Wind Jan, Cremers Jan E L, van Berge Henegouwen Mark I, Gouma Dirk J, Jansen Frank-Willem, Bemelman Willem A
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Surg Endosc. 2007 Nov;21(11):2094-9. doi: 10.1007/s00464-007-9315-8. Epub 2007 Apr 5.
Installation of the pneumoperitoneum is an essential part of laparoscopic surgery. Creation can be performed by either the open or a closed technique. The aim of this study was to assess the number of and contributing factors to entry-related complications in medical liability insurance claims in The Netherlands.
A retrospective chart review was performed, including all malpractice claims filed at MediRisk, which is presently the largest medical liability mutual insurance company for institutions, mainly hospitals, in healthcare in The Netherlands.
From January 1993 to December 2005, 41 claims were identified as entry-related complications which comprised 18% of all laparoscopy-related complications leading to claims. Most were young (median age = 35 years) female patients who had routine, nonadvanced, laparoscopic procedures planned as short-stay or day-care procedures. The claims were equally divided between general surgery (n = 20) and gynecology (n = 21). A total of 51 structures were injured. There were 18 vascular structure injuries, 30 bowel injuries, and three other injuries. An open entry technique was used in only two (5%) patients. Vascular injury was exclusively associated with closed entry. In only 19 (46%) patients the entry-related complication was diagnosed peroperatively, consisting of 70% of the vascular and 25% of the bowel injuries. Twenty-six patients (64%) were admitted to the intensive care unit for a median of five days. There was no mortality. Besides conversion, the majority of the patients filed a claim to compensate for a longer hospital stay and related costs. A payment was made in 17 (57%) of the 30 settled claims.
Medical liability claims concerning laparoscopic entry-related complications comprised a fifth of all laparoscopy-related claims. Claims concerning entry-related complications occurred in young patients who had routine, nonadvanced procedures. In the investigated cases most claims involved the closed-entry technique.
气腹的建立是腹腔镜手术的重要组成部分。建立气腹可采用开放技术或闭合技术。本研究的目的是评估荷兰医疗责任保险索赔中与穿刺相关并发症的数量及相关因素。
进行了一项回顾性病历审查，纳入了向MediRisk提交的所有医疗事故索赔，MediRisk是荷兰目前最大的针对医疗机构（主要是医院）的医疗责任互助保险公司。
1993年1月至2005年12月，41例索赔被认定为与穿刺相关的并发症，占所有导致索赔的腹腔镜相关并发症的18%。大多数是年轻（中位年龄 = 35岁）女性患者，她们计划进行常规、非复杂的腹腔镜手术，作为短期住院或日间手术。索赔在普通外科（n = 20）和妇科（n = 21）之间平分。共有51个结构受损。有18例血管结构损伤、30例肠损伤和3例其他损伤。仅2例（5%）患者采用了开放穿刺技术。血管损伤仅与闭合穿刺相关。仅19例（46%）患者在术中诊断出与穿刺相关的并发症，其中血管损伤占70%，肠损伤占25%。26例患者（64%）入住重症监护病房，中位住院时间为5天。无死亡病例。除了中转开腹外，大多数患者提出索赔以补偿更长的住院时间和相关费用。在30例已结案的索赔中，17例（57%）获得了赔偿。
与腹腔镜穿刺相关并发症的医疗责任索赔占所有腹腔镜相关索赔的五分之一。与穿刺相关并发症的索赔发生在进行常规、非复杂手术的年轻患者中。在所调查的病例中，大多数索赔涉及闭合穿刺技术。
