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Find a Laparoscopic & Minimally Invasive Surgery Expert →Overview
A laparoscopic surgery expert answers two questions: did the surgeon identify the anatomy and work safely, and once something went wrong, was it recognized and treated in time? Many of these cases turn less on the injury than on what happened in the hours and days after it. A known complication is not by itself negligence. The expert has to explain why this injury, in this patient, on this operative record, did or did not fall below the standard of care. This page covers the technique across procedures. General surgery, gynecology, bariatric and colorectal pages cover those fields as a whole.
Laparoscopic cholecystectomy is the procedure most often litigated in this field. Reported rates vary with how an injury is defined. A population-based study of 29,739 laparoscopic cholecystectomies reported overall, minor and major injury rates of 0.81%, 0.68% and 0.13%, with no significant decline over the study period 1. A single-center review from Queensland cites large studies reporting an incidence of 0.08% to 0.3%, and says those studies suggest that injuries in the laparoscopic era are more severe than in the era of open surgery 2. So the base rate is low, the injury is known, and the rate has not gone away.
That is why technique matters. The Society of American Gastrointestinal and Endoscopic Surgeons' Safe Cholecystectomy Program sets out strategies to minimize the risk, and its first is to use the Critical View of Safety method to identify the cystic duct and cystic artery 3. The program also says the surgeon should recognize when the dissection is approaching a zone of significant risk, halt before entering it, and finish by a safe method other than cholecystectomy if conditions require 3. It adds that the advice of a second surgeon is often very helpful when the dissection is stalled or the anatomy is unclear 3.
The operative note, images and video are the core evidence. An expert compares what was recorded with those steps: was the critical view documented, was a photograph taken, did the surgeon consider conversion or a bailout? SAGES itself notes that the strategies are based on best available evidence 3, and they are not a legal rule. They can be used to frame what careful surgeons do.
Entry is the other classic risk. Trocars and Veress needles can injure bowel or major vessels, and energy devices can burn tissue outside the field of view. A thermal or missed bowel injury may not show itself for days, so the post-operative record often matters most. Expected recovery after laparoscopy is usually quick. A patient who gets worse instead, with rising pain, fever, tachycardia or abnormal labs, should prompt a search for an injury. Expert review often centers on those early warnings and on how fast imaging or return to the operating room followed. Causation may also need an infectious disease or critical care opinion.
Gynecologic surgery has its own device history. In a safety communication dated December 29, 2020, the FDA said that it recommends performing laparoscopic power morcellation for myomectomy or hysterectomy only with a tissue containment system 4. It told providers to inform patients that use of these devices during fibroid surgery may spread cancer and decrease long-term survival, and that the risk of occult cancer increases with age, particularly in women over 50 4. A case may turn on the date of surgery, because the warnings changed over time, and on what the consent discussed.
Robotic systems add a device layer. The FDA says that, although it has found robotically-assisted surgery safe and effective for certain procedures when used appropriately with proper training, it has not granted marketing authorization for any such system specifically for the prevention or treatment of cancer 5. Its 2019 safety communication urged caution in women's health, including mastectomy and other cancer-related surgeries 5. Claims may reach credentialing, training hours and hospital proctoring as well as the operation.
Look for a board-certified surgeon who routinely performs the same procedure, by the same approach, in the relevant period. A general surgeon certified by the American Board of Surgery may be right for a gallbladder case 6, and a gynecologic surgeon for a hysterectomy. The expert's own case volume, complication experience and teaching role are all useful. A radiologist may read imaging. An infectious disease or critical care physician may address sepsis. A biomedical engineer addresses device failure.
A population-based study of 29,739 laparoscopic cholecystectomies reported overall, minor and major bile duct injury rates of 0.81%, 0.68% and 0.13%, with no significant decline over the study period.
Case Types
Bile duct injury during laparoscopic cholecystectomy
Bowel perforation and delayed diagnosis after laparoscopy
Major vessel injury during trocar entry
Thermal injury from energy devices
Failure to convert to open surgery
Power morcellation and spread of unsuspected cancer
Robotic-assisted surgery complications and credentialing
Informed consent for minimally invasive procedures
Qualifications
Related Specialties
FAQ
Look for a board-certified surgeon who routinely performs the same procedure by the same approach, during the period at issue. Ask about case volume, how the surgeon handles the complication in question, and any teaching role. For robotic cases, ask about direct system experience.
No. It is a known complication, and reported rates vary by definition. An expert reviews whether the surgeon identified the anatomy, documented the steps, recognized danger and responded properly. Whether the care met the standard depends on the facts and the law of the forum.
It is a method for identifying the cystic duct and cystic artery during laparoscopic cholecystectomy, listed first in the SAGES Safe Cholecystectomy Program. Three criteria are required to achieve it. An expert compares the operative note, images, and video with those criteria.
In a December 29, 2020 safety communication, the FDA recommended performing laparoscopic power morcellation for myomectomy or hysterectomy only with a tissue containment system. It told providers to inform patients these devices may spread cancer and decrease long-term survival. The date of surgery matters, because guidance changed over time.
The FDA says it has not granted marketing authorization for any robotically-assisted surgical device system specifically for the prevention or treatment of cancer. It says robotic surgery is safe and effective for certain procedures when used appropriately with proper training. Claims may reach credentialing and training.
In general, laparoscopic surgery expert fees are determined by the expert themselves, based on a variety of criteria. Among those criteria are clinical experience, board certifications, forensic experience, academic appointments, and publications. Vident does have some influence over expert fees by comparing experts within a specialty, but ultimately it is a personal decision by the expert.
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