Single port hand – assisted laparoscopy using a rigid rectosigmoidoscope, a light source and manual insufflators in low income settings

Abdulkadir Yakubu, MD, MSc, PhD, Musa Ibrahim, MD, MScPhD. Deparment of Surgery, Kazaure General Hospital, Jigawa state, Nigeria. Paediatric Surgical Unit, Murtala Muhammad specialist Hospital, Kano State, Nigeria.

Background: Minimal invasive surgery (MIS) is a challenge in Africa and other developing regions due to lack of equipment and skilled personnel. In this study we demonstrated the feasibility of MIS using minimum available surgical instrument.

Methods and materials: This was a prospective study carried out at departments of surgery of Murtala Muhammad Specialist Hospital and Kazaure General Hospital over a period of 4 years (September, 2008 – June, 2012), during this period 70 patients were evaluated. The patients were divided into two groups (GPs). GP1 consists of 30 patients (42.9%) who undergone conventional lapaotomy while GP2 includes 40 patients (57.1%) who had hand-assisted laparoscopy (HAL) using a rigid rectosigmoidoscope, a light source and manual insufflators.

Demographic information, clinical characteristics, types of surgery, operation time, postoperative hospital stay, complications, conversion rate and postoperative mortality were evaluated and compared for the two GPs. Student’s t tests for p values were evaluated for statistical significant.

Results: The age range of patients was 2 days to 14 years. The male: female ratio was 1:1.5 .The age of 72.0% of all subjects was 4 to 8 years, while 24.5% and 3.5% were less than 1 and greater than 10 years respectively. In GP1 HAL was enough for 78.4% of the patients. There was a conversion of 13.6%. All patients in GP2 underwent convectional laparotomy. Mickel’s diverticulum, acute appendicitis, intussusceptions, Hirschsprung’s disease, colonic polyposis, typhoid perforation, duodenal atresia and ovarian cyst were included in the study.

Conclusion: Less privileged experienced MIS surgeon can obtain acceptable surgical outcomes with minimum available instrument in low income facilities.

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