Journal of the European Society for Gynaecological Endoscopy


From complication to litigation: The importance of non-technical skills in the management of complications *

* This document has not been peer-reviewed by Facts, Views and Vision but has been reviewed and approved by the Executive Board of the European Society for Gynaecological Endoscopy.

ESGE special interest group ‘quality , safety and legal aspects’ working group, A. A. Watrelot 1, V. Tanos 2, G.Grimbizis 3, E.Saridogan 4, R.Campo 5, A.Wattiez 6

1 Hospital Natecia, Lyon, France;
2 Nicosia University Medical School and Aretaeio Hospital, Nicosia, Cyprus;
3 Aristotle University, Thessaloniki, Greece;
4 University College London Hospital, London, United Kingdom;
5 Life Center, Leuven, Belgium;
6 Latifa Hospital, Dubai, United Arab Emirates.


complications, gynaecological surgery, litigation, malpractice, medicolegal

Published online: Aug 05 2020


Complications do occur in daily clinical life and can sometimes lead to litigation, which adversely affect the entire health care system, leading to a loss of confidence in medical providers, an increase in defensive medical practice and high professional indemnity insurance costs. Some complications are inevitable but can be minimised by completing a structured training programme. The likelihood of litigation can be reduced when adequate and clear information is given to the patient preoperatively. Non-technical skills are essential in complication management and crucial if confronted with litigation. Checklists and documentation of medication and surgical steps should be routine in all surgeries. Awareness of the complexity of the planned operation, theatre set-up and equipment are important in preventing complications. Mental preparation of surgeons is of the utmost importance in order to be able to confront any problem. When complications occur, remaining calm, calling for assistance, effective team leadership and harmony in the team are important in managing the situation. Good and effective communication with the patient and relatives, offering explanations, apologies and timely intervention without delays reduce the risk of litigation and strengthen any defence in court.