Page 35 - World Journal of Laparoscopic Surgery

WJOLS

Laparoscopic Surgery in Low-income and Limited-resource Settings: Does It safely add Value?
Faster recovery and quicker return to work make these Project. Patients were determined to be a candidate for
6,7
procedures less expensive in the long run which is par- laparoscopic intervention if they were not obese, had
ticularly important in low-income settings. simple pathologies, no previous laparotomies, or any
The cost-effectiveness of laparoscopy continues to be preexisting comorbidities. On average, 400 to 450 surger-
an important consideration in low- and middle-income ies were conducted each year.
countries (LMICs) countries and generates regular debate; The charts of all patients who underwent laparoscopic
8
however, Sculpher et al in their review determined that surgery during the Week of Healing Project surgical
laparoscopy was in fact significantly (25–30%) cheaper camps between 1992 and 2015 were retrospectively
9
when compared to laparotomies. Chao et al in their reviewed for demographic data, procedure performed,
systematic review of laparoscopic surgery in LMICs length of hospital stay, morbidity, and mortality. All of the
reviewed 1,101 abstracts from 25 LMICs and concluded de-identified data were compiled into a secure database
that laparoscopic surgery was particularly advantageous and the data categorized and analyzed using. Numbers
in LMICs. In the presence of poor sanitation, limited for Mac (Apple Inc., Cupertino, CA, USA). All General
diagnostic and imaging facilities, crowded hospital beds, Surgery cases were excluded from the analysis to focus
lack of blood banks, and single-income households, on the use of laparoscopy for gynecologic procedures
laparoscopy is safe, effective, feasible, and cost-effective in this setting. Approval was obtained from the Bomu
when offered in LMICs. Hospital’s Institutional Review Board.
The principal author started his laparoscopic surgery
career in 1992, at the Kilifi District Hospital along the RESULTS
Kenyan Coast and with the collaborative efforts of a general
surgeon, carried out biannual surgical camps performing Seventeen rural, low-income, and resource-limited public
200 surgeries per year. By 2000, The Kenya Society of hospitals in Kenya were visited between 1992 and 2015,
Endoscopic Specialties (KESES) partnered with Round and 2,901 laparoscopic gynecological procedures were
Table, a young men’s charitable club, and laparoscopic undertaken between these institutions. The mean age of
surgery was offered as a surgical option for treatment in patients undergoing a laparoscopic procedure was 34.2,
various rural hospitals in Kenya. Since then, laparoscopy with the majority of patients (70.5%) ranging between
has been successfully undertaken in 17 rural hospitals in ages 18 and 50 (Table 1). The surgeries performed over
Kenya, with more than 3,000 procedures performed. Given the reporting period are identified in Table 2. The most
the need to expand access to all modalities of surgery common gynecologic procedures performed were
including laparoscopy in LMICs, and given the extensive ovarian surgery and myomectomy, with 704 (22.8%) and
laparoscopy experience in this setting, this assessment 582 (17.4%) cases respectively. Gynecological laparoscopic
was designed to test the hypothesis that laparoscopic
surgery, when performed by experienced surgeons, can Table 1: Demographic data
be successfully and safely implemented as an alternative n %
to laparotomy in rural settings in LMICs. Gender
Female 2,901 100
MATERIALS AND METHODS Age
Under 18 39 1.34
The laparoscopic surgery program began with the receipt 18–50 2,046 70.5
of laparoscopic tubal ligation kits from Johns Hopkins Over 50 816 28.1
Program for International Education in Gynecology and
Obstetrics (JHPIEGO) in the 1990s. Laparoscopic surgical
interventions continued in various rural hospitals with Table 2: Gynecologic procedures
support from Round Table, providing logistics, supplies, n %
preoperative advertising, and patient screening. Addi- Ovarian biopsy, cystectomy, drilling 704 22.8
tionally, transport and accommodations were provided Myomectomy 676 20.0
to all volunteer surgeons through this organization. The Total/subtotal hysterectomy 582 17.4
17.0
527
Adhesiolysis, tuboplasty, salpingectomy
laparoscopic surgical camps or “Week of Healing Pro- Bilateral tubal ligation 322 11.1
jects” were organized biannually, and two laparoscopic Radical hysterectomy 31 0.99
surgeons – one specializing in Gynecology and the other Oopherectomy 22 0.8
in General Surgery – performed the procedures. Saccrocolpopexy 21 0.67
The patients were screened to determined candi- Bilateral tubal ligation reversal 14 0.1
dacy for laparoscopic surgical intervention by various Metroplasty 2 0.001
clinicians at each hospital hosting the Week of Healing Total gynecology cases 2,901
World Journal of Laparoscopic Surgery, May-August 2016;9(2):82-85 83