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Vleugels MPH, Rahimi M. Feeling of pulsations in artificial arteries with a real time haptic feedback laparoscopic grasper: a validation study. Surg Endosc 2024:10.1007/s00464-024-10877-w. [PMID: 38858248 DOI: 10.1007/s00464-024-10877-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/23/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Despite the advancements in technology and organized training for surgeons in laparoscopic surgery, the persistent challenge of not being able to feel the resistance and characteristics of the tissue, including pulsations, remains unmet. A recently developed grasper (Optigrip®) with real time haptic feedback, based on photonic technology, aims to address this issue by restoring the tactile sensation for surgeons. The key question is whether pulsations can be detected and at what minimal size level they become clinical significant. METHODS To simulate arterial conditions during laparoscopic procedures, four different silicone tubes were created, representing the most prevalent arteries. These tubes were connected to a validated pressure system, generating a natural pulse ranging between 80 and 120 mm Hg. One control tube without pressure was added. The surgeons had to grasp these tubes blindly with the conventional grasper or the haptic feedback grasper in a randomized order. They then indicated whether they felt the pressure or not and the percentage of correct answers was calculated. RESULTS The haptic grasper successfully detected 96% of all pulsations, while the conventional grasper could only detect 6%. When considering the size of the arteries, the Optigrip® identified pulsations in 100% the 4 and 5 mm arteries and 92% of the smallest arteries. The conventional grasper was only able to feel the smallest arteries in 8%. These differences were highly significant (p < 0.0001). CONCLUSION This study demonstrated that the newly developed haptic feedback grasper enables detection of arterial pulsations during laparoscopy, filling an important absence in tactile perception within laparoscopic surgery.
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Affiliation(s)
- Michel P H Vleugels
- Department of Obstetrics and Gynecology, Hospital Clinica Benidorm, Benidorm, Spain
- , Malden, The Netherlands
| | - Masie Rahimi
- Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, The Netherlands.
- Amsterdam Skills Centre for Health Sciences, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Aryankalayil J, Atwood R, Johnson M, Fitch J, Ayvar A, Natuzzi E, Muñoz JE, Jagilly R, Siota S, Worlton TJ. Beyond the Expected: Evaluating Preoperative Predictors of a Difficult Cholecystectomy Aboard the USNS Comfort. ANNALS OF SURGERY OPEN 2024; 5:e411. [PMID: 38911643 PMCID: PMC11191968 DOI: 10.1097/as9.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/06/2024] [Indexed: 06/25/2024] Open
Abstract
Mini abstract Typical preoperative markers of a difficult laparoscopic cholecystectomy did not apply during the US Naval ShipComfort Deployment in 2019. This prospective study reveals the importance of preparedness for short-term surgical missions, the impact of health care disparities on the severity of disease, and the need for deliberate and thoughtful engagement with host-nation partners.
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Affiliation(s)
- Joseph Aryankalayil
- From the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Rex Atwood
- From the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Mark Johnson
- Department of General Surgery, Navy Medicine Readiness and Training Command, Portsmouth, VA
| | - Jamie Fitch
- From the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of General Surgery, Naval Medical Center Camp Lejeune, Jacksonville, NC
| | - Aldo Ayvar
- Department of surgery, Carrera de Medicina Humana, Universidad Cientifica del Sur, Lima, Peru
- Department of surgery, Servicio de Cirugia General, Centro Medico Naval- Cirujano Mayor Santiago Tavara, Marina de Guerra del Peru, Callao, Peru
| | - Eileen Natuzzi
- Center for Australian, New Zealand, and Pacific Studies, Georgetown University School of Foreign Service, Washington, DC
| | - Juan Elvin Muñoz
- Department of Surgery, Military Teaching Hospital- Dr. Ramón De Lara, Santo Domingo, Dominican Republic
- Department of Surgery, Punta Cana Medical Center, Punta Cana, Dominican Republic
| | - Rooney Jagilly
- General Surgery Department, National Referral Hospital, Honiara, Solomon Islands
| | - Scott Siota
- General Surgery Department, National Referral Hospital, Honiara, Solomon Islands
| | - Tamara J. Worlton
- From the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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Mangray H, Madziba SS, Ngobese A, Govender Y, Clarke DL. Implementation of Laparoscopic Nissen Fundoplications in a Developing South African Pediatric Surgical Service. J Indian Assoc Pediatr Surg 2024; 29:261-265. [PMID: 38912030 PMCID: PMC11192267 DOI: 10.4103/jiaps.jiaps_251_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Pediatric laparoscopic Nissen fundoplication (LNF) has become the standard approach at many centers. We developed a minimal access surgery (MAS) training curriculum to enhance the delivery of MAS for pediatric patients in a resource-limited setting. We reviewed our 10-year experience in implementing and performing LNF at our institution. Methods We described the challenges of implementing MAS training for LNF and how we addressed them. Beneficial technical considerations were described. A retrospective review was performed on all pediatric LNFs performed. Results We performed 268 LNFs. Specialists or trainees under supervision performed all LNFs. The trainee group performed 43 LNFs (16%). The median operative time for the specialists was 94 min (interquartile range [IQR] 50), and the trainee group was 140 min (IQR 62.5). The median number of cases performed until we improved operative time amongst the trainees was nine (IQR 3). There were seven repeat LNFs, and 11 cases were converted to open. The overall complication rate was 8.9%. A reduction in complications among specialists occurred over the years. The 30-day mortality post-LNF was 0.7%. Conclusion LNF can be successfully introduced at a tertiary training centre in South Africa with good outcomes. A comprehensive quality improvement program, including MAS training, supported this.
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Affiliation(s)
- Hansraj Mangray
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Sanele Stanley Madziba
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Amanda Ngobese
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Yashlin Govender
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Damian L. Clarke
- Department of Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
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Faye PM, Ndong A, Niasse A, Thiam O, Toure AO, Cisse M. Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis. Hernia 2024; 28:355-365. [PMID: 38324087 DOI: 10.1007/s10029-023-02931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/12/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. METHODS We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. RESULTS We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5 years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1 min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). CONCLUSION These results confirm that LGHR is safe and feasible and would be recommended in our African context.
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Affiliation(s)
- P M Faye
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal.
| | - A Ndong
- Gaston Berger University, Saint Louis, Senegal
| | - A Niasse
- General Surgery Department, Cheikhoul Khadim Hospital, Touba, Senegal
| | - O Thiam
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal
| | - A O Toure
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal
| | - M Cisse
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal
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Djote SM, Muhie DA, Alemayehu GD. Advancing laparoscopy in resource-limited settings. BMC Surg 2024; 24:98. [PMID: 38532330 DOI: 10.1186/s12893-024-02387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Although laparoscopic surgery has made remarkable progress and become the standard approach for various surgical procedures worldwide over the past 30 years, its establishment in low-resource settings, particularly in public hospitals, has been challenging. The lack of equipment and trained expertise has hindered its widespread adoption in these settings. Cholecystectomy is one of the most commonly performed procedures using laparoscopy world wide AIM: The aim of the study is to determine whether laparoscopic cholecystectomy is feasible in a resource challenged setting METHODS: The research focused on individuals who underwent laparoscopic or open cholecystectomies at Yekatit 12 Hospital in Addis Ababa, Ethiopia, over a one-year period. Comprehensive data collection was conducted prospectively, encompassing both intraoperative and postoperative parameters. Follow-up was carried out via phone calls. The surgical procedures employed innovative techniques, including the reuse of sterilized single-use equipment and the utilization of local resources. The evaluation involved a comparison of demographic information, intraoperative details (such as critical view determination and operative duration), and postoperative complications, including assessments of pain and wound infections RESULTS: From August 2021 to September 2022, 119 patients were assessed. Among these patients, 65 (54.6%) underwent open cholecystectomies, while the remaining 54 (45.4%) underwent laparoscopic cholecystectomies. The average duration of the laparoscopic cholecystectomies was 90.7 min, which is 17.7 min behind the open. Patients in the laparoscopy group had significantly shorter hospital stays than the open group, and 94% were discharged by post operative day 2. The conversion rate from laparoscopic to open surgery was determined to be 3.3% CONCLUSION: To sum up, the safe execution of laparoscopic cholecystectomies is feasible in public hospitals and settings with limited resources, given adequate training and resource distribution. The study findings showcased superior outcomes, including reduced hospitalization duration and fewer complications, while maintaining comparable levels of operative duration and patient satisfaction in both groups.
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Affiliation(s)
- Surafel Mulatu Djote
- Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
- Asan Medical Center Division of Colorectal Surgery, Seoul, South Korea.
| | - Daniel Ahmed Muhie
- Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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Obayemi JE, Donkersloot J, Kim E, Thelander K, Byrnes M, Kim GJ. A needs assessment for simulation in African surgical education. Surg Endosc 2024; 38:1654-1661. [PMID: 38326586 DOI: 10.1007/s00464-023-10665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION There is a critical need for comprehensive surgical training in African countries given the unmet surgical burden of disease in this region. Collaborative and progressive initiatives in global surgical education will have the greatest impact on trainees. Little is known about surgical education needs from the perspective of practicing surgeons and trainees in low-middle-income countries (LMICs). Even less is known about the potential role for simulation to augment training. METHODS A modified Delphi methodology with 2 rounds of responses was employed to survey program directors (PD) and associate program directors (APD) of Pan-African Association of Christian Surgeons (PAACS) general surgery residency programs across eight low-middle-income countries in Africa. 3 PD/APDs and 2 surgical residents participated in semi-structured interviews centered around the role of simulation in training. Descriptive analysis was performed to elicit key themes and illustrative examples. RESULTS The survey of program directors revealed that teaching residents the psychomotor skills need to perform intracorporeal suturing was both high priority and desired in multiple training sites. Other high priority skills were laparoscopic camera driving and medial visceral rotation. The interviews revealed a specific desire to perform laparoscopic surgery and a need for a simulation curriculum to familiarize staff and trainees with laparoscopic techniques. Several barriers to laparoscopic surgery exist, such as lack of staff familiarity with the equipment, lack of public buy in, and lack of generalizable and adaptable educational modules. Trainees saw utility in the use of simulation to optimize time in the operating room and sought opportunities to improve their laparoscopic skills. CONCLUSION Faculty and surgical trainees in LMICs have interest in learning advanced surgical techniques, such as laparoscopy. Developing a simulation curriculum tailored to the trainees' local context has the potential to fill this need.
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Affiliation(s)
- Joy E Obayemi
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA.
| | - John Donkersloot
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Erin Kim
- University of Michigan Medical School, University of Michigan, Ann Arbor, USA
| | - Keir Thelander
- Pan-African Academy of Christian Surgeons, Palatine, IL, USA
| | - Mary Byrnes
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Grace J Kim
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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Adisa A, Kachapila M, Ekwunife C, Alakaloko F, Olanrewaju B, Kadir B, Nepogodiev D, Aderounmu A, Igwilo I, Omar O, Oppong R, Simoes J, Bhangu A, Ademuyiwa A. A Prospective, Observational Cost Comparison of Laparoscopic and Open Appendicectomy in Three Tertiary Hospitals in Nigeria. World J Surg 2023; 47:3042-3050. [PMID: 37821649 PMCID: PMC10694127 DOI: 10.1007/s00268-023-07148-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The clinical benefits of laparoscopic appendicectomy are well recognized over open appendicectomy. However, laparoscopic procedures are not frequently conducted in many low-and middle-income countries (LMICs) for several reasons, including perceived higher costs. The aim of this study was to assess the feasibility and cost of laparoscopic appendicectomy compared to open appendicectomy in Nigeria. METHODS A multicenter, prospective, cohort study among patients undergoing appendicectomy was conducted at three tertiary hospitals in Nigeria. Data were collected from October 2020 to February 2022 and analyses compared the average healthcare costs at 30 days after surgery. Quantile regression was conducted to identify variables that had an impact on the costs, reported in Nigerian Naira (Naira) and US dollars ($), with standard deviations (SD). FINDINGS This study included 105 patients, of which 39 had laparoscopic appendicectomy and 66 had open appendicectomy. The average healthcare cost of laparoscopic appendicectomy (147,562 Naira (SD: 97,130) or $355 (SD: 234)) was higher than open appendicectomy (113,556 Naira (SD: 88,559) or $273 (SD: 213)). The average time for return to work was shorter with laparoscopic than open appendicectomy (mean: 8 days vs. 14 days). At the average daily income of $5.06, laparoscopic appendicectomy was associated with 9778 Naira or $24 cost savings in return to work. Further, 5.1% of laparoscopic appendicectomy patients had surgical site infections compared to 22.7% for open appendicectomy. Regression analysis results showed that laparoscopic appendicectomy was associated with $14 higher costs than open appendicectomy, albeit non-significant (p = 0.53). INTERPRETATION Despite selection bias in this real-world study, laparoscopic appendicectomy was associated with a slightly higher overall cost, a lower societal cost, a lower infection rate, and a faster return to work, compared to open appendicectomy. It is technically and financially feasible, and its provision in Nigeria should be expanded.
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Affiliation(s)
- Adewale Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, 220005, Nigeria.
| | - Mwayi Kachapila
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | | | - Felix Alakaloko
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Balogun Olanrewaju
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Bryar Kadir
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Dmitri Nepogodiev
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Adewale Aderounmu
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, 220005, Nigeria
| | - Innocent Igwilo
- Department of Surgery, Federal Medical Center, Owerri, Nigeria
| | - Omar Omar
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Raymond Oppong
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Joana Simoes
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Aruparayil N, Gnanaraj J, Mishra A, Bains L, Corrigan N, Brown J, Ensor T, King R, Shinkins B, Jayne D. Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve. Surg Endosc 2023; 37:8227-8235. [PMID: 37653156 PMCID: PMC10615921 DOI: 10.1007/s00464-023-10392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND A program of gasless laparoscopy (GL) has been implemented in rural North-East India. To facilitate safe adoption, participating rural surgeons underwent rigorous training prior to independent clinical practice. An online registry was established to capture clinical data on safety and efficacy and to evaluate initial learning curves for gasless laparoscopy. METHODS Surgeons who had completed the GL training program participated in the online RedCap Registry. Patients included in the registry provided informed consent for the use of their data. Data on operative times, conversion rates, perioperative complications, length of stay, and hospital costs were collected. Fixed reference cumulative sum (CUSUM) model was used to evaluate the learning curve based on operative times and conversion rates published in the literature. RESULTS Four surgeons from three rural hospitals in North-East India participated in the registry. The data were collected over 12 months, from September 2019 to August 2020. One hundred and twenty-three participants underwent GL procedures, including 109 females (88.6%) and 14 males. GL procedures included cholecystectomy, appendicectomy, tubal ligation, ovarian cystectomy, diagnostic laparoscopy, and adhesiolysis. The mean operative time was 75.3 (42.05) minutes for all the surgeries. Conversion from GL to open surgery occurred in 11.4% of participants, with 8.9% converted to conventional laparoscopy. The main reasons for conversion were the inability to secure an operative view, lack of operating space, and adhesions. The mean length of stay was 3 (2.1) days. The complication rate was 5.7%, with one postoperative death. The CUSUM analysis for GL cholecystectomy showed a longer learning curve for operative time and few conversions. The learning curve for GL tubal ligation was relatively shorter. CONCLUSION Gasless laparoscopy can be safely implemented in the rural settings of Northeast India with appropriate training programs. Careful case selection is essential during the early stages of the surgical learning curve.
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Affiliation(s)
- N Aruparayil
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
- St. James's University Hospital, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK.
| | | | - A Mishra
- Maulana Azad Medical College, Delhi, India
| | - L Bains
- Maulana Azad Medical College, Delhi, India
| | - N Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - J Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - T Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - R King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - B Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - D Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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Gaba F, Ash K, Blyuss O, Bizzarri N, Kamfwa P, Saiz A, Cibula D. International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1). Cancers (Basel) 2023; 15:5001. [PMID: 37894368 PMCID: PMC10605858 DOI: 10.3390/cancers15205001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054-2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066-1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081-1.502, p = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128-1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175-1.664, p ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509-5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.
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Affiliation(s)
- Faiza Gaba
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Karen Ash
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Paul Kamfwa
- Cancer Diseases Hospital, Lusaka 10101, Zambia
| | - Allison Saiz
- Northwestern University in Chicago, Chicago, IL 60611, USA
| | - David Cibula
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
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Nyundo M, Umugwaneza N, Bekele A, Chikoya L, Detry O, Gashegu J. Exploring Laparoscopic Surgery Training Opportunities in the College of Surgeons of East, Central, and Southern Africa region. JOURNAL OF SURGICAL EDUCATION 2023; 80:1454-1461. [PMID: 37620181 DOI: 10.1016/j.jsurg.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/30/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE The resource-limited environment in Sub-Saharan countries, with a lack of expert trainers, impedes the progress of laparoscopic training. This study aimed to identify the opportunities and limitations of laparoscopic surgery training in the College of Surgeons of East, Central, and Southern Africa (COSECSA) countries. DESIGN AND SETTING A multicountry online survey was conducted from January 2021 to October 2021 in COSECSA-accredited training hospitals within 16 countries. Available resources and challenges faced in order to set up well-structured laparoscopic training programs were explored. RESULTS Ninety-four surgeons answered the questionnaire. The average resources reported per hospital were 3 trained laparoscopic surgeons, 2 laparoscopic towers, and 2 sets of laparoscopic instruments. The training of the majority of these surgeons has been in local institutions (53%), a further 37% within African countries and only 10% outside Africa. Approximately 45% of them declared that laparoscopic modules were planned within the University Curricula, while only 18% of surgeons recognized that laparoscopic modules are only planned within the COSECSA program. About 57% of participants reported that at the end of residency training, graduating surgeons were not able to perform basic laparoscopic procedures. The quoted barriers included: limited laparoscopic equipment, absence of simulation lab, lack of qualified trainers, lack of training programs and time for teaching by skilled doctors, and lack of institutional support. CONCLUSIONS The well-structured set up of laparoscopic training programs in the COSECSA region is hindered due to the lack of qualified personnel and insufficient resources for the acquisition of equipment and simulation laboratories. Ongoing efforts to set up laparoscopic programs through the development of adaptive curricula, innovative strategies for reduction of equipment cost and adequate training of surgeons are crucial for patient safety and the development of laparoscopy.
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Affiliation(s)
- Martin Nyundo
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda.
| | - Nathalie Umugwaneza
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Abebe Bekele
- Department of Surgery, School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Laston Chikoya
- Department of Neurosurgery, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium
| | - Julien Gashegu
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda; Clinical Anatomy Department, University of Rwanda, Kigali, Rwanda
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13
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Nyundo M, Kayondo K, Gasakure M, Urimubabo JC, Houben JJ, Limgba A, Nifasha A, Gashegu J, Detry O. Patient-reported outcome, perception and satisfaction after laparoscopic cholecystectomy in Kigali, Rwanda. Surg Open Sci 2023; 15:67-72. [PMID: 37745196 PMCID: PMC10514211 DOI: 10.1016/j.sopen.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background Laparoscopic surgery is the gold standard for many abdominal surgeries. Laparoscopic programs in low- and middle-income countries (LMICs) and in sub-Saharan Africa face many constraints, although its use is safe, feasible, and clinically beneficial. The authors assessed patient-reported outcomes and the experience of patients operated on at the University Teaching Hospital of Kigali (CHUK). Methods This is a retrospective cross-sectional study combining medical data from medical files and information collected from telephone calls to 288 patients who underwent laparoscopic cholecystectomy at CHUK from January 2015 to December 2020. Results Among 446 laparoscopic surgeries performed at CHUK over 6 years, cholecystectomies accounted for 64.6 % of cases (288/446). Postoperative complications and mortality after laparoscopic cholecystectomy were low, respectively 1.7 % and 0.7 %, while the median length of stay was 3 days. About 74 % of surveyed patients had never heard of laparoscopic surgery prior to their procedure. Knowledge of laparoscopic surgery was associated with patient education level (p < 0.001). Half of patients had not been involved in the choice of the surgical technique. Overall satisfaction was over 95 % and >90 % of patients consider laparoscopic surgery as the best surgical approach in Rwanda, and for this reason they declared to be ready to promote this new technology despite its higher cost. However, patients reported some weaknesses and made recommendations for improving public awareness of laparoscopy and its benefits, patient-provider relationships, training of surgical workforce, laparoscopic equipment, and infrastructure. Conclusion Laparoscopic cholecystectomy can be performed with a low rate of postoperative complications in a resource-limited setting like Rwanda. Patient satisfaction was high, but efforts should be made to improve public awareness of laparoscopic surgery, improve surgical capacity, laparoscopic equipment, and infrastructure.
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Affiliation(s)
- Martin Nyundo
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
| | - King Kayondo
- Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Miguel Gasakure
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
| | | | - Jean Jacques Houben
- Department of Abdominal Surgery, ERASME Hospital, Université Libre de Bruxelles, Belgium
| | - Augustin Limgba
- Department of Abdominal Surgery, King Faisal Hospital, Kigali, Rwanda
| | - Antoine Nifasha
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
| | - Julien Gashegu
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Rwanda
- Clinical Anatomy Department, University of Rwanda, Rwanda
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liège, University of Liège, Belgium
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Reynolds CW, Rooney DM, Jeffcoach DR, Barnard M, Snell MJ, El-Hayek K, Ngam BN, Bidwell SS, Anidi C, Tanyi J, Yoonhee Ryder C, Kim GJ. Evidence supporting performance measures of laparoscopic appendectomy through a novel surgical proficiency assessment tool and low-cost laparoscopic training system. Surg Endosc 2023; 37:7170-7177. [PMID: 37336843 DOI: 10.1007/s00464-023-10182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Laparoscopic training remains inaccessible for surgeons in low- and middle-income countries, limiting its widespread adoption. We developed a novel tool for assessment of laparoscopic appendectomy skills through ALL-SAFE, a low-cost laparoscopy training system. METHODS This pilot study in Ethiopia, Cameroon, and the USA assessed appendectomy skills using the ALL-SAFE training system. Performance measures were captured using the ALL-SAFE verification of proficiency tool (APPY-VOP), consisting of a checklist, modified Objective Structured Assessment of Technical Skills (m-OSATS), and final rating. Twenty participants, including novice (n = 11), intermediate (n = 8), and expert (n = 1), completed an online module covering appendicitis management and psychomotor skills in laparoscopic appendectomy. After viewing an expert skills demonstration video, participants recorded their performance within ALL-SAFE. Using the APPY-VOP, participants rated their own and three peer videos. We used the Kruskal-Wallis test and a Many-Facet Rasch Model to evaluate (i) capacity of APPY-VOP to differentiate performance levels, (ii) correlation among three APPY-VOP components, and (iii) rating differences across groups. RESULTS Checklist scores increased from novice (M = 21.02) to intermediate (M = 23.64) and expert (M = 28.25), with differentiation between experts and novices, P = 0.005. All five m-OSATS domains and global summed, total summed, and final rating discriminated across all performance levels (P < 0.001). APPY-VOP final ratings adequately discriminated Competent (M = 2.0), Borderline (N = 1.8), and Not Competent (M = 1.4) performances, Χ2 (2,85) = 32.3, P = 0.001. There was a positive correlation between ALL-SAFE checklist and m-OSATS summed scores, r(83) = 0.63, P < 0.001. Comparison of ratings suggested no differences across expertise levels (P = 0.69) or location (P = 0.66). CONCLUSION APPY-VOP effectively discriminated between novice and expert performance in laparoscopic appendectomy skills in a simulated setting. Scoring alignment across raters suggests consistent evaluation, independent of expertise. These results support the use of APPY-VOP among all skill levels inside a peer rating system. Future studies will focus on correlating proficiency to clinical practice and scaling ALL-SAFE to other settings.
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Affiliation(s)
| | - Deborah M Rooney
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Melanie Barnard
- Department of Surgery, Southern Illinois University, Carbondale, IL, USA
| | | | - Kevin El-Hayek
- Department of Surgery, The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Chioma Anidi
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - John Tanyi
- Mbingo Baptist Hospital, Mbingo, Cameroon
| | | | - Grace J Kim
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5331, Ann Arbor, MI, 48109-5331, USA.
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Essobiyou TB, Labou AK, Sakiye KA, Alassani F, Tchangai B. The place of presumptive diagnosis in the management of peritoneal tuberculosis: A case report from rural Togo. Int J Surg Case Rep 2023; 110:108655. [PMID: 37591195 PMCID: PMC10457525 DOI: 10.1016/j.ijscr.2023.108655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Tuberculosis is a major public health problem in developing countries. Its main abdominal form is peritoneal. The diagnosis of this peritoneal form is complex and difficult. We describe the role of presumptive diagnosis in the management of this condition in Togo, based on a case study. CASE PRESENTATION A security guard with no previous pathological history was seen in consultation with febrile ascites. Investigations revealed the exudative and lymphocytic nature of the ascites. The other investigations did not reveal any other organic lesion, particularly hepatic, or the germ. This typical ascites picture had for us a strong diagnostic value in favour of a tubercular origin. The patient was treated with antituberculosis drugs for 6 months. The evolution was satisfactory. CLINICAL DISCUSSION The diagnosis of peritoneal tuberculosis is difficult. Biological explorations are rather disappointing in this approach. Laparoscopy coupled with histological examination represents the best means of diagnosing peritoneal tuberculosis to date. However, in developing countries, the absence of these resources poses a real problem. Clinical and biological arguments are always at the forefront of the diagnosis in endemic countries. The latter is based on the demonstration of febrile, exudative and lymphocytic ascites. CONCLUSION The difficult diagnosis of peritoneal tuberculosis coupled with the lack of technical facilities gives the presumptive diagnosis an important place in the management of this condition in endemic countries.
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Affiliation(s)
- Tamassi Bertrand Essobiyou
- General Surgery Department, Dapaong Regional Hospital Center, Dapaong, Togo; General Surgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo.
| | - Albert Kossi Labou
- Neurosurgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo
| | | | - Fousseni Alassani
- Visceral Surgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo
| | - Boyodi Tchangai
- Visceral Surgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo
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Sherif YA, Adam MA, Imana A, Erdene S, Davis RW. Remote Robotic Surgery and Virtual Education Platforms: How Advanced Surgical Technologies Can Increase Access to Surgical Care in Resource-Limited Settings. Semin Plast Surg 2023; 37:217-222. [PMID: 37842543 PMCID: PMC10569862 DOI: 10.1055/s-0043-1771301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Advanced surgical technologies consist of remote and virtual platforms that facilitate surgical care and education. It also includes the infrastructure necessary to utilize these platforms (e.g., internet access, robotic systems, and simulators). Given that 5 billion people lack access to safe and timely surgical care, the appeal of these technologies to the field of global surgery lies primarily in its ability to eliminate geographical barriers and address surgeon shortages. This article discusses the use of virtual and remote technologies in resource-limited settings, the potential applications of these technologies, the possible barriers to their integration, and the impact these technologies may have on access to surgical care and education. Specifically, it will explore how robotic surgery, telesurgery, virtual education platforms, and simulations have the potential to be instrumental in enhancing worldwide access to safe surgical care.
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Affiliation(s)
- Youmna A. Sherif
- Michael E. DeBakey Department of Surgery, Center for Global Surgery at the Baylor College of Medicine, Houston, Texas
| | | | - Aimee Imana
- Sudanese Consortium for Surgical Development, Khartoum, Sudan
| | - Sarnai Erdene
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Rachel W. Davis
- Michael E. DeBakey Department of Surgery, Center for Global Surgery at the Baylor College of Medicine, Houston, Texas
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Bryce-Alberti M, Campos LN, Dey T, del Valle DD, Hill SK, Zaigham M, Vela A, Juran S, Anderson GA, Uribe-Leitz T. Availability of laparoscopic surgery in Mexico's public health system: a nationwide retrospective analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 24:100556. [PMID: 37521438 PMCID: PMC10372900 DOI: 10.1016/j.lana.2023.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023]
Abstract
Background Laparoscopic surgery remains limited in low-resource settings. We aimed to examine its use in Mexico and determine associated factors. Methods By querying open-source databases, we conducted a nationwide retrospective analysis of three common surgical procedures (i.e., cholecystectomies, appendectomies, and inguinal hernia repairs) performed in Mexican public hospitals in 2021. Procedures were classified as laparoscopic based on ICD-9 codes. We extracted patient (e.g., insurance status), clinical (e.g., anaesthesia technique), and geographic data (e.g., region) from procedures performed in hospitals and ambulatories. Multivariable analysis with random forest modelling was performed to identify associated factors and their importance in adopting laparoscopic approach. Findings We included 97,234 surgical procedures across 676 public hospitals. In total, 16,061 (16.5%) were performed using laparoscopic approaches, which were less common across all procedure categories. The proportion of laparoscopic procedures per 100,000 inhabitants was highest in the northwest (22.2%, 16/72) while the southeast had the lowest (8.3%, 13/155). Significant factors associated with a laparoscopic approach were female sex, number of municipality inhabitants, region, anaesthesia technique, and type of procedure. The number of municipality inhabitants had the highest contribution to the multivariable model. Interpretation Laparoscopic procedures were more commonly performed in highly populated, urban, and wealthy northern areas. Access to laparoscopic techniques was mostly influenced by the conditions of the settings where procedures are performed, rather than patients' non-modifiable characteristics. These findings call for tailored interventions to sustainably address equitable access to minimally invasive surgery in Mexico. Funding None.
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Affiliation(s)
- Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, PE, Brazil
| | - Tanujit Dey
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana D. del Valle
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Sarah K. Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Mehreen Zaigham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alejandro Vela
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Anesthesia, Complete Surgery Houston Northwest, Houston, TX, USA
| | - Sabrina Juran
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Geoffrey A. Anderson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Tarsicio Uribe-Leitz
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Plastic Surgery, Boston Children's Hospital, Boston, MA, USA
- Epidemiology, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
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18
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Hayashi Y, Ishii Y, Ishida T, Yamashita K, Saito T, Tanaka K, Yamamoto K, Makino T, Takahashi T, Kurokawa Y, Eguchi H, Doki Y, Nakajima K. Management of abdominal gas leakage from surgical trocars in laparoscopic surgery: a preclinical study. MINIM INVASIV THER 2023; 32:183-189. [PMID: 37288765 DOI: 10.1080/13645706.2023.2211661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/01/2023] [Indexed: 06/09/2023]
Abstract
Introduction: There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. Material and methods: We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. Results: Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. Conclusions: We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.
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Affiliation(s)
- Yoshinori Hayashi
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Tomo Ishida
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Tanoli O, Ahmad H, Khan H, Khan A, Aftab Z, Khan MI, St-Louis E, Chen T, LaRusso K. Laparoscopy in Low- and Middle-Income Countries: A Survey Study. Cureus 2023; 15:e40761. [PMID: 37363112 PMCID: PMC10284685 DOI: 10.7759/cureus.40761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs) has impelled the need for implementing laparoscopic surgery, a safe and cost-effective surgical service. However, despite countless benefits, laparoscopic surgery programs remain limited throughout LMICs, and limited understanding is known of healthcare professionals' views regarding the implementation of laparoscopic surgery in their local healthcare environments. Therefore, the purpose of this study is to better understand the perceived challenges and barriers to implementing long-term laparoscopic surgery programs from the perspective of healthcare professionals. METHODS Upon receiving ethical approval from the McGill University Health Center (MUHC), a nine-question survey (concerning attributes required to establish a successful laparoscopic program in LMICs and to gain insight into what surgeons from LMICs believed were the necessary next steps) was pilot tested amongst faculty members, and subsequently disseminated to healthcare professionals practicing in LMICs. Explicit consent was obtained from the participants before answering the survey. Results: Thirty-four participants representing a total of 35 countries participated in the survey with the majority having received laparoscopic surgery training. Overall, participant responses were characterized by two major themes. Highlighted in the first theme, Laparoscopic Experience and Training Curriculum, were responses concerning current laparoscopic training and education, improved career opportunities provided by laparoscopic training, and a particular existing potential to incorporate laparoscopic surgery into the current surgical curriculum at various levels of training. Emphasized in the second theme, Challenges and Next Steps, were responses concerning barriers to the implementation of laparoscopic surgery, current institutional capabilities, and the need for improving mentorship through existing surgical societies such as the College of Surgeons of East, Central, and Southern Africa (COSECSA), West African College of Surgeons (WACS), and The Pan-African Academy of Christian Surgeons (PAACS). CONCLUSIONS A buy-in from the government, hospitals, staff, and industry is crucial for the long-term implementation of laparoscopic surgery in LMICs, which can only be accomplished through increased advocacy and the dissemination of the benefits of minimally invasive surgery both economically and socially.
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Affiliation(s)
| | - Hamza Ahmad
- Experimental Surgery, McGill University, Montreal, CAN
| | - Haider Khan
- Department of Surgery, Bacha Khan Medical College, Mardan, PAK
| | - Awais Khan
- Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Zoha Aftab
- Department of Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Mashal I Khan
- Internal Medicine, Khyber Girls Medical College, Peshawar, PAK
| | - Etienne St-Louis
- Surgery, Centre for Global Surgery, McGill University, Montreal, CAN
| | - Tanya Chen
- Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, CAN
| | - Kathryn LaRusso
- Surgery, Centre for Global Surgery, McGill University, Montreal, CAN
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20
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Varghese G, Shankar B, Dsouza R, Jesudason MR. Laparoscopic Versus Open Pre-Treatment Loop Colostomy for Fecal Diversion in Rectal Cancer Patients: Is Laparoscopic Colostomy Better? Indian J Surg Oncol 2023; 14:387-391. [PMID: 37324316 PMCID: PMC10267036 DOI: 10.1007/s13193-020-01179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022] Open
Abstract
Diversion colostomy plays a crucial role in the management of carcinoma rectum in low- and middle-income countries as significant number of patients present with partial intestinal obstruction. The aim of this study was to compare laparoscopic and open approaches for fecal diversion done in patients with adenocarcinoma of the rectum as a pretreatment procedure. The primary end point of our study was time to initiation of neoadjuvant chemo radiation. It was a retrospective study that included all patients diagnosed to have carcinoma rectum and underwent a pretreatment fecal diversion between 2012 and 2014. A total of 55 patients underwent pretreatment diversion colostomy of which 33 were performed via the laparoscopic approach while 22 had open diversion. The time for initiation of neoadjuvant therapy was shorter in the laparoscopic group compared to the open approach (16 days vs. 20.5 days, P = 0.31). The study concluded that pretreatment diversion colostomy using the laparoscopic approach was a safe option in low- and middle-income countries as it was associated with faster recovery and early initiation of neoadjuvant therapy in patients with partially obstructed locally advanced carcinoma rectum.
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Affiliation(s)
- Gigi Varghese
- Department of Colorectal Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu India
| | - Bharat Shankar
- Department of Colorectal Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu India
| | - Royson Dsouza
- Department of General Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu India
| | - Mark Ranjan Jesudason
- Department of Colorectal Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu India
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21
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Damous SHB, Menegozzo CAM, Rocha MC, Collet-E-Silva FS, Utiyama EM. Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil. Rev Col Bras Cir 2023; 50:e20233527. [PMID: 37222347 PMCID: PMC10508672 DOI: 10.1590/0100-6991e-20233527-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. MATERIALS AND METHODS retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. RESULTS we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period. CONCLUSION the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.
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Affiliation(s)
| | | | - Marcelo Cristiano Rocha
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | | | - Edivaldo Massazo Utiyama
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Cirurgia - São Paulo - SP - Brasil
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22
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van Kesteren J, van Goudoever LAE, Conteh A, van Acker GJD, Bonjer HJ, Bolkan HA. Technical Perspective for Video Based Assessment of Surgeries in Low-Resource Settings. JOURNAL OF SURGICAL EDUCATION 2023; 80:495-498. [PMID: 36775728 DOI: 10.1016/j.jsurg.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Scalable digital learning environments are essential to sustain surgical training programs worldwide. Detailed images of surgeries enriched with educational annotations are vital to train the eyes of the learners. Here, we report a low-cost method, deployed in a low-resource setting in West Africa, which may contribute to the growth of use in open-sourced digital surgical resources world-wide. DESIGN This paper is based on the authors participatory and observational experiences creating surgical video content by way of recording surgical procedures and reflecting on field notes and video content. All surgeries were recorded between January and December 2018. SETTING Masanga Hospital, a rural district hospital in Sierra Leone, West Africa. PARTICIPANTS Thirty-five patients undergoing inguinal hernia repair, elective caesarian section, salpingectomy, bowel resection, hydrocele repair, or below-knee amputation consented for recording their surgical procedure and using the anonymized material for educational purposes. RESULTS This manual for non-professional cinematographers provides chronological steps for shooting a surgical procedure in a low-resource setting. Recording a surgical procedure to explain surgical techniques, and perform quality assessment through error analysis and coaching requires more than just point-and-shoot. While taking into account local customs and possibilities, practical tips were provided to prepare for the set-up, and recording of a surgical procedure in a low-resourced setting. CONCLUSION Commercially available digital video technology allows for filming high-quality surgical procedures for educational purposes at rural district hospitals in a low-resource setting.
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Affiliation(s)
- Jurre van Kesteren
- Department of Surgery, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, The Netherlands; Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Leandra A E van Goudoever
- Global Surgery Amsterdam, Amsterdam, The Netherlands; Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amara Conteh
- Masanga Hospital, Tonkolili district, Sierra Leone
| | | | - H Jaap Bonjer
- Department of Surgery, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, The Netherlands; Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway; CapaCare, Norway
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23
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Nyundo M, Umugwaneza N, Bekele A, Chikoya L, Gashegu J, Detry O. Assessment of resource capacity and barriers to effective practice of laparoscopic surgery in training hospitals affiliated with the College of Surgeons of East, Central and Southern Africa (COSECSA). Surg Endosc 2023:10.1007/s00464-023-09985-w. [PMID: 36932190 DOI: 10.1007/s00464-023-09985-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The adoption and accessibility of laparoscopy have been serious issues in countries with limited resources, and for varied reasons. This study assessed resource capacity and barriers to the effective practice of laparoscopic surgery in training hospitals affiliated with the College of Surgeons of East, Central and Southern Africa (COSECSA). METHODS A multi-country survey was conducted from January 2021 to October 2021 using a questionnaire distributed to surgeons in COSECSA hospitals located in 16 different countries. Available resources and surgical volume were assessed, and the barriers to routinely performing laparoscopy were determined. RESULTS Ninety-four surgeons working in 44 different hospitals from 16 countries participated in the survey. The majority of respondents were general surgeons (n = 75, 79.7%). Other specialties included urology (n = 12, 12.8%) and pediatric surgery (n = 7, 7.4%). Senior surgeons accounted for 60.6% of participants, more than 40% had a managerial position and approximately 20% were surgical trainees. Most respondents practiced in public hospitals (n = 66, 70.2%). A median of three surgeons per hospital performed laparoscopic surgery with, on average, two laparoscopic towers and two sets of laparoscopic instruments available. A median of 10 procedures was carried out per month. The cost of laparoscopic procedures and laparoscopic consumables were reported as being covered by some health insurance payments in 76.9% and 48.4% of cases, respectively. Cholecystectomy was the most commonly reported laparoscopic procedure performed. The five top barriers to performing laparoscopic surgery were: a lack of consumables, a limited quantity of equipment, a lack of skilled surgeons, the high cost of laparoscopic procedures and complicated cases. In addition, having access to skilled anesthesiologists and anesthesia equipment, carbon dioxide, a consistent electric power supply and equipment maintenance were cited as significant challenges. CONCLUSION The practice of laparoscopy is currently limited in COSECSA countries due to a scarcity of skilled staff and the lack of a funding plan to make laparoscopic services accessible. Therefore, policymakers and stakeholders should take strategic measures to respond to this need.
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Affiliation(s)
- Martin Nyundo
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda.
| | - Nathalie Umugwaneza
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Abebe Bekele
- School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Laston Chikoya
- Department of Neurosurgery, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Julien Gashegu
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda.,Clinical Anatomy Department, University of Rwanda, Kigali, Rwanda
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium
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24
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Fatiregun OA, Bakewell N. Malnutrition after cancer surgery in low-income and middle-income countries. Lancet Glob Health 2023; 11:e302-e303. [PMID: 36796964 DOI: 10.1016/s2214-109x(23)00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Omolara Aminat Fatiregun
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3M6, ON, Canada.
| | - Nicholas Bakewell
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3M6, ON, Canada
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25
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Ruf L, Greuter L, Guzman R, Soleman J. Distal shunt placement in pediatric ventriculoperitoneal shunt surgery: an international survey of practice. Childs Nerv Syst 2023; 39:1555-1563. [PMID: 36780037 DOI: 10.1007/s00381-023-05855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/15/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE Ventriculoperitoneal shunt (VPS) surgery is a common treatment for hydrocephalus in children and adults, making it one of the most common procedures in neurosurgery. Children being treated with a VPS often require several revisions during their lifetime with a lifetime revision rate of up to 80%. Several different techniques exist for inserting the distal catheter, while mini-laparotomy, trocar, or laparoscopy is traditionally used. As opposed to adults, only few studies exist, comparing the outcome of the different distal catheter placement techniques in children. This international survey aims to investigate the current daily practice concerning distal shunt placement techniques in children. MATERIAL AND METHODS An online questionnaire investigating the different techniques used to place the distal catheter in pediatric VPS surgery was distributed internationally. All results were analyzed using descriptive and comparative statistics. RESULTS A total of 139 responses were obtained. Mini-laparotomy was reported to be the most frequently used technique (n = 104, 74.8%) for distal shunt placement in children, while laparoscopic or trocar-assisted placements were only used by 3.6% (n = 5) and 21.6% (n = 30) of all respondents, respectively. Over half (n = 75, 54.0%) of all respondents do not believe that laparoscopic placement improves the outcome. CONCLUSION This international survey shows that mini-laparotomy is the most frequently used technique for distal VPS placement in children all over the world. Further randomized trials are needed to elucidate this matter.
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Affiliation(s)
- Linus Ruf
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ladina Greuter
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Raphael Guzman
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Division of Pediatric Neurosurgery, University Children's Hospital of Basel (UKBB), Spitalstrasse 21, 4031, Basel, Switzerland
| | - Jehuda Soleman
- Faculty of Medicine, University of Basel, Basel, Switzerland. .,Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Division of Pediatric Neurosurgery, University Children's Hospital of Basel (UKBB), Spitalstrasse 21, 4031, Basel, Switzerland.
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26
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Asfaw ZK, Todd R, Abasi U, Marcela Bailez M, Narvaez J, Carrasquilla A, Hernandez Centeno R, Yanowsky Reyes G, Zhang LP. Use of virtual platform for delivery of simulation-based laparoscopic training curriculum in LMICs. Surg Endosc 2023; 37:1528-1536. [PMID: 35852623 DOI: 10.1007/s00464-022-09438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Laparoscopic surgery is rapidly expanding in low-and middle-income countries (LMICs), yet many surgeons in LMICs have limited formal training in laparoscopy. In 2017, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. In light of COVID-19, SAGES adapted GLAP to a virtual format with telesimulation. This study explores the feasibility and efficacy of virtual laparoscopic simulation training in resource-limited settings. METHODS Participants from San Jose, Costa Rica, Leon, México, and Guadalajara, México enrolled in the virtual GLAP curriculum, meeting biweekly for 2-h didactic classes and 2-h hands-on live simulation practice. Surgical residents' laparoscopic skills were evaluated using the five Fundamentals of Laparoscopic Surgery (FLS) tasks during the initial and final weeks of the program. Participants also completed pre-and post-program surveys assessing their perception of simulation-based training. RESULTS The study cohort consisted of 16 surgical attendings and 20 general surgery residents. A minimum 70% response rate was recorded across all surveys in the study. By the end of GLAP, residents completed all five tasks of the FLS exam within less time relative to their performance at the beginning of the training program (p < 0.05). Respondents (100%) reported that the program was a good use of their time and that education via telesimulation was easily reproduced. Participants indicated that the practice sessions, guidance, and feedback offered by mentors were their favorite elements of the training. CONCLUSION A virtual simulation-based curriculum can be an effective strategy for laparoscopic skills training. Participants demonstrated an improvement in laparoscopic skills, and they appreciated the mentorship and opportunity to practice laparoscopic skills. Future programs can expand on using a virtual platform as a low-cost, effective strategy for providing laparoscopic skills training to surgeons in LMICs.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Todd
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Unwana Abasi
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Marcela Bailez
- Hospital de Pediatría Dr. J.P. Garrahan, Buenos Aires, Argentina.,Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA
| | - Jacqueline Narvaez
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA
| | | | | | | | - Linda P Zhang
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA.
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27
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Bains L, Mishra A, Aruparayil N, Culmer P, Gnanraj J. Gasless Laparoscopic Surgery-A Technique Requiring Multidisciplinary Collaboration to Improve Equitable Access to Surgery Worldwide. Surg Innov 2023; 30:131-133. [PMID: 36484307 DOI: 10.1177/15533506221145305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lovenish Bains
- Department of Surgery, 28862Maulana Azad Medical College, New Delhi, India
| | - Anurag Mishra
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Noel Aruparayil
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Peter Culmer
- School of Mechanical Engineering, University of Leeds, UK
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Harrell Shreckengost CS, Reitz A, Ludi E, Rojas Aban R, Jáuregui Paravicini L, Serrot F. Lessons learned during the COVID-19 pandemic using virtual basic laparoscopic training in Santa Cruz de la Sierra, Bolivia: effects on confidence, knowledge, and skill. Surg Endosc 2022; 36:9379-9389. [PMID: 35419639 PMCID: PMC9007578 DOI: 10.1007/s00464-022-09215-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND An international surgical team implemented a virtual basic laparoscopic surgery course for Bolivian general and pediatric surgeons and residents during the COVID-19 pandemic. This simulation course aimed to enhance training in a lower-resource environment despite the challenges of decreased operative volume and lack of in-person instruction. METHODS The course was developed by surgeons from Bolivian and U.S.-based institutions and offered twice between July-December 2020. Didactic content and skill techniques were taught via weekly live videoconferences. Additional mentorship was provided through small group sessions. Participants were evaluated by pre- and post-course tests of didactic content as well as by video task review. RESULTS Of the 24 enrolled participants, 13 were practicing surgeons and 10 were surgery residents (one unspecified). Fifty percent (n = 12) indicated "almost never" performing laparoscopic surgeries pre-course. Confidence significantly increased for five laparoscopic tasks. Test scores also increased significantly (68.2% ± 12.5%, n = 21; vs 76.6% ± 12.6%, n = 19; p = 0.040). While challenges impeded objective evaluation for the first course iteration, adjustments permitted video scoring in the second iteration. This group demonstrated significant improvements in precision cutting (11.6% ± 16.7%, n = 9; vs 62.5% ± 18.6%, n = 6; p < 0.001), intracorporeal knot tying (36.4% ± 38.1%, n = 9; vs 79.2% ± 17.2%, n = 7; p = 0.012), and combined skill (40.3% ± 17.7%; n = 8 vs 77.2% ± 13.6%, n = 4; p = 0.042). Collectively, combined skill scores improved by 66.3% ± 10.4%. CONCLUSION Virtual international collaboration can improve confidence, knowledge, and basic laparoscopic skills, even in resource-limited settings during a global pandemic. Future efforts should focus on standardizing resources for participants and enhancing access to live feedback resources between classes.
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Affiliation(s)
| | - Alexandra Reitz
- Department of Surgery, Emory University, 1364 Clifton Road Suite B206, Atlanta, GA, 30322, USA
| | - Erica Ludi
- Department of Surgery, Emory University, 1364 Clifton Road Suite B206, Atlanta, GA, 30322, USA
| | - Raúl Rojas Aban
- Department of Pediatric Surgery, Caja de Salud de la Banca Privada, Santa Cruz de la Sierra, Bolivia
| | | | - Federico Serrot
- Department of Surgery, Emory University, 1364 Clifton Road Suite B206, Atlanta, GA, 30322, USA
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Ijah RF, Ray-Offor E, Igwe PO, Ekeke ON, Okoro PE, Nyengidiki TK, Omodu JO, Oriji VK, Ocheli EO, Okohue JE, Jebbin N, Ikimalo JI. Minimally Invasive Surgery in Port Harcourt, Nigeria: Progress So Far. Cureus 2022; 14:e32049. [PMCID: PMC9710494 DOI: 10.7759/cureus.32049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
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Global Health Challenges: Why the Four S's Are Not Enough. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121867. [PMID: 36553311 PMCID: PMC9777240 DOI: 10.3390/children9121867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
A well-known tenant of global health is the need for the four-S's to be successful in providing care in any context; Staff, Stuff, Space and Systems. Advanced thoracoscopy is slow to gain traction in low- and middle-income countries (LMICs). To our knowledge, no pediatric advanced thoracoscopy had been attempted previously in either LMIC. Therefore, we report the challenges associated with the adoption of the first advanced thoracoscopic procedures in two LMIC hospitals by a visiting surgeon. To further identify aspects of care in promoting the introduction of advanced thoracoscopy, we added a fifth S as an additional category-Socialization. A key to accomplishing goals for the patients as a visiting surgeon, particularly when introducing an advanced procedure, is acceptance into the culture of a hospital. Despite facing significant obstacles in caring for complex thoracic pathology with heavy reliance on disposable and reusable instrumentation provided through donation and limitations in staff such as access to neonatologists and pediatric surgeons, many obstacles have been overcome. In this perspective article, we show that a "fifth S" is also integral-having local surgeons and anesthesiologists eager to learn with acceptance of the visiting surgeon's expertise opens a path towards attempting advanced procedures in limited-resource settings.
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Dawkins B, Aruparayil N, Ensor T, Gnanaraj J, Brown J, Jayne D, Shinkins B. Cost-effectiveness of gasless laparoscopy as a means to increase provision of minimally invasive surgery for abdominal conditions in rural North-East India. PLoS One 2022; 17:e0271559. [PMID: 35921367 PMCID: PMC9348710 DOI: 10.1371/journal.pone.0271559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Laparoscopic surgery, a minimally invasive technique to treat abdominal conditions, has been shown to produce equivalent safety and efficacy with quicker return to normal function compared to open surgery. As such, it is widely accepted as a cost-effective alternative to open surgery for many abdominal conditions. However, access to laparoscopic surgery in rural North-East India is limited, in part due to limited equipment, unreliable supplies of CO2 gas, lack of surgical expertise and a shortage of anaesthetists. We evaluate the cost-effectiveness of gasless laparoscopy as a means to increase provision of minimally invasive surgery (MIS) for abdominal conditions in rural North-East India. A decision tree model was developed to compare costs, evaluated from a patient perspective, and health outcomes, disability adjusted life years (DALYs), associated with gasless laparoscopy, conventional laparoscopy or open abdominal surgery in rural North-East India. Results indicate that MIS (performed by conventional or gasless laparoscopy) is less costly and produces better outcomes, fewer DALYs, than open surgery. These results were consistent even when gasless laparoscopy was analysed using least favourable data from the literature. Scaling up provision of MIS through increased access to gasless laparoscopy would reduce the cost burden to patients and increase DALYs averted. Based on a sample of 12 facilities in the North-East region, if scale up was achieved so that all essential surgeries amenable to laparoscopic surgery were performed as such (using conventional or gasless laparoscopy), 64% of DALYS related to these surgeries could be averted, equating to an additional 454.8 DALYs averted in these facilities alone. The results indicate that gasless laparoscopy is likely to be a cost-effective alternative to open surgery for abdominal conditions in rural North-East India and provides a possible bridge to the adoption of full laparoscopic services.
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Affiliation(s)
- Bryony Dawkins
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Noel Aruparayil
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
- Leeds Institute of Medical Research at St. James’, University of Leeds, Leeds, United Kingdom
| | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | | | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - David Jayne
- Leeds Institute of Medical Research at St. James’, University of Leeds, Leeds, United Kingdom
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
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Zadey S, Mueller J, Fitzgerald TN. Improving Access to Laparoscopic Surgery in Low- and Middle-Income Countries. JAMA Surg 2022; 157:844-845. [PMID: 35857291 DOI: 10.1001/jamasurg.2022.2675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Siddhesh Zadey
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Jenna Mueller
- Department of Bioengineering, University of Maryland, College Park
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina
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The Successful Implementation of a Laparoscopic Simulation Training Program in the Dominican Republic. J Surg Res 2022; 278:337-341. [PMID: 35660303 DOI: 10.1016/j.jss.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Mount Sinai Hospital in New York introduced a laparoscopic surgery simulation center to a public hospital in Santiago, Dominican Republic to determine the feasibility of training programs in low-and-middle income countries (LMICs). METHODS In August 2018, recruitment and preliminary data were collected at the Hospital Jose Maria Cabral y Báez in Santiago, Dominican Republic. The simulation room consists of three simulation stations. Residents were required to practice 1 h/wk guided by a general surgery postgraduate year 3 (PGY3) Mount Sinai resident. Number of hours practiced was self-reported and follow-up data was collected in June 2019. The study endpoints include times on three simulated laparoscopic tasks including peg-transfer, precision cutting, and intracorporeal knot tying. Wilcoxon-signed rank tests were used for statistical analysis. RESULTS The partnership between hospitals allowed for successful integration into the Dominican general surgery training. Over 10 mo, residents averaged 25 h of practice (range: 8-35 h; SD 9.95 h). In total, 85% of the residents participated in the study (5 postgraduate year 1 [PGY1], 2 postgraduate year 2 [PGY2], and 4 postgraduate year 3 [PGY3]). Resident median simulation times significantly improved for precision cutting (3:49 min versus 2:09 min, P = 0.002) and intracorporeal knot tying (5:20 min versus 2:47 min, P = 0.037). There was neither significant difference in peg-transfer times nor performance between resident years (P = 0.12). CONCLUSIONS This study demonstrates the successful integration of a laparoscopic simulation program into an LMIC surgical resident training program. With commitment from local institutions and external resources, establishing laparoscopic simulation centers are feasible and expandable, thereby allowing general surgery residents in other LMICs, the opportunity to improve their laparoscopic skills.
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Oodit R, Biccard BM, Panieri E, Alvarez AO, Sioson MRS, Maswime S, Thomas V, Kluyts HL, Peden CJ, de Boer HD, Brindle M, Francis NK, Nelson G, Gustafsson UO, Ljungqvist O. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg 2022; 46:1826-1843. [PMID: 35641574 PMCID: PMC9154207 DOI: 10.1007/s00268-022-06587-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 12/24/2022]
Abstract
Background This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low–middle-income countries (LMIC’s) for elective abdominal and gynecologic care. Methods The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC’s. The group consisted of seven members from the ERAS® Society and eight members from LMIC’s. An updated systematic literature search and evaluation of evidence from previous ERAS® guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592–695, Nelson et al in Int J Gynecol Cancer 29(4):651–668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC’s and LMIC’s were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC’s. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC’s and determined through discussions and consensus. Results In addition to previously described ERAS® Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline. Conclusions These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC’s.
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Affiliation(s)
- Ravi Oodit
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Bruce M Biccard
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Eugenio Panieri
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Adrian O Alvarez
- Anesthesia Department, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Peron, 4190, C1199ABB, Beunos Aires, Argentina
| | - Marianna R S Sioson
- Head Section of Medical Nutrition, Department of Medicine and ERAS Team, The Medical City, Ortigas Avenue, Manila, Metro Manila, Philippines
| | - Salome Maswime
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Viju Thomas
- Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, Francie Van Zyl Drive, Parow, Cape Town, Western Cape, South Africa
| | - Hyla-Louise Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Medunsa, Molotlegi Street, P.O. Box 60, Ga-Rankuwa, Pretoria, 0204, Gauteng, South Africa
| | - Carol J Peden
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Mary Brindle
- Cumming School of Medicine, University of Calgary, London, Canada.,Alberta Children's Hospital, Calgary, Canada.,Safe Systems, Ariadne Labs, Stockholm, USA.,EQuIS Research Platform, Orebro, Canada
| | - Nader K Francis
- Division of Surgery and Interventional Science- UCL, Gower Street, London, WC1E 6BT, UK
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, University of Calgary, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - Ulf O Gustafsson
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Entrevägen 2, 19257, Stockholm, Danderyd, Sweden
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, 701 85, Örebro, Sweden.
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Jaiswal V, Naz S, Ishak A, Batra N, Quinonez J, Mukherjee D, Pokhrel NB. A rare case of pediatric pancreatic pseudocyst. Clin Case Rep 2022; 10:e05879. [PMID: 35600019 PMCID: PMC9107915 DOI: 10.1002/ccr3.5879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/26/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Sidra Naz
- BIDMC Harvard Medical School Boston Massachusetts USA
| | - Angela Ishak
- Larkin Community Hospital South Miami Florida USA
| | - Nitya Batra
- Maulana Azad Medical College New Delhi India
| | - Jon Quinonez
- Larkin Community Hospital South Miami Florida USA
| | | | - Nishan Babu Pokhrel
- Department of Internal Medicine Tribhuvan University Institute of Medicine Maharajgunj Nepal
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Ayodele SO, Aremu SK. The Cost of Setting Up an ENT Endoscopic Practice in Lower Middle-Income Countries of Sub-Saharan Africa. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:104-108. [PMID: 36213808 PMCID: PMC9536405 DOI: 10.4103/jwas.jwas_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/13/2022] [Indexed: 06/16/2023]
Abstract
Ear, nose, and throat (ENT) surgeons in developing countries are constrained to practicing with lower technology, lower cost surgery, and reliance on outdated surgical techniques carried out with improvised instruments when compared with their counterparts in the developed world. In this review, we planned to lay open the bottle necks militating against setting up an ENT endoscopy practice in our setting with possible outcomes. The literature search was carried out to retrieve relevant published articles, books, and guidelines. Unpublished literatures were excluded. The search was limited to articles in English. ENT clinical practice in lower middle-income countries (LMICs) where there are limited or no ENT endoscopic setup due to high cost of procurement and maintenance, human resources, lack of subspecialty training, and inadequate funding by policy makers poses major challenges that can militate against the provision of adequate and effective surgical management. A continually improved management practices will positively affect the organisational structure, efficiency, and safety of a system. That is, an affordable and standard ENT endoscopic setup will go a long way to improve the access to training and practice for both ENT clinical and surgical purposes. The expansion of ENT endoscopic specialist training will improve both the diagnostic and therapeutic acumen in ENT practice in LMICs. The budget for health and the health-funding systems of our institutions must receive special and specific attentions tailored towards putting our health facilities in better shapes, subspecialty training, and procurement of state-of-the-art endoscopic equipment with proper plans on maintenance culture.
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Affiliation(s)
- Samuel Oluyomi Ayodele
- ENT Department, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun, Nigeria
| | - Shuaib Kayode Aremu
- College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti, Nigeria
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Tshering S, Dorji T, Dorji N, Monger R, Choden K, Lhamo K. Setting up minimal invasive surgery services in gynecology in a resource-limited setting: an experience from Bhutan. BMC Res Notes 2022; 15:59. [PMID: 35172895 PMCID: PMC8848657 DOI: 10.1186/s13104-022-05953-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the clinical profile of minimal invasive procedures performed in gynecology at the national referral hospital in Bhutan. A review of such procedures performed in gynecology was needed to assess the baseline information and generate our own experience. We conducted a descriptive study with a review of hospital records of minimal invasive procedures performed from 1st January to 31st December 2020 at the Department of Gynecology. Data were extracted into a structured pro forma. Descriptive statistics were used to express the results. RESULTS The mean age of the patients was 33.9 ± 8.6 years of which the maximum was in the age group 25-34 years. 28 (17.5%) and 132 (82.5%) patients underwent emergency and elective procedures respectively. 142 (88.8%) and 18 (11.2%) patients underwent laparoscopic and hysteroscopic procedures respectively. Ovarian cystectomy was the most commonly performed procedure. The median operating time was 100 min (IQR 62.5-157.5). The overall complication rate was 2.5%. The median postoperative length of hospital stay was 24 h (IQR 3-24). Using our data and experience, we recommend a new health policy to recognize MIS in gynecology as a subspecialty and strengthen the existing service in gynecological MIS.
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Affiliation(s)
- Sangay Tshering
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Renuka Monger
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kesang Choden
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kezang Lhamo
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Singhirunnusorn J, Niyomsri S, Dilokthornsakul P. The cost-effectiveness analysis of laparoscopic hepatectomy compared with open liver resection in the early stage of hepatocellular carcinoma: a decision-analysis model in Thailand. HPB (Oxford) 2022; 24:183-191. [PMID: 34238678 DOI: 10.1016/j.hpb.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic liver resection is increasing operate. In the early stage of hepatocellular carcinoma (HCC), many studies supported that laparoscopic liver resection was a safe procedure and showed some clinical benefits. However, the full economic evaluation has not been fully investigated. METHODS A hybrid model of decision tree and Markov state transition model was constructed. Health outcomes were life-year gained (LYs), and quality-adjusted life years (QALYs). A deterministic sensitivity analysis was performed and a probabilistic sensitivity analysis was conducted by 1,000 micro-simulation. The incremental cost-effectiveness ratio (ICER) was reported and the willingness to pay (WTP) was defined at 160,000 THB per QALY gained. RESULTS Laparoscopic liver resection in the early stage of HCC was not cost-effective. In the base-case analysis, the total lifetime cost of laparoscopic approach was an average of 413,377 THB (US$13,214) higher than open approach by 55,474 THB (US$1,773) with a small QALY gained. The resulting ICER was 1,356,521 THB (US$43,362) per QALY gained. CONCLUSION Laparoscopic liver resection is not considered as a cost-effective alternative to open liver surgery in the early stage of HCC. In the Thai healthcare perspective, the results from this study may inform policymakers for the future policy implementation and healthcare resource allocation.
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Affiliation(s)
- Jumpol Singhirunnusorn
- National Cancer Institute of Thailand, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Siwaporn Niyomsri
- National Cancer Institute of Thailand, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Lenssen T, Dankelman J, Horeman T. SATA-LRS: A Modular and Novel Steerable Hand-Held Laparoscopic Instrument Platform for Low-Resource Settings. Med Eng Phys 2022; 101:103760. [DOI: 10.1016/j.medengphy.2022.103760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/23/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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40
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Puri S, Bandyopadhyay A, Ashok V. Improving Anesthesia Capacity for Ambulatory Surgery in Low- and Middle-Income Countries: Current Scenario and Future Prospects. Anesth Analg 2021; 133:1451-1455. [PMID: 34784331 DOI: 10.1213/ane.0000000000005764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sunaakshi Puri
- From the Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021; 35:None. [PMID: 34632156 PMCID: PMC8480410 DOI: 10.1016/j.ijso.2021.100399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 12/11/2022]
Abstract
Background Benefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. Methods A 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. Results Seven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. Conclusion Structured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.
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Murakami M, Poudel S, Bajracharya J, Fukuhara M, Kiriyama K, Shrestha MR, Chaudhary RP, Pokharel RP, Kurashima Y, Ieiri S. Support for Introduction of Pediatric Endosurgery in Nepal as Global Pediatric Surgery: Preliminary Needs Assessment Survey. J Laparoendosc Adv Surg Tech A 2021; 31:1357-1362. [PMID: 34612720 DOI: 10.1089/lap.2021.0307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Endosurgery provides several advantages over open surgery in the context of global surgery; however, there are several barriers to its introduction. The preliminary assessment of needs and barriers is essential for carrying out effective support as Global Surgery. However, no report has described the initiation of support for endosurgery based on a preliminary survey of the needs and barriers. The present survey study aimed at determining the needs and barriers of pediatric endosurgery in Nepal. Materials and Methods: A needs assessment survey was conducted among all pediatric surgeons in Nepal via an online platform. This was followed by workshop on pediatric endosurgical skills in Nepal. To assess the skills of participants and effectiveness of the workshop, the skill evaluation tests and the questionnaire survey were conducted. Results: Fourteen pediatric surgeons (response rate: 60.9%) responded to the needs assessment survey. More than 70% of the participants did not have any experience with advanced endosurgical procedures. However, advanced endosurgical procedures were strongly needed. A lack of training was indicated as a major barrier for the introduction of pediatric endosurgery. Fifteen participants completed the workshop. Participants' confidence in their endosurgical skills improved significantly after the workshop. The skill evaluation tests revealed that participants' endosurgical skills also improved significantly after the workshop, although even after the workshop, participants still took an average of 415.6 seconds to place and knot one suture. Conclusions: The needs assessment survey and workshop for Nepalese pediatric surgeons helped clarify their needs for endosurgery and the barriers to its introduction.
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Affiliation(s)
- Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Saseem Poudel
- Department of Surgery, Steel Memorial Muroran Hospital, Muroran-shi, Japan
| | - Jasmine Bajracharya
- Department of Surgery, Nepal Medical College Teaching Hospital, Gokarneshwor, Nepal
| | - Masahiro Fukuhara
- Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Kotoe Kiriyama
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Ramnandan P Chaudhary
- Department of Pediatric Surgery, Ishan Children & Women's Hospital, Kathmandu, Nepal
| | | | - Yo Kurashima
- Clinical Simulation Center, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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43
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Farda W, Tani MK, Manning RG, Fahmi MS, Barai N. Laparoscopic cholecystectomy: review of 1430 cases in Cure International Hospital, Kabul, Afghanistan. BMC Surg 2021; 21:344. [PMID: 34530783 PMCID: PMC8447664 DOI: 10.1186/s12893-021-01342-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of cholelithiasis in most countries of the world. The objective of this study was to evaluate the outcomes of LC in the surgery department of Cure International Hospital, Kabul, Afghanistan. Methods A retrospective study was conducted on 1430 LC cases performed by the general surgery department of Cure International Hospital. Data was collected from patient files and the operation theatre registry for whom LC was performed during January 2008 through December, 2019. Results Mean age was 45.77 ± 13.45 years (14–90 years), with male/female ratio of 1:4.7. One third (33%) had comorbidities. Most of patients (~ 97%) were classified as ASA grade I and II. Of all patients, 26.8% of males and 13.2% of females had gallbladder inflammation (OR = 2.203, 95% CI 1.56–2.61, P = 0.000). Overall mean duration of anesthesia was 75 ± 25.6 min. The conversion rate to OC was 4.6% (N = 66), most commonly dense adhesions at Callot’s triangle (3.8%). The intraoperative complication rate was 17.5% (N = 249), where bile/stone spillage was the most common indication (N = 235, 16.4%). Immediate postoperative complication rate was 2.4% (N = 35). Average length of stay (ALOS) after LC was 2.23 ± 1.43 days (1–19 days). Conclusion This study shows that elective LC can be performed safely in Afghanistan with comparable outcomes in terms of complications, conversion rates, and ALOS to other countries of the region and the world. Proper case selection and careful preoperative evaluation and management can decrease further conversion, intra- and postoperative complications.
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Affiliation(s)
- Wais Farda
- General Surgery Department, Isteqlal Hospital, Alaudin Square, Darulaman Road, Kabul, Afghanistan.
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44
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Aruparayil N, Bolton W, Mishra A, Bains L, Gnanaraj J, King R, Ensor T, King N, Jayne D, Shinkins B. Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis. Surg Endosc 2021; 35:6427-6437. [PMID: 34398284 PMCID: PMC8599349 DOI: 10.1007/s00464-021-08677-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. METHODS A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. SECONDARY OUTCOMES operative times and length of stay. The inverse variance random-effects model was used to synthesise data. RESULTS 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45-2.40] or gynaecological surgery RR 0.66 [0.14-3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26-60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD - 18.74 [CI - 29.23, - 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD - 3.94 [CI - 5.93, - 1.95] and gynaecology MD - 1.75 [CI - 2.64, - 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. CONCLUSION Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.
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Affiliation(s)
- N Aruparayil
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. .,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK.
| | - W Bolton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - A Mishra
- Maulana Azad Medical College, Delhi, India
| | - L Bains
- Maulana Azad Medical College, Delhi, India
| | | | - R King
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - T Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - N King
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - B Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
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45
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Roa L, Ramos JA, Citron I, Staffa SJ, Jardim YJ, Alonso N, Zurakowski D, Abrao MS, Boatin AA. Trends in Mode of Gynecologic Surgery for Benign Disease in Brazil. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Jania Arcia Ramos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yuri J. Jardim
- Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Nivaldo Alonso
- Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mauricio S. Abrao
- Gynecologic Division BP, A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Obstetrics and Gynecology Department, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Adeline A. Boatin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
Minimally invasive surgery continues to transform the field of gynecological surgery and is now the standard of care for the surgical treatment of many diseases in gynecology. Owing to minimally invasive surgery's clear advantages, new advances in technology are being employed rapidly and enabling even the most complicated procedures to be performed less invasively. We examine recent literature on minimally invasive surgical innovations, advances, and common practices in benign gynecology that, from our point of view, made an impact on the way laparoscopic surgery is performed and managed in the last decade.
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Affiliation(s)
- Lior Levy
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
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47
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Robertson D, Gnanaraj J, Wauben L, Huijs J, Samuel VM, Dankelman J, Horeman-Franse T. Assessment of laparoscopic instrument reprocessing in rural India: a mixed methods study. Antimicrob Resist Infect Control 2021; 10:109. [PMID: 34301325 PMCID: PMC8300979 DOI: 10.1186/s13756-021-00976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Laparoscopy is a minimally-invasive surgical procedure that uses long slender instruments that require much smaller incisions than conventional surgery. This leads to faster recovery times, fewer post-surgical wound infections and shorter hospital stays. For these reasons, laparoscopy could be particularly advantageous to patients in low to middle income countries (LMICs). Unfortunately, sterile processing departments in LMIC hospitals are faced with limited access to equipment and trained staff which poses an obstacle to safe surgical care. The reprocessing of laparoscopic devices requires specialised equipment and training. Therefore, when LMIC hospitals invest in laparoscopy, an update of the standard operating procedure in sterile processing is required. Currently, it is unclear whether LMIC hospitals, that already perform laparoscopy, have managed to introduce updated reprocessing methods that minimally invasive equipment requires. The aim of this study was to identify the laparoscopic sterile reprocessing procedures in rural India and to test the effectiveness of the sterilisation equipment. Methods We assessed laparoscopic instrument sterilisation capacity in four rural hospitals in different states in India using a mixed-methods approach. As the main form of data collection, we developed a standardised observational checklist based on reprocessing guidelines from several sources. Steam autoclave performance was measured by monitoring the autoclave cycles in two hospitals. Finally, the findings from the checklist data was supported by an interview survey with surgeons and nurses. Results The checklist data revealed the reprocessing methods the hospitals used in the reprocessing of laparoscopic instruments. It showed that the standard operating procedures had not been updated since the introduction of laparoscopy and the same reprocessing methods for regular surgical instruments were still applied. The interviews confirmed that staff had not received additional training and that they were unaware of the hazardous effects of reprocessing detergents and disinfectants. Conclusion As laparoscopy is becoming more prevalent in LMICs, updated policy is needed to incorporate minimally invasive instrument reprocessing in medical practitioner and staff training programmes. While reprocessing standards improve, it is essential to develop instruments and reprocessing equipment that is more suitable for resource-constrained rural surgical environments. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00976-x.
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Affiliation(s)
- Daniel Robertson
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | | | - Linda Wauben
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Jan Huijs
- Heart Consultancy, Renkum, The Netherlands
| | - Vasanth Mark Samuel
- Surgery Unit 1, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Jenny Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Tim Horeman-Franse
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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48
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Nogoy DM, Padmanaban V, Balazero LL, Rosado J, Sifri ZC. Predictors of Difficult Laparoscopic Cholecystectomy on Humanitarian Missions to Peru Difficult LC in Surgical Missions. J Surg Res 2021; 267:102-108. [PMID: 34157489 DOI: 10.1016/j.jss.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the gold standard treatment of gallstone disease. On short-term surgical missions (STSMs), it is unclear what factors can predict safety of LC. This study evaluates patient risk factors of difficult LC in Northern Peru, towards optimizing outcomes. MATERIALS AND METHODS A retrospective review was performed of patients who underwent LC during short-term surgical missions to Peru from 2016-2019 under the International Surgical Health Initiative (ISHI). Difficult and routine LC groups were compared for: age, weight, gender, symptom duration, pain on presentation, history of abdominal or pelvic surgery, diabetes and hypertension. RESULTS 68 of 194 patients underwent LC; 42 patients (62%) were classified as difficult with OR (operating room) time > 70 min (90%), 2 cases converted to open (5%) and 2 aborted cases (5%). Higher weight class was found to correlate with difficult LC. CONCLUSION Increased patient weight was correlated to longer operative time during STSMs. Patients undergoing LC must be selected carefully to mitigate risks of difficult operations on STSMs.
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Affiliation(s)
- Danielle M Nogoy
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Vennila Padmanaban
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Jesus Rosado
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Pizzol D, Trott M, Grabovac I, Antunes M, Colangelo AC, Ippoliti S, Ilie CP, Carrie A, Veronese N, Smith L. Laparoscopy in Low-Income Countries: 10-Year Experience and Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115796. [PMID: 34071312 PMCID: PMC8198316 DOI: 10.3390/ijerph18115796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022]
Abstract
Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19-0.97; I2 = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43-0.65; I2 = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI -0.00; 1.15; I2 = 96.52), while the pooled SMD in hospitalization days was -1.35 (95% CI -1.87; -0.82; I2 = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential.
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Affiliation(s)
- Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum 11111, Sudan
- Correspondence: ; Tel.: +39-366-873-1237
| | - Mike Trott
- The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK; (M.T.); (L.S.)
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna 1010, Austria;
| | - Mario Antunes
- Department of Surgery, Central Hospital of Beira, Beira 13016, Mozambique;
- Department of Surgery, Catholic University of Mozambique, Beira 13016, Mozambique
| | - Anna Claudia Colangelo
- Department of Surgery and Organ Transplantation, University of Padua, 35125 Padua, Italy;
| | - Simona Ippoliti
- Department of Urology, The Queen Elizabeth Hospital, King’s Lynn PE30 4ET, UK; (S.I.); (C.P.I.); (A.C.)
| | - Cristian Petre Ilie
- Department of Urology, The Queen Elizabeth Hospital, King’s Lynn PE30 4ET, UK; (S.I.); (C.P.I.); (A.C.)
| | - Anne Carrie
- Department of Urology, The Queen Elizabeth Hospital, King’s Lynn PE30 4ET, UK; (S.I.); (C.P.I.); (A.C.)
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90121 Palermo, Italy;
| | - Lee Smith
- The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK; (M.T.); (L.S.)
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50
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Zaragoza technique of laparoscopic appendicectomy. Ann Med Surg (Lond) 2021; 65:102331. [PMID: 34007441 PMCID: PMC8111591 DOI: 10.1016/j.amsu.2021.102331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Appendectomy is one of the most frequent emergency surgical procedures, currently with a preference for laparoscopic management worldwide. Objective To report a new laparoscopic appendectomy technique and its results. Material and methods Cohort study of patients with a diagnosis of appendicitis who are managed laparoscopically. In a total 1063 patients, 148 were operated on with the Zaragoza technique during the period from January 2002 to December 2018. The technique consists of making a window in the appendicular base between the meso and the appendicular wall, two prolene or silk sutures are placed, and the cecal appendix is cut between the two sutures, finally the mesoappendix is sectioned with a harmonic scalpel or bipolar clamp. Results From our results, we had 1.4% residual abscesses, 1.4% umbilical surgical wound infection and 0% mortality. Discussion Various laparoscopic management methods for appendectomy are reported in the literature, with a wide range in the results. We have obtained good results in patients subjected to our technique. Conclusions The Zaragoza technique for laparoscopic appendectomy is an effective and safe option that prevents excessive manipulation of the inflamed appendix and is easily reproducible. Acute appendicitis is one of the most common problems in daily practice. Our technique is a safe method. It is a reproducible and economical technique.
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