Laparoscopy or what is more commonly known as keyhole surgery is a type of surgical procedure performed on the abdomen (stomach) using small surgical incisions in the skin.  It is therefore considered a minimally invasive type of surgery.  The surgeon will use an instrument called a laparoscope which is a small flexible tube that has a light source and camera which sends images back to a television monitor.  This type of surgery was introduced into Ireland approximately in the year 2000 and it is noted over more recent years that there is a higher prevalence of complications arising from keyhole surgery.  Keyhole surgery is a ‘blind’ procedure and as a consequence the risk remains of negligent injury occurring in the internal structures, including the bowel and vessels.  Keyhole surgery does carry an increased risk of damage to these structures because the surgeon must cut into the skin to allow the insertion of the laparoscope.  It is important that the patient is made aware of the risks and that a discussion given to any alternatives to keyhole surgery including more conventional or traditional ‘open’ surgery that may just be as effective in the treatment goals.  This relates back to informed consent and the consent form should reflect this discussion and advice.  It is therefore of high importance that keyhole surgery is the most suitable operation for the patient.  The surgeon carrying out the surgery must have the necessary training, skills and experience and that safe techniques are used at surgery.  If there is a poor outcome following keyhole surgery, it is most important that prompt treatment from a multi-disciplinary team should be considered and should there be poor outcome following surgery it is only proper that there is openness and honestly on the part of the surgeon and that this should be communicated to the patient as soon as possible.  Cases we have seen over the years involve perforation or tearing or indeed puncturing internal tissues and organs such as injury to the bowel, bladder and blood vessels.  Furthermore if the surgeon does not follow general and approved laparoscopy protocols which are designed to minimise the risk of injury during keyhole surgery then the hospital may be liable in negligence to pay compensation for the harm suffered.

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