Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

Abstract

IntroductionThe Caribbean lags behind global trends for volume and complexity of laparoscopic operations. In an attempt to promote laparoscopy at a single facility, a partnership was formed between the University of the West Indies (UWI) and the Port of Spain General Hospital in Trinidad and Tobago. This study seeks to document the effect of this partnership on laparoscopic practice.Materials and methodsIn this partnership, the UWI took the bold step of volunteering to staff a surgical team if the Ministry of Health provided the necessary legislative changes. On August 1, 2013, a UWI team was introduced with a mandate to optimize teaching and promote laparoscopic surgery. The UWI team had a similar staff complement to the existing service-oriented teams. There was no immediate investment in equipment, hospital beds, ICU beds, or operating room space. Therefore, the new team was introduced with limited change in existing conditions, resources, and equipment.ResultsThere were 252 laparoscopic operations performed over the study period. After introduction of the UWI team, there was an increase in the mean number of unselected laparoscopic operations (3.17 vs 10.83 cases per month; P<0.001; 95% confidence interval [95% CI] −8.5 to −6.84; standard error of the difference [SED] 0.408), the mean number of basic laparoscopic operations (3.17 vs 6.94 cases per month; P<0.0001; 95% CI −4.096 to −3.444; SED 0.165), the mean number of advanced laparoscopic operations (0 vs 3.89; P<0.0001), the number of teams undertaking unselected laparoscopic operations (2 vs 5), and the number of teams independently performing advanced laparoscopic operations (0 vs 4).ConclusionAt this facility, we have demonstrated a significant increase in laparoscopic case volume and complexity when partnerships were formed between the UWI and this service-oriented hospital. Continued cross-fertilization and distribution of skill sets across the surgical community can reasonably be expected. We also identified maneuvers that can be used as a template to build laparoscopic services in other service-oriented hospitals in developing nations.

Single-Incision Laparoscopic Cholecystectomy: Initial Report From the Turks and Caicos Islands

“…This report adds to the existing data in support of SILS cholecystectomies in the Caribbean. This is important because conventional laparoscopic surgeons in the Caribbean continue to argue that the SILS approach is not well suited to the Caribbean healthcare environment [ 4 , 18 , 19 ], reminiscent of the resistance that open surgeons had for conventional MPL in the 1990s. This barrier will only be overcome when more data are available to prove that SILS is feasible and safe in the Caribbean setting.…”

“…We acknowledge that SILS operations require advanced surgical skill sets to adapt to counterintuitive hand movements, instrument collision, and restricted movements of instruments through one entry point. In addition to proctorship, local surgeons may further hone these skills by extra-corporeal training with simulators [ 18 ].…”

Laparoscopic Liver Resection by Distance Mentoring – Trinidad to Barbados: A Report

“…Laparoscopic surgery in the Anglophone Caribbean is still relatively novel, having only gained popularity at the turn of the 21st century after the repatriation of fellowship-trained surgeons with experience in advanced laparoscopy [2-3]. However, while advanced laparoscopy is available in select territories, it is still not universally available across the region.…”

“…This situation extends to laparoscopic liver resections as well. In this environment, laparoscopic liver resections are only performed in Trinidad and Tobago, Jamaica, and the Bahamas [1, 3, 5-6], where there are active hepatobiliary teams (Figure 1). Some of the other Caribbean countries have competent surgeons who may not have formal training in liver resections but possess the necessary advanced laparoscopic skill sets to complete laparoscopic liver resections.…”

Totally Laparoscopic Whipple’s Operation: Initial Report from the Caribbean

“…Oncologic surgery in the Caribbean has evolved over the past decade, with increasing reports of advanced minimally invasive operations being reported in the region [1][2][3]. However, as it relates to pancreatic surgery, the minimally invasive approach has been limited to operations for pancreatic pseudocysts and distal pancreatectomies, with little application to periampullary lesions [4][5][6]. This is because a totally laparoscopic Whipple's operation is a technically demanding and time-consuming operation.…”