challenges and prospect of laparoscopic surgery in a low resource setting : our experience at fmc...

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.