New checks on controversial keyhole surgery

As a widower wins damages, Rosie Waterhouse reports on the troubles of a technique hailed as medicine's future

The Department of Health is today expected to announce new controls on keyhole surgery, amid growing concern about its increased use by surgeons without adequate training or evaluation.

A statement is to be made by Gerald Malone, Minister for Health, at the opening of a new training unit for techniques in "minimal access" therapy, which includes keyhole surgery, at the Royal College of Surgeons in London. The department's planned new system for evaluating medical technology, similar to the control of new medicines, comes after a series of medical negligence cases involving laparoscopic, or keyhole, surgery.

In an out-of-court settlement announced yesterday, substantial damages were awarded to a man whose wife died after surgeons used keyhole surgery to remove a bowel obstruction. Ruth Silverman went into the private Portland hospital in north London in May 1992 for a routine hysterectomy but developed a blockage in the bowel. She died 21 days later from a brain haemorrhage brought on by blood poisoning caused when surgeons punctured her bowel during keyhole surgery.

Another surgeon, Peter Hawley, had been standing by and was preparing to perform the operation using open surgery. But Professor Albert Singer, the consultant gynaecologist who performed the hysterectomy, and Russell Macdonald, registrar from Queen Charlotte's hospital, decided to perform keyhole surgery.

Professor Singer and Mr Macdonald admitted liability and agreed to pay "substantial" undisclosed damages to Michael Silverman, a former management consultant, from St John's Wood, north London.

Mr Silverman alleged that Professor Singer employed the services of Mr Macdonald to perform laparoscopic surgery without his knowledge or that of his wife. The Silvermans understood that Mr Hawley would be the operating surgeon, using the traditional technique of laparotomy, or open surgery.

Since his wife's death Mr Silverman has launched a campaign for safety in keyhole surgery. He claims he knows of 1,400 cases in which patients have not recovered properly and that 30 per cent of these died. After winning his own case and receiving a declaration of "profound regret", he said: "This demonstrates to every doctor that only the most experienced and capable should undertake keyhole surgery."

Mr Macdonald declined to comment. In a statement issued by the Medical Defence Union, Professor Singer said: "It was a very tragic and complex case and I am glad that it has been satisfactorily settled. Nothing can replace a life lost and I still feel very upset by its tragic conclusions; this indeed will live with me for many years."

Keyhole surgery was pioneered eight years ago and has been heralded as the future for medicine. The Department of Health has estimated that 70 per cent of operations will one day be carried out using this technique. It involves miniature cameras and long instruments being inserted into the patient through tiny holes and the operation performed via a screen, avoiding the need to open the body.

But keyhole surgery has spread in an uncontrolled and haphazard way - formal training was brought in only last year. The Royal College of Surgeons admits that keyhole surgery was introduced too quickly and without proper regulations and last year issued guidelines on its use.

The Medical Research Council has called for a thorough evaluation of the method and the Centre for Health Economics at York University issued a report saying the technique had not been subjected to such rigorous testing as a new drug and not all surgeons had been properly trained.

Alan Maynard, the centre's director, said there had been several medical negligence cases associated with keyhole surgery.The method is also costly, in terms of the cost of equipment, and although patients may leave hospital more quickly they spend longer in the operating theatre.