A review of a laparoscopic & endoscopic training program in central Haiti.

Luther Ward, MD1, Michelson Padovany, MD2, Alexis N Bowder3, Andre Patrick Jeudy, MD2, Frank Junior Turenne, MD2, Thomas McIntyre, MD4, John G Meara, MD1, Jean Louis Mac Lee, MD2. 1Boston Children’s Hospital, 2Zamni Lasante-Partners in Health, 3University of Nebraska Medical Center, 4SUNY Downstate Medical Center

INTRODUCTION: After thirty years of implementation, laparoscopic procedures have become the gold standard of treatment for a number of procedures in advancing countries. This is in part due to the consistently documented benefits of minimally invasive surgery. Despite this there still remains considerable controversy and resistance to implementing laparoscopy in resource poor settings amongst surgeons from high-income countries.  For the last two years the Hôpital Universitaire de Mirebalais (HUM) in Haiti has provided surgical care to over 4,000 patients. Recently a laparoscopic and endoscopic training program has been initiated for Haitian surgeons and surgical residents.

METHODS & PROCEDURES: This project is a descriptive analysis of our experience implementing endoscopy & minimally invasive surgery at HUM. The endoscopy program was initiated in January of 2014 and focused on endoscopy and colonoscopy. The laparoscopic program was introduced in October 2014 by the department of surgery at HUM and consisted of basic laparoscopic procedures such as cholecystectomy, appendectomy and diagnostic laparoscopy.  Outcomes, complications, rates of conversion to open procedures, and procedures needed for laparoscopic competency were recorded.

RESULTS: After five months of endocscopy/colonoscopy training and ten months of laparoscopic training with an American general surgeon Haitian surgeons were able to perform endoscopy, colonoscopy,  and laparoscopic cholecystectomies safely. In total, 240 endoscopic procedures and 30 laparoscopic cases performed at our institution. There were no perioperative deaths and 4 laparoscopic appendectomies were converted to open procedures due to dense adhesions.

CONCLUSION: We believe this study demonstrates that endoscopy and laparoscopy can be taught and used safely in low-income settings. In addition, training surgeons can be done efficiently and result in satisfactory perioperative outcomes. Documentation of this is incredibly important so that minimally invasive surgery can been seen as an adjunct and necessary component to developing surgical systems in low-income countries. 

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