Feasibility of Laparoscopic Surgery in a Resource Limited Setting: Cost Containment, Skills Transfer and Outcomes

Abstract

Background: Where as the first Laparoscopic cholecystectomy was performed more than three decades ago in Europe. In Uganda interventional laparoscopic procedures like cholecystectomy and appendicectomy commenced only recently. This paper in three parts describes the first 178 procedures done at a hospital in Kampala, a cost saving technique for Laparoscopic appendicectomy as well as highlighting a practical skills transfer model. Method: Multiple designs; a descriptive retrospective design for part one, a prospective single cohort for part two and a qualitative description for part three. The data was collected from the operating room logs operative notes and follow-up visits notes for the first part. For the second part a prospective single cohort design, every consecutive patient who presented with features of acute appendicitis and consented was included in the study. A low cost extra corporeal appendiceal stump ligation technique is described. For part three, the notes, materials and schedules used for skills transfer session were reviewed. Sata was manually analysed using a spreadsheet. Institutional Review Board (IRB) approval was secured. Results: Of the 178 procedures 64 (36%) were appendicectomy, 30 (17%) were cholecystectomy and 75 (42%) were diagnostic. Male: Female ratio was 1:3. Major complications occurred in 1.7% of the study group. Two appendicectomy and two cholecystectomy were converted. A cost containment extracorporeal ligation technique for appendiceal stump ligation was performed for 50 appendicectomy with no wound sepsis recorded, in the follow up period. Conclusion: The complication rates were comparable to work done elsewhere. The appendicectomy extracorporeal technique was safe and low cost. Short but repetitive hands-on training sessions are appropriate for training qualified surgeons on site. Interventimal Laparoscopic surgery is feasible in resource limited settings.