Rougé C, Tuech J J, Casa C, Arnaud J P
Service de Chirurgie Viscérale, CHU Angers.
J Chir (Paris). 1997 Nov;134(5-6):258-63.
Legal suits against visceral surgeons have increased since the advent of laparoscopic surgery. The duties of physicians have not however changed with the development of laparoscopic techniques. Since the decree promulgated in 1936, physicians have a legal commitment to provide the means required for patient care. This obligation has been recalled in different court judgements and in the new deontology code. In addition, jurisprudence tends more and more towards responsibility without risk. Laparoscopic cholecystectomy is not risk-free. Although morbidity and mortality have not risen with laparoscopic procedures, the types of complications encountered have changed. Reported accidents have become more frequent. The number of suits against surgeons has also increased. Surgeons must therefore be highly prudent and diligent. Precautions concerning personnel management, the choice of material and its upkeep. Special care must be given to the peroperative pneumoperitoneum and the use of monopolar electrocoagulation. A peroperative cholangiogram should be obtained. A careful operative report is very important. The surgeon must be able to justify his competence. Finally, the surgical community should publish more results concerning the rate of complications in order to establish reference material for experts.
自腹腔镜手术出现以来，针对内脏外科医生的法律诉讼有所增加。然而，医生的职责并未随着腹腔镜技术的发展而改变。自1936年颁布法令以来，医生有法律义务提供患者护理所需的手段。这一义务在不同的法院判决和新的职业道德准则中都有提及。此外，判例法越来越倾向于无风险责任。腹腔镜胆囊切除术并非没有风险。虽然腹腔镜手术的发病率和死亡率并未上升，但所遇到的并发症类型已经改变。报告的事故变得更加频繁。针对外科医生的诉讼数量也有所增加。因此，外科医生必须高度谨慎和勤勉。在人员管理、材料选择及其维护方面要采取预防措施。必须特别注意术中气腹和单极电凝的使用。应进行术中胆管造影。一份仔细的手术报告非常重要。外科医生必须能够证明自己的能力。最后，外科界应该公布更多关于并发症发生率的结果，以便为专家建立参考资料。
