Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications.
BACKGROUND
This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise the medicolegal ramifications of complications arising from laparoscopic entry.


METHODS
A systematic literature search of MEDLINE and EMBASE (1996-2007) was performed as well as a national surgeon survey by questionnaire (May-December 2006).


RESULTS
Laparoscopic entry criteria involving 10 steps were established based on the systematic literature search and evidence-based critical appraisal. The national survey had 226 respondents, with the majority aware of the Middlesbrough consensus or Royal College of Obstetricians and Gynaecologists [RCOG]-sourced guidance. There was considerable variation in preferred laparoscopic entry techniques. Currently, there is clear judicial guidance on the medicolegal stance toward laparoscopic entry-related complications.


CONCLUSIONS
Despite widespread awareness of laparoscopic entry guidelines, there remains considerable variation in the techniques adopted in clinical practice. Unless practice concurs with recommended guidance, women undergoing laparoscopy will be exposed to increased unnecessary operative risk. Laparoscopic entry-related injury in an uncomplicated woman is considered negligent practice according to UK legal case law.
Varma
Rajesh
R
Department of Women's Health, Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK. rajesh.varma@gstt.nhs.uk
Gupta
Janesh K
JK
D003625:Data Collection; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D019359:Knowledge; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008318:Malpractice / Q000331:legislation & jurisprudence*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011312:Pressure; D011677:Punctures / Q000009:adverse effects*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom