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Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications.

机译：腹腔镜进入技术：临床指南，国家调查和法医学后果。

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摘要

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.
机译：背景：本研究旨在通过系统的文献检索和循证医学评估建立腹腔镜安全进入的标准，确定外科医生在英国对腹腔镜进入的偏爱，并评估腹腔镜进入引起的并发症的法医学后果。方法：对MEDLINE和EMBASE（1996-2007）进行了系统的文献检索，并通过问卷对全国外科医生进行了调查（2006年5月至12月）。结果：基于系统的文献检索和基于证据的严格评估，建立了包括10个步骤的腹腔镜进入标准。全国调查有226名受访者，其中大多数人知道米德尔斯堡共识或皇家妇产科学院[RCOG]的指导。首选腹腔镜进入技术存在很大差异。目前，对于腹腔镜进入相关并发症的法医学立场有明确的司法指导。结论：尽管对腹腔镜进入指南的认识广泛，但临床实践中所采用的技术仍存在很大差异。除非实践与推荐的指导意见一致，否则接受腹腔镜检查的妇女将面临增加的不必要手术风险。根据英国法律判例法，单纯性妇女的腹腔镜进入相关伤害被认为是过失做法。

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