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July 2003

Laparoscopic Surgery: Ethical Considerations and Lawful Medicine

Arch Surg. 2003;138(7):810. doi:10.1001/archsurg.138.7.810

The availability of local, national, or international guidelines that state preferences for laparoscopic operations raises the question, Is it right to have the patient undergo a laparotomy, when the laparoscopic option is available? This is the status questionis of an eventuality that is becoming more and more frequent.

The first concern, which is of a deontological nature, is that the doctor should provide the patient with as much accurate information as possible on the operating methods, the patient's clinical condition, and up-to-date surgical techniques. We will analyze the risks and benefits of laparoscopic operations for patients as well as for the community in which health structures operate. So-called outpatient surgery, or 1-day surgery, has considerable advantages in terms of hospital admittance costs. The increase in the number of patients treated with laparoscopy can provide financial coverage for instruments and specialized laparoscopic staff. This justifies the tendency of health institutions to adapt the general guidelines proposed by International Scientific Organizations (the European Association of Endoscopic Surgery and the Society of American Gastrointestinal Endoscopic Surgery) in order to benefit from promotion of laparoscopy.1,2 Laparoscopic procedures are less invasive, and patients require less management postoperatively, especially elderly patients, who have a higher risk of developing complications. Despite these advantages and the increasing use of laparoscopic techniques, one must not neglect patients who are left to their own resources soon after the operation.