“Laparoscopic Complications”: “Suturing Skill”, “Surgical Technique”, and Malpractice Claims
Published .
Why “Laparoscopic Suturing” Requires Specific Skill
In minimally invasive surgery, a surgeon works through small incisions while viewing a camera image and manipulating long instruments. Suturing and tying knots in that environment require hand-eye coordination, depth perception, controlled instrument movement, and practice. A complication such as bleeding, a leak, or damage to nearby tissue can occur without negligence; the event alone does not show that a surgeon lacked skill or departed from the standard of care.
What the “Skills Data” Shows—and Does Not Show
A Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) study at four medical-school institutions assessed practicing surgeons who were credentialed in laparoscopy. Of 87 surgeons who completed a baseline Fundamentals of Laparoscopic Surgery (FLS) manual-skills assessment, 22 (25.3%) did not meet the passing score; the institution-specific baseline rates ranged from 0% to 46%. The assessment included five simulated tasks, one involving intracorporeal suturing. This is a notable finding, but it is a limited sample from four institutions, not a representative national survey. It does not establish that one-quarter of surgeons cannot suture in an actual operation, and the published abstract does not say that all 22 failed the suturing task. The results support careful attention to how technical proficiency is taught and assessed—not a blanket conclusion about surgeons.
“Simulation” Is a Useful Measure, Not the Legal Standard
FLS is an educational assessment of basic laparoscopic knowledge and manual skills. Its five tasks include peg transfer, precision cutting, loop ligation, and suturing with extracorporeal and intracorporeal knot tying. A simulation score may help explain a skill or training issue, but a passing or failing score does not by itself decide whether care in a particular operation met Maryland’s legal standard. The applicable standard and any departure must be established through admissible evidence about the procedure, circumstances, and relevant specialty.
When “Technical Skill” May Matter in a Claim
A claim may raise questions about how the surgeon placed a stitch, secured a knot, controlled bleeding, protected nearby structures, recognized a tissue injury, or responded when a repair was not working. The appropriate technique depends on the anatomy, procedure, patient condition, and what was encountered. The analysis may also consider whether the surgeon should have called for assistance, changed approach, or converted to open surgery. A known complication is not automatically negligence, and a technically difficult case is not automatically malpractice.
“Evidence” Needed to Evaluate the Surgery
Relevant material may include the operative report, anesthesia and nursing records, instrument and supply information, postoperative imaging and laboratory results, the timing of symptoms, and any retained photographs or video. Credentialing or training material may be relevant when admissible and discoverable. A qualified surgeon with experience in the procedure can compare the actual steps with the applicable standard and explain whether a particular technical error caused the injury. Maryland’s expert and HCADRO requirements also apply to covered malpractice claims.
“Complication” and “Malpractice” Are Different Questions
The patient’s outcome matters, but it is not a direct measure of a surgeon’s technical competence. The legal questions are whether the care fell below the applicable standard and whether that departure caused the claimed harm. Informed consent presents a separate question about what material risks and alternatives were disclosed before treatment. A risk may be disclosed and still result from negligent technique; conversely, an adverse event can occur even when the procedure was performed appropriately.
Related Maryland Cases and Authorities
Sources: Society of American Gastrointestinal and Endoscopic Surgeons, “Ensuring Competency: Is FLS Certification Necessary for Practicing Surgeons?” (study abstract); Fundamentals of Laparoscopic Surgery, “About FLS”; Md. Code, Cts. & Jud. Proc. §§ 3-2A-04, 3-2A-06B; Md. Rule 5-702; Rochkind v. Stevenson, 471 Md. 1 (2020).