last Century that the first experimental laparoscopy was performed. Georg Kelling used a cystoscope to examine the abdomen of a dog after first insufflating it with air [1]. Even though the rudiments of the technique are more than one hundred years old, operative laparoscopy did not gain acceptance until the late 1980’s. Kurt Semm, a pioneer of gynaecological laparoscopic surgery, performed the first laparoscopic appendicectomy in 1980. This was deemed unethical by his peers [2]. Eric Muhe faced the same rejection from the German Surgical Society after performing the first laparoscopic cholecystectomy in 1985 [3]. The common theme was the belief that minimal access surgery was inherently risky and therefore flawed. The following account critically evaluates the evidence that laparoscopic surgery carries increased clinical risks to the patient, and increased risks of litigation to the surgeon. A discussion of new technologies in the field is included. An approach to auditing personal practise is outlined, and communication of specific risks to prospective patients undergoing laparoscopic gynaecological surgery is discussed.