A decade of laparoscopic surgery training in Tanzania

Duncan Light2, Ayesiga Herman1, Salum Kondo1, Liam Horgan2. 2Northumbria NHS Trust, 1Kilimanjaro Christian Medical Centre

Background:  We present the results from 10 years of practice since the introduction of laparoscopic surgery in Tanzania. This study establishes the feasibility and safety of establishing laparoscopic surgery in a rural African nation.

Methods:  A professional relationship was commenced in 2005 between a surgeon in KCMC hospital and a surgeon in the Northumbria NHS Trust, United Kingdom. This was instigated by the desire to commence laparoscopic surgery by surgeons in Tanzania. A mentorship was developed in 2005.

Diagnosis for symptomatic gallstones was obtained from ultrasonography and liver function tests. Derangement of liver function tests was considered an exclusion for laparoscopic cholecystectomy. Previous laparotomy was considered a relative contraindication to laparoscopic surgery, although this was considered on a case by case basis

All operative cases from KCMC were entered into a prospective database from the commencement of the project. Cases have been reviewed retrospectively from 2005 to 2015.

Results:  495 patients were included. The mean age was 43 years (range 25 to 80 years). 411 were female,84 male. The procedures were: 353 laparoscopic cholecystectomy, 81 laparoscopic appendicectomy and 61 diagnostic laparoscopy. The conversion rate for laparoscopic cholecystectomy was 7% (26/325) , lap appendix was 1.2% (1/81) and diagnostic laparoscopy was 7% (4/61). The rate of common bile duct injury was 0.8%.

Conclusion:  The introduction of laparoscopic surgery is safe and feasible in the remote setting. Telementoring is a successful method of surgical education in rural Africa.  Laparoscopic surgery brings benefits to developing settings in terms of reduced hospital stay.

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