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INTRODUCTION: Despite its advantages, laparoscopy is not yet routinely offered in rural low resource settings in Kenya due to high capital investment. With increased focus on globally accessible surgery, smaller hospitals must weigh costs versus demand. We describe the cost of laparoscopic surgery in rural Western Kenya through review of an initial launch effort in September 2016. METHODS: Practicality was assessed through a retrospective cost analysis. Prices of equipment previously purchased for laparotomy were excluded. Cost saving tactics were reported. Prices were obtained through local medical supply companies and hospital management. RESULTS: The cost of the laparoscopic tower was 62,924.46 USD. The cost of a basic set of thirteen re-useable instruments needed to perform gynecologic laparoscopy was 13,063.70 USD. The mean cost of pre-intra and post-operative care per patient was 135.84 USD. Given mean hospital charges of 495 USD per patient for pre-, intra- and post-operative care, we calculated it is necessary to perform 212 surgeries within a year to return a profit. Cost saving tactics included donated equipment and reuse of equipment with chemical sterilization. CONCLUSION: Literature published regarding the cost of laparoscopy is conflicted. Laparoscopy requires a large initial investment. We advocate for careful consideration of patient volume, available donations, local suppliers and technical assistance before launching laparoscopy in a rural setting within a developing nation.

A 43-year-old, who underwent a subtotal hysterectomy for postpartum hemorrhage following a normal delivery, 10 years ago, presented with a history of persistent vaginal discharge and post-coital bleeding. A pap smear reported moderate dysplasia, and a subsequent colposcopic biopsy reported severe dysplasia with crypt extension. The patient underwent a laparoscopic trachelectomy, and histology of the stump reported cervical squamous carcinoma in situ, with no microinvasion.