Laparoscopy: would a robotics revolution reduce the risk of injury to patients?

Laparoscopy, or keyhole surgery as it’s more commonly known, is used to diagnose and treat various medical conditions affecting the abdomen or pelvis. Unlike conventional surgery, keyhole operations are carried out through small incisions with the aid of a camera, meaning recovery time is quicker, chance of scarring is reduced, and patients can usually go home the same day.

While its minimally invasive nature brings with it a wide range of benefits, laparoscopy is still a challenging surgical technique and thus has risks attached to it. The success of keyhole surgery depends on the technical skillset of the surgeon; spatial awareness, depth perception, and perfect co-ordination are a must. If undertaken by inexperienced and less competent hands, the consequences can be catastrophic; a simple error or misjudgement resulting in serious – and sometimes fatal – injuries.

A perforated bowel, damaged organs, torn blood vessels and sepsis are just some of the devastating after-effects if surgery is not performed and managed correctly.

So, is keyhole surgery as safe as you think? Or should we reconsider the casual attitude we have towards laparoscopies?
One of the most common procedures laparoscopy is used for is to remove gall bladders, medically known as a cholecystectomy. Surgical removal of the gall bladder is needed if gall stones have formed and are causing swelling, pain or infection. It is one of the most common digestive system disorders and keyhole is hailed the gold standard of surgical treatment for gall bladder disease.

However, a known complication of cholecystectomy is damage to the bile duct. This happens when the bile duct is burned, pinched, or mistaken for the cystic duct (which attaches the gallbladder to the bile duct) and cut. Any of these scenarios would mean that corrosive bile would leak into the abdomen or other parts of the body and cause infection.

Injury to the bile duct is a recognised risk of gall bladder removal surgery and therefore not always classed as a negligent act. However, clinical negligence occurs when there is a delay in diagnosis and treatment of such damage. Failure to recognise bile duct injury can result in serious conditions such as peritonitis (infection of abdomen lining), liver damage, and cholangitis (infection of gall bladder) which, if not treated quickly, can be life-threatening.

Laparoscopy Negligence Compensation Claims
Treatment should be by way of surgical emergency, not conservative management, as we found in a case recently settled by solicitor, Miriam Bi, where a delayed reaction to an acknowledged bile duct injury proved deadly for a patient.

After undergoing gallbladder surgery in June 2017, this patient was discharged from hospital the following day, despite complaints of not feeling well with abdominal pain and vomiting. We alleged, and it was admitted, that she should not have been discharged with these complaints. She developed sepsis and multiple organ failure which led to her death nearly a month after the surgery, aged 58.

In this medical negligence case, we assisted the family through the Inquest process which was emotionally distressing to them. Detailed investigations were done post-Inquest and a Letter of Claim was served setting out various failures in the case, most of which were subsequently admitted, including causation of death.

Our client, the widower, received a six-figure settlement which included compensation for the loss of his wife, funeral expenses, the loss of  past and future  services she provided, as well as  the  financial loss suffered by her widower.  There were also claims for the children of the deceased patient who were reliant on their mother for services such as childcare.

Read more about gall bladder and bile duct injury compensation claims here

The main issue with bile duct injury is that symptoms don’t always show immediately post-surgery; only between 10-30 percent of cases are discovered by the surgeon while they are operating. This means a large proportion of patients may not actively have any symptoms for weeks.

Symptoms of bile duct injury include:

• Fever

• Chills

• Nausea/vomiting

• Abdominal pain

• Swelling of the abdomen

• Jaundice

• General discomfor

Post-surgery, numerous tests can be undertaken to detect bile duct injury. The main one is the IOC or intraoperative cholangiogram. This is a test where dye is injected to make bile visible under x-ray. Other tests include transabdominal ultrasound and either ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography). The former uses an instrument called an endoscope and dye, whereas the later uses MRI and dye, to examine the bile ducts. If the bile duct is found to be damaged, it may need reconstructing using intestinal tissue which can be complex if undertaken after the initial surgery.

But how will robotics improve keyhole surgery and the risks associated?
Laparoscopy has always been an area of medicine driven by technology due to the use of a camera to aid performing surgery. But the thought of a surgeon controlling huge mechanical arms while sat watching a computer console may make most people think we’ve entered a virtual reality. Yet this is not a game; mechanical assistance could be the difference between life and death.

Several NHS trusts already have the use of robotics and have found it to be greatly beneficial. AI-controlled implements improve dexterity and reduce tremors. The 3D/HD view means delicate and complex procedures can be done more precisely. One drawback of traditional keyhole surgery which often leads to complications is that the area around the gallbladder, for example, is masked and so a surgeon cannot always see clearly, particularly if there is a lot of bleeding, swelling or scarring. This affects their ability to identify the cystic duct they are meant to cut or clip with 100 percent confidence.

Improvements in how laparoscopies are performed may well reduce the risk of bile duct injury in gallbladder removal patients. This in turn would lower the chance of other effects bile duct injury causes such as extensive recovery times, further surgery, scarring, psychiatric injury, reduced life expectancy and future risk of injury.

Only time will tell if robotic technology reduces the number of laparoscopic errors and injuries caused compared to traditional methods. The study of Gastroenterology, medicine focused on the digestive system, was thought to have been practiced by physicians in the Egyptian pharaoh period. Technology, knowledge and practices have vastly improved since then. But there is still room for improvement in the aftercare of patients to prevent life-changing – or threatening – injuries from occurring.

At Medical Solicitors, we have specialist experience in this area. It is important that if you are seeking advice, it is from a specialist who not only understands the law, but also the relevant medicine. We have a database of carefully selected medical experts who we trust and rely on. These experts will help with advising on elements of substandard care in that specific area of medicine.