Page 23 - World Journal of Laparoscopic Surgery

Minimal Access Surgical Experience in Developing Economy: A Young Trainee Stimulant
The colonoscopy appears to follow the same pattern with 51
(98%) cases of cecal intubation. The average procedure duration
was 45 minutes. All patients had a very good outcome.

dIscussIon
Minimal access surgery involves the use of camera-guided images
to carry out procedures upon patients. Some authors prefer to use
the term minimal invasive or incision surgery. It is also termed, in
some instances, as key-hole surgery and also button-hole operation.
These are for easy comprehension or clarity of terminology for
trainees and clients or patients. The author preferred minimal access
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surgery to be a more comprehensive term just like his trainer.
However, endo-luminal, laparoscopy, and some other related
procedures within the scope of this minimal access surgery were
considered here. Hence, this review is expected to stimulate a young
trainee surgeon to set up a career choice in minimal access surgery
in a developing economy. The issue of the learning curve has been
Fig. 1: Pie chart showing different MAS procedures. In the pie chart, the overemphasized and attention should be drawn to commonly
first numbers show the numbers of cases (n) and the second number
percentage of procedures performed procedures. Those who have high demanding practice,
are easily available, and give a good outcome should be of prime
importance in the scale of preference.
A glance at the results of the above procedures shows that
endoscopic procedures were more than laparoscopies. This could
be the result of high demand for upper and lower gastrointestinal
endoscopies. This could also have been a result of associated lower
costs. Most laparoscopic procedures appear to be more expensive
than endo-luminal procedures as can be seen in the index report.
More studies are required to elucidate MAS in developing countries.
A young trainee should be aware of this fact, as acquiring skill in
endo-luminal procedures could hasten experience in MAS. More
data and studies will be required to compare activities of those
with endo-luminal experience before laparoscopic procedures in
low-income countries. Most hernia procedures are still done under
regional or local anesthesia in low or medium-income countries,
thereby, reducing the demand for laparoscopies that most often
utilize general anesthesia.
Although the author recorded a nil conversion rate and nil
case fatality rate, this may be due to a limited number of cases
performed. It might also be due to adequate training that the
Fig. 2: The number of different types of laparoscopic cases author underwent at a good training center. The act of conversion
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should always be borne in mind and discussed with the patient. The
surgeon should be familiar with the anatomy of the area. He may
(n = 11), laparoscopic appendectomies (n = 8), laparoscopic not necessarily know how to repeat the open type of the operation
fundoplication (n = 1), and foreign body retrieval (n = 1). The but should have a colleague who can perform the open type
laparoscopic surgeries had a female to male ratio of 12:1. This around especially while operating in a developing economy. Also, a
result showed a gradual shift from mild to more complex minimal more senior minimal access surgeon, laparoscopist, or endoscopic
access procedures, with females being more beneficiaries. Most surgeon is a good asset.
of the patients were young. The mean age was 29.3 ± 11.6 years. This result showed a gradual shift from mild to more complex
The oldest patient was a 65-year-old woman who had laparoscopic minimal access procedures. Some cases, such as appendicectomy
cholecystectomy while the youngest patient was an 8-year-old and laparoscopic cholecystectomy may be termed basic
boy who had diagnostic laparoscopy with orchidectomy for laparoscopic procedures. However, the author has encountered
undescended (intra-abdominal) right testes. The laparoscopic two instances where laparoscopic cholecystectomy was not
cases had an average procedure time of 60 minutes and both the the usual norm. He could remove giant calculi in the procedure
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conversion and case fatality rates were nil (0%). Only one patient via laparoscopy. Laparoscopic fundoplication or retrieving a
had a port site infection that was managed conservatively. sharp foreign body is an advanced procedure. Some authors
8,9
The author could intubate the duodenums in all cases of OGS have reported retrieval of sharp foreign bodies. The young
performed, except in three patients with gastric outlet obstruction trainee surgeon should have acquired the skill of intra-corporeal
where the risk of perforation was high and the endoscope could suturing technique. He should have mastered the act, especially
not enter the first part of the duodenum. The average intubation during laparoscopic cholecystectomy, appendicectomy, and
and procedure durations were 10 and 15 minutes, respectively. the likes.

World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021) 21