Page 34 - World Journal of Laparoscopic Surgery

WJOLS

Rafique B Parkar et al 10.5005/jp-journals-10033-1278
RevieW ARticLe

Laparoscopic Surgery in Low-income and Limited-resource

Settings: Does It safely add Value? A Review of 2,901
Laparoscopic Gynecologic Procedures

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1 Rafique B Parkar, Leeya F Pinder, JG Wanyoike, Yamal Patel, David Otieno, Yusuf Palkhi
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7 Richard Baraza, Khama Rogo
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ABSTRACT following conversion to laparotomy for an ovarian tumor. The
mean hospitalization was 1.9 days.
Objectives: Of the 234 million surgeries conducted yearly
worldwide, only 3.5% are carried out in low-income countries. Conclusion: Laparoscopic surgery is feasible, safe, and
Known advantages exist to laparoscopic surgery, and it is cost-effective, and it has important advantages in low-income
widely utilized in high-income countries; however, many countries with limited resources. Laparoscopic surgery
barriers exist to uptake in low-income countries. Since 1992, does add value in low-resource settings, and our activities
laparoscopic surgery has been successfully undertaken in demonstrate that it is a safe alternative to traditional open
various rural public hospitals in Kenya. We sought to review modalities of surgery.
outcomes of laparoscopic surgeries performed by our group
in these facilities. Keywords: Global surgery, Gynecologic surgery, Laparoscopic
surgery, Low- and middle-income country surgery.
Materials and methods: Between 1992 and 2015, 3,119
laparoscopic procedures were performed at 17 rural hospitals How to cite this article: Parkar RB, Pinder LF, Wanyoike JG,
in Kenya as a part of the Round Table’s “Week of Healing Patel Y, Otieno D, Palkhi Y, Baraza R, Rogo K. Laparoscopic
Project.” The medical and operative records of all patients Surgery in Low-income and Limited-resource Settings: Does It
who underwent gynecological laparoscopic surgery were safely add Value? A Review of 2,901 Laparoscopic Gynecologic
retrospectively reviewed for outcomes. Procedures. World J Lap Surg 2016;9(2):82-85.
Results: During the reporting period, 2,901 cases performed Source of support: Nil
were gynecologic procedures; the mean age of patients was Conflict of interest: None
34.2. Forty-one complications were encountered (1.41%),
and one death (0.03%) occurred secondary to hemorrhage
INTRODUCTION

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1 Associate Professor, Instructor and Postdoctoral Research Until recently, access to surgical interventions has been
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Fellow, Senior Lecturer, Lecturer, Consultant, Surgeon a neglected global issue despite up to 30% of the world’s
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1 Department of Obstetrics and Gynecology, University of Cape disease burden requiring surgical intervention. Almost
Town, Cape Town, South Africa 2 billion people in the world have no access to needed
interventions, and of the 234 million surgeries conducted
2 Department of Obstetrics and Gynecology, Boston University
School of Medicine, Boston, Massachusetts, USA worldwide each year, only 3.5% are conducted in low-
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income countries. For almost 35 years, there has been a
3 Department of Obstetrics and Gynaecology, University of
Nairobi, Nairobi, Kenya rapid spread and evolution of laparoscopic surgery in the
developed world, where this modality is largely regarded
4 Department of Obstetrics and Gynecology, Aga Khan as the first choice in 98% of all surgical interventions by
University Hospital, Nairobi, Kenya
adequately trained surgeons. 3
5 Department of Anesthesiology, The Nairobi Hospital, Nairobi In low-income countries, restricted access and avail-
Kenya
ability of equipment and lack of adequate training of
6 Department of General Surgery, Mombasa Hospital Mombasa surgeons have been barriers to establishing successful
Kenya 3
laparoscopic surgery programs. Gawande reported that
7 Department of General Surgery, Nairobi Hospital, Nairobi lack of clean water, sanitary living conditions, depleted
Kenya blood facilities, lack of sufficient infection control, and
8 Department of Obstetrics and Gynecology, Sagam Community diag nostic imaging techniques have further delayed the
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Hospital, Siaya County, Kenya uptake of laparoscopic surgery in rural areas. The notable
Corresponding Author: Rafique B Parkar, Associate Professor advantages to laparoscopic surgery include smaller, cos-
Department of Obstetrics and Gynecology, University of Cape metically acceptable incisions; less scarring and postop-
Town, Cape Town, South Africa, Phone: +2540203740752 erative pain; less utilization of antibiotics and analgesics;
e-mail: rafsan254@gmail.com
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reduced overall hospital stay; and less ward congestion.
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