STANDARDS OF CARE IN LAPAROSCOPIC SURGERY - THE PARTICULAR CASE OF CHOLECYSTECTOMY

Legal suits against visceral surgeons have increased since the advent of laparoscopic surgery. The duties of physicians have not however cha nged with the development of laparoscopic techniques. Since the decree promulgated in 1936, physicians have a legal commitment to provide th e means required for patient care. This obligation has been recalled i n different court judgements and in the new deontology code. In additi on, jurisprudence tends more and more towards responsibility without r isk. Laparoscopic cholecystectomy is nor risk-fee. Although morbidity and mortality have not risen with laparoscopic procedures, the types o f complications encountered have changed. Reported accidents have beco me more frequent. The number of suits against surgeons has also increa sed. Surgeons must therefore be highly prudent and diligent. Precautio ns concerning personnel management, the choice of material and its upk eep. Special care must be given to the peroperative pneumoperitoneum a nd the use of monopolar electrocoagulation. A peroperative cholangiogr am should be obtained. A careful operative report is a very important. The surgeon must be able to justify his competence. Finally, the surg ical community should publish more results concerning the rate of comp lications in order to establish reference material for experts.