Improving Access to Laparoscopy in Low-Resource Settings

Rosenbaum, Alan J.; Maine, Rebecca

doi:10.5334/aogh.2573

Cited by 26 publications

(32 citation statements)

References 27 publications

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“…There were several factors contributing towards the successful training. First, inclusive training for the doctors, nurses, biomedical engineers, and private sector medical supply companies increased awareness, motivation, and understanding in each other's role in the field of laparoscopic surgery [4,8,19]. Importantly, training for senior doctors and nurses had a favorable influence on the hierarchical culture, and the former supported their junior colleagues to participate actively in the subsequent workshops [17,19].…”

Section: Discussionmentioning

confidence: 99%

“…First, inclusive training for the doctors, nurses, biomedical engineers, and private sector medical supply companies increased awareness, motivation, and understanding in each other's role in the field of laparoscopic surgery [4,8,19]. Importantly, training for senior doctors and nurses had a favorable influence on the hierarchical culture, and the former supported their junior colleagues to participate actively in the subsequent workshops [17,19]. Second, clinical collaboration with technical support at the operating theater and in daily clinical practice encouraged doctors to take up the challenge with a minimal risk of technical complications or open conversions [22].…”

Section: Discussionmentioning

confidence: 99%

“…Technical support with troubleshooting and peer debriefing were offered in the operating theater to the doctors and nurses regardless of their specialties. "Laparoscopy Bellwether procedures" including laparoscopic cholecystectomy, appendectomy, diagnostic laparoscopy, salpingectomy, oophorectomy, and ovarian cystectomy were the initial targets for laparoscopic surgery, considering the high prevalence of indications as well as the level of expertise of the operators [19]. Locally trained nurses participated in the initial cases, and the overseas trained nurses later interactively implemented their professional competency.…”

Section: Laparoscopic Surgery In Garhmentioning

confidence: 99%

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Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

Kang

Apea-Kubi

et al. 2020

Annals of Global Health

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Background: Healthcare equipment funded by international partners is often not properly utilized in many developing countries due to low levels of awareness and a lack of expertise. A long-term on-site training program for laparoscopic surgery was established at a regional hospital in Ghana upon request of the Ghana Health Service and local surgeons. Objective: The authors report the initial 32-month experience of implementing laparoscopic surgery focusing on the trainees' response, technical independence, and factors associated with the successful implementation of a "new" surgical practice. Methods: Curricular structure and feedback results of the trainings for doctors and nurses, and characteristics of laparoscopic procedures performed at the Greater Accra Regional Hospital between January 2017 and September 2019 were retrospectively reviewed. Findings: Comprehensive training including two weeks of simulation workshops followed by animal labs were regularly provided for the doctors. Among the 97 trainees, 27.9% had prior exposure in laparoscopic surgery, 95% were satisfied with the program. Eleven nurses attained professional competency over 15 training sessions where none had prior exposure to laparoscopic surgery. Since the first laparoscopic cholecystectomy in February 2017, 82 laparoscopic procedures were performed. The scope of the surgery was expanded from general surgery (n = 46) to gynecology (n = 33), pediatric surgery (n = 2), and urology (n = 1). The volume of local doctors as primary operators increased from 0% (0/17, February to December 2017) to 41.9% (13/31, January to October 2018) and 79.4% (27/34, November 2018 to September 2019), with 72.5% of the cases being assisted by the expatriate surgeon. There were no open conversions, technical complications, or mortalities. Local doctors independently commenced endoscopic surgical procedures including cystoscopies, hysteroscopies, endoscopic neurosurgeries and arthroscopies. Conclusion: Sensitization and motivation of the surgical workforce through long-term continuous on-site training resulted in the successful implementation of laparoscopic surgery with a high level of technical independence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Laparoscopic Surgery In Garhmentioning

confidence: 99%

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Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

Kang

Apea-Kubi

et al. 2020

Annals of Global Health

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“…At the macrosystemic level, the most obvious and pernicious obstacle is the competition for scarce resources. As with other health interventions that require long-term investment, rehabilitation services appear less attractive than measures that produce immediate results [11]. The primary care health needs of populations in LMIC may be so great that attending to people with chronic disabilities feels like a luxury.…”

Section: Obstacles To Rehabilitation Accessmentioning

confidence: 99%

Expanding Global Rehabilitation Services through International Academic-Community Partnerships

AlHeresh

Cahn

2020

Annals of Global Health

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Background: More than one billion people worldwide live with a disability, yet rehabilitation professionals are scarce in low-and middle-income countries. Attempts to expand access to rehabilitation services have encountered barriers on multiple levels: limited resources on the systemic level, hierarchies on the professional level, and cultural stigma on the community level. Objectives: We sought to determine if an academic-community partnership could overcome multiple levels of barriers to expand services for people with disabilities. Methods: Toward an All-Inclusive Jordan incorporates community-based rehabilitation with prelicensure health professions education to address the three primary levels of barriers to rehabilitation services in low-and middle-income countries. The yearlong curriculum includes formal training, research, and advocacy with graduate students from the United States and health professions students and community members in Palestinian refugee camps near Amman, Jordan. Findings: After two cycles of the program, 14 Jordanian volunteers have partnered with 20 graduate students from the United States. They have delivered over 300 direct rehabilitation sessions, conducted ten workshops with mothers of children with disabilities, and trained 12 community-based rehabilitation workers in the refugee camps. Conclusions: The academic-community partnership model builds on the evidence base for the success of community-based rehabilitation services in low-and middle-income countries. Its components address barriers on multiple levels to create a sustainable expansion of services to people with disabilities.

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“…The recurring cost of expensive laparoscopic instruments, logistics of providing medical-grade gases in remote areas, and nonavailability of general anesthetics 3 make it difficult to adopt MAS in low-resource settings.…”

mentioning

confidence: 99%

Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study

Mishra

Bains

Jesudin³

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Minimal access surgery is not available to most people in rural areas of low-to middle-income countries. This leads to an increase in morbidity and economic loss to the poor and marginalized. Gasless laparoscopic (GAL) procedures are possible in rural areas because they can be performed under spinal anesthesia. In most cases, it does not require the logistics of providing gases for pneumoperitoneum and general anesthesia. The current study compares GAL with conventional laparoscopic (COL) operations for general surgical procedures. METHODS: A single-center, nonblinded randomized controlled trial was conducted to evaluate noninferiority of GAL vs COL at a teaching hospital in New Delhi, India. Patients were allocated into 3 groups and underwent minimal access surgery (cholecystectomies and appendectomies). The procedures were performed by 2 surgeons choosing randomly between GAL and COL. The data were collected by postgraduates and analyzed by a biostatistician. RESULTS: One hundred patients who met the inclusion criteria were allocated into 2 groups. No significant difference was observed in the mean operating time between the GAL group (52.9 minutes) and the COL group (55 minutes) (p ¼ 0.3). Intraoperative vital signs were better in the GAL group (p < 0.05). The postoperative pain score was slightly higher in the GAL group (p ¼ 0.01); however, it did not require additional analgesics. CONCLUSIONS: No significant differences were found between the 2 groups. GAL can be considered as noninferior compared with COL and has the potential to be adopted in low-resource settings.

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Improving Access to Laparoscopy in Low-Resource Settings

Cited by 26 publications

References 27 publications

Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

Expanding Global Rehabilitation Services through International Academic-Community Partnerships

Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study

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