challenges and prospect of laparoscopic surgery in a low resource setting : our experience at fmc...
TRANSCRIPT
C H A L L E N G E S A N D P R O S P E C T O F L A PA R O S C O P I C
S U R G E RY I N A L O W R E S O U R C E S E T T I N G : O U R
E X P E R I E N C E AT F M C B I R N I N - K E B B I
P R E S E N T E D B Y
D R Y U S U F TA N K O S U N U N U ( M B B S , F WA C S , F M A S , D M A S )
&
D R A D A M U N A I S H A ( M B B S , F WA C S , F M A S , D M A S )
L A PA R O S C O P I C S U R G I C A L U N I T
F M C B I R N I N K E B B I
AT
S O G O N A S A B A 2 0 1 4 P R E - C O N F E R E N C E W O R K S H O P
Outline
IntroductionResult of our ExperienceChallengesOvercoming ChallengesProspectsConclusion
Introduction
Technological advancement has made it possible for many "open surgical" procedures to be done via endoscopic route.
Laparoscopy has advantages of;
Less postoperative pain
Shorter duration of hospital stay
Early return of patients to normal activities.
Less post operative adhesion formation
Precise definition of anatomy and pathology
Despite above advantages practice of laparoscopy in Nigeria is still rudimentary and is mainly diagnostic.
Possible reasons are; underfunding of healthcare Cost of the service Inadequacy of trained personnel Reluctance of locally based Gynaecologist to change from
the traditional method of surgery
Our Experiences
Laparoscopic Surgical Unit was established in April, 2012
A total 60 surgeries have been done with 42 (70%) Gynaecological
Out of the forty two cases 22 (57.14%) were operative and 18 (42.8 6%) were diagnostic
The patient age ranges from16 to 37 years and mean age was 25.8
Complication were minimal with only 2 cases of Subcutaneous emphysema
Conversion rate was 7.1% (N = 3)
Procedures
Laparoscopy and dye testLaparoscopic ovarian drillingLippes loop retrievalAdhesiolysisOvarian cystectomyLaparoscopic Salpingectomy for ectopic pregnancyLaparoscopic bilateral tubal ligationLaparoscopic assisted MyomectomyHysteroscopic adhesiolysis for Ashermans Syndrome
nit has received 3 gynaecologists for hands on training
Challenges
Patient factorsCost of the service to the patients leading to poor
patient’s complianceUnyielding cervix Late presentation and so non-suitability of most patients
that could benefit from laparoscopic surgeryProvider factors include –
No centre provide all ranges of minimal access gynaecological procedures
Having to negotiate the a learning curve Lack of interest for the procedure among other cadre
of staff
Logistic issues Maintenance of equipment – costly, expertise not
readily available Constant supply of electricity
Systemic factorsIndependent laparoscopic surgical unit vs. combine theatre unitsCost of providing laparoscopic surgical services to the hospital
Overcoming the Challenges
Locally improvise instrumentsUse of reusable instruments as much as possibleUse of hybrid or clone laparoscopic machineSubsidising cost to the patientsProvision of alternative sources of power supply Proper patient selection
Respect for learning curve
Encouraging team work among Gynaecologist, surgeons and other stake holders
Prospect
Prospect for laparoscopy in gynaecological practice in Nigeria is good
However may require ;Institutional collaborations Incorporation of laparoscopy in our postgraduate training curriculaCapital investment in man power development and equipmentsCreating awareness among patientsFormation of National and Regional Association of Laparoscopic surgeons
Conclusion
Despite challenges practise of laparoscopic surgery in a low resource setting is possible.
It requires more interest in acquisition of new skills by our surgeons, more financial commitment from our health care managers, and a raised awareness on its advantages to our patients/clients.
With these achieved, the prospect of laparoscopic surgery in low resource settings is good
Teckno Laparoscopic Tower and Machine
Laparoscopic Session
Slow leaking ectopic gestationuss findings
Day 5 post op following laparoscopic salpingectomy
Improvised fluid delivery system for hysteroscopy
Thank you for listening
References
Perissat J. Laparoscopic surgery: A pioneer's point of view. World J Surg 1999;23:863-8.
Garry R. Gynaecological Endoscopy. The next 10 years; Editorial, Gynae. Endos. 2002; 11:1-3.
Bittner R. Laparoscopic surgery – 15years after clinical introduction. World J Surg 2006; 30: 1190–1203.