Charlotte Horne, MD, Godwin Onyema, MD, Afam Onyema, Kevin El-Hayek, MD. Cleveland Clinic
Laparoscopic surgery has routinely become the standard approach and standard of care for numerous surgical procedures in the developed world. Currently, over 3.5 million laparoscopic procedures are performed annually in the United States1. However, many developing nations are still routinely performing these surgeries via open techniques due to lack of infrastructure or lack of training. Laparoscopic surgery has been shown to decrease both wound morbidity and length of stay. It also allows for faster return to work 2,3,4, which can significantly benefit populations where work is imperative for those to meet their basic needs.
To address these issues, we conducted a mission trip to Awka, Nigeria under the GEANCO Foundation to establish infrastructure, teach the surgeons and operating room personal the techniques, appropriate instrument handling, basic troubleshooting and equipment sterilization procedures. Nigeria presents an excellent location for this, as it is the largest country in Africa, is a regional power in Africa and has one of the top twenty largest economies in the world5. Despite this, the human development index ranks 152 in the world, 70 million lack access to safe drinking water and 110 million people are lacking appropriate sanitation6. Due to these public health concerns, minimally invasive surgery has the potential to significantly decrease wound morbidity.
To establish the infrastructure, donated products were obtained from device and medical redistribution companies. Lectures were conducted daily and included basic laparoscopic principles as well as procedure specific techniques. We chose patients who required a cholecystectomy, appendectomy or inguinal herniorrhaphy as these procedures would commonly need to be performed locally and are appropriate to establish a basic laparoscopic skill set. Working directly with one surgeon and his senior registrar, techniques for abdominal entry, basic procedural related steps, equipment care and troubleshooting were taught.
Over 7 days, a total of 11 laparoscopic cases were performed. Conversion to open was required in two patients. All 11 patients were discharged home at the completion of the mission without inpatient complication. Overall length of stay after all procedures was approximately 1.5 days, mostly due to patient discomfort in being discharged home earlier.
There is a significant need in developing countries for improved access to what is considered standard of care in the United States. We advocate for establishing the infrastructure and teaching laparoscopic techniques to greatly decrease post-operative morbidity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95511
Program Number: P611
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster