Common bile duct damage is the injury most frequently associated with laparoscopic surgery. It is followed by small bowel and colon perforation, respectively, injuries occur most often during gall bladder operations, with exploratory laparoscopy coming second.
The data are contained in a report from the Physicians Insurers Association of America, which draws on information from 19 medical insurance companies from the US, Canada, UK and Republic of Ireland under a data-sharing project.
This study analysed data from 535 cases. The injury was not identified until after the procedure in over two-thirds of the incidents examined. In some cases delay led to serious complications, such as peritonitis and sepsis.
The average payment was US$212 350.
163 claims were settled, with payments to the plaintiffs totalling US$34m (£24.3m). The average payment made was US$212 350. Indemnity payments averaged 10% more when the patient's injury had not been recognized.
Cholecystectomy injuries were not recognized before the conclusion of the surgery in 83% of claims. Vascular injuries tended to be recognized before the end of surgery, whereas visceral injuries causing complications were more likely to remain unrecognized.
Difficulty in visualising the anatomical structures during laparoscopic surgery was a contributing factor to these types of adverse incident. Trocars were the most common type of device causing injury.