Starting a Laparoscopic Surgery Program in the 2nd Largest Teaching Hospital in Ghana

Adam Gyedu, MD, FGCS, Juliane Bingener-Casey, MD, FACS, Eric P Amaning, MD, PhD, FPCS, FGCS, Charles K Dally, MD, FICS, Joseph K Oppong, MBChB, FWACS, Raymond R Price, MD, FACS, Kaye M Reid-Lombardo, MS, MD, FACS, Francis A Abanatanga, MD, PhD, FWACS, FGCS

Kwame Nkrumah University of Science and Technology, Ghana; Komfo Anokye Teaching Hospital, Ghana; Mayo Clinic, USA; University of Utah, USA

Background: Komfo Anokye Teaching hospital (KATH) is the 2nd largest teaching hospital in Kumasi, Ghana with a bed capacity of 1000, whose surgeons perform 880 operations/year.
Two years have elapsed after the purchase of laparoscopic equipment, basic laparoscopic training of 8 surgeons, outside expert visits and the first laparoscopic cholecystectomy. Here we examine our experience and lessons learned.

Methods: We evaluated the surgeons, equipment, environment and processes involved in the development of this program. We reviewed leadership support, the role of a surgeon champion, training of physician and OR staff, and the influence of experienced laparoscopic surgeons from outside Ghana and equipment status.

Results: Strong leadership support was evidenced by equipment purchase, dedicated time for training of all surgeons and invitation of outside experts yearly from 2008. Four US surgeons, including two Ghanaians practicing in the US, and an individual providing technical support met in 2010. A KATH surgeon champion was identified at that time. A dedicated OR team received “pre-run” and “on the job” training, worked with the SAGES trouble shooting guide and exhibited excellent ownership of equipment preparation.
A laparoscopic tower was accessible in 2010 and minor adjustments were needed to ensure functionality. CO2 and biomedical engineering support was achieved through collaboration with the in house fertility team.

Since 2010, 25 laparoscopic cholecystectomies for 24 female and one male patient, have been performed at KATH, 17 (68%) independently by a single surgeon. Average patient age was 45 yrs, ASA score 1.2 (+/- 0.4), operative time 1.41 hrs (1.55 hrs independently, 1.19 hrs with expert trainer), average length of stay 1.5 days (+/- 1.0), conversion rate 4% (1/25), and complication rate 20% (5/25). Complications included dehydration from diarrhea, readmission for pain control, an unexpected intraoperative finding of a subphrenic abscess leading to post-operative percutaneous drainage, post-operative pain from peptic ulcer disease, and one death post-op day 1 in a patient with severe acute cholecystitis necessitating conversion, subtotal cholecystectomy and drain placement. At 14 days post-op median patient satisfaction score was 5 on a scale of from 1-5 where 5 is most satisfied.

Conclusion: Laparoscopic surgery at KATH has become a reality with persistent support from leadership and talented teams. Many factors beyond equipment and basic training contributed to this initial success. Continued concerns are resident training, reimbursement discussions, access to and cost of single use items (clips, mesh e.g.), and a certain resistance to change not yet counteracted by patient demand.

Session: Poster Presentation

Program Number: P507

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