[Forensic medical implications of vascular injuries in the course of video-endoscopic surgery]

We report 21 case files. Seven concerned gynecology laparoscopy with 3 deaths and 4 severe sequelae. Five cases involved laparoscopic appendicectomy with 1 death and 4 severe sequelae. In 3 cases complications during conventional appendicectomy were treated laparoscopically. Three cases concerned post-operative complications and finally, 6 cases of laparoscopic cholecystectomy are reported, including 4 fatal cases. Three-fourths of these cases occurred after 1990 and the fatal cases were usually related to bleeding caused by the inflation trocar, emphasizing the importance of strict safety measures, especially control of intraabdominal pressure and verification of ligatures. These case-files demonstrate that severe vascular events can occur in all laparoscopic procedures. In most of the cases, the surgeon was not unexperienced but rather well trained in this type of surgery. Practicians using this technique must have training in vascular surgery or at least operate within structures allowing immediate relay by a vascular surgeon.