[The standards of care in laparoscopic surgery. The specific case of cholecystectomy]. / L'obligation de moyens en chirurgie laparoscopique. Cas particulier de la cholécystectomie.

ABSTRACT

Legal suits against visceral surgeons have increased since the advent of laparoscopic surgery. The duties of physicians have not however changed with the development of laparoscopic techniques. Since the decree promulgated in 1936, physicians have a legal commitment to provide the means required for patient care. This obligation has been recalled in different court judgements and in the new deontology code. In addition, jurisprudence tends more and more towards responsibility without risk. Laparoscopic cholecystectomy is not risk-free. Although morbidity and mortality have not risen with laparoscopic procedures, the types of complications encountered have changed. Reported accidents have become more frequent. The number of suits against surgeons has also increased. Surgeons must therefore be highly prudent and diligent. Precautions concerning personnel management, the choice of material and its upkeep. Special care must be given to the peroperative pneumoperitoneum and the use of monopolar electrocoagulation. A peroperative cholangiogram should be obtained. A careful operative report is very important. The surgeon must be able to justify his competence. Finally, the surgical community should publish more results concerning the rate of complications in order to establish reference material for experts.