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Medicolegal Issues in Laparoscopic Surgery

OVER THE PAST two decades, there have been rapid developments in medical technology, which have facilitated the ability to perform surgical operations using minimally invasive or laparoscopic (‘keyhole’) surgery. Modern laparoscopic equipment including high definition systems, provide the surgeon with an excellent view of the relevant anatomy. ‘Keyhole’ surgery has many advantages for patients in terms of a rapid recovery from surgery, less post-operative pain and better cosmetic results. Nevertheless, laparoscopic surgery is associated with specific risks and complications which are only seen in minimally invasive surgery. These may be in addition to known complications associated with traditional open surgery. Several factors influence the outcome of clinical negligence claims in relation to laparoscopic surgery.

Psychological trauma can have effects in many ways

PSYCHOLOGICAL trauma is often a focus of assessment and intervention in personal injury claims and as such it is helpful to consider the range and complexity of difficulties that might arise as a result of some form of traumatic event. ‘Trauma’ has become part of everyday language, so it may be helpful to define what is meant by the term.

In formal diagnostic terms, in order that an event be considered to be traumatic it requires the person to either experience or witness something (or things) that involve actual or threatened death or serious injury, or threat to the integrity of self or others, and that the person experienced fear, helplessness or horror (American Psychiatric Association 1994).

Beware when making decisions for people

WHAT IS mental capacity? To have capacity is usually accepted as the ability to make decisions concerning oneself; to be able to have autonomy over one’s life. That leads on to the question: what is meant by autonomous? Does being autonomous mean the ability to make a decision that can be accepted or does it require the added ability to carry out any related action? The recent introduction of the Mental Capacity Act 2005 has brought this issue to the fore in health and social care. Consequently, a decision that is contrary to medical advice cannot suggest that the decision maker does not have capacity.

Accepting that ‘mental capacity’ is having the ability to determine what happens to one’s body, ie habeas corpus, rather than the ability to carry out all functions, then the next question is how is mental capacity assessed and is an assessment a once-and-for-all event.

Assessing the psyche can help assess the person

THE USEFULNESS of neuropsychological assessments to the legal professional is manifold. Many people think of neuropsychological assessments only as cognitive (IQ) testing. Others may think of using these assessments when determining psychological damages in litigation. However, both criminal law and family court practitioners can find that neuropsychological assessments are a valuable tool that can help determine many more issues than is commonly thought.

In criminal law the use of cognitive testing to determine capacity is well known. Few, however, realise that in cases where consent is an issue, assessing not only alleged perpetrators but also alleged victims gives valuable information.