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The claimant presented with abdominal pain from the age of 18 years through to the age of 36 years. When she finally underwent a laparoscopy, she was found to have grade 4 endometriosis which had spread around her ovaries, colon and the wall of the abdomen. She underwent treatment, but as the endometriosis was so far advanced it could not be fully treated and it was alleged: i) it had been negligent to consider her symptoms to be related to irritable bowel syndrome (IBS) alone; ii) there had been a failure to consider a diagnosis of endometriosis earlier; iii) there had been a failure to perform a laparoscopy earlier, even though her symptoms remained unchanged after treatment.
Gynaecological operative laparoscopy has progressed significantly over the past two decades. The process of laparoscopic surgery should be based on an appropriate risk management system that allows for improved quality of care. Regarding women with severe endometriosis, specialist referral centres should be developed. Units performing laparoscopic surgery should adopt recommendations and guidelines from scientific bodies (RCOG, NICE, BSGE) and should benchmark their audited activity against the national standards. The main components for consideration when developing models of service in laparoscopic surgery include: gynaecology outpatients, pre-operative preparation, operative and post-operative. Laparoscopic training can be developed and augmented with the use of simulators or laparoscopic trainers. Laparoscopic surgery necessitates a team approach between surgical, nursing and technical support staff. Audit of length of stay, analgesia requirement, complication rate and re-admission rate help to redesign and configure the service.
The first gynaecological reports for laparoscopy came from Hope in 1937 (Hope, 1937) on the diagnosis of extrauterine pregnancy but it was not until the 1970s that laparoscopic surgery started to become established (Semm, 1970). The introduction of good-resolution camera systems and the development of new surgical instruments have enabled the advancement of laparoscopic surgery. In addition, advances in technology have increased the safety parameters and enabled surgery to be performed more efficiently. These technological developments include the expansion of bipolar technology and the introduction of laser modalities, the harmonic scalpel and haemostatic stapling devices.
Originally laparoscopic surgery was referred to as minimally invasive surgery but it soon became apparent that the surgery was highly invasive but performed through small incisions, and hence the term minimal access surgery was coined. Minimal access surgery can be considered as an alternative procedure to the traditional operation; it aims to achieve the same end result as the traditional operation but is performed through small incisions. In hysteroscopic surgery, most laparoscopic procedures should aim to emulate the open operation, the only difference being the size of the incision. However, there may be modifications in the minimal access route as a result of the improved vision that it affords or the difficulty in emulating the open procedure. The perceived disadvantages of the laparoscopic route over the open route are the potential complications, the time to perform the operation and the cost.
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