Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study

Farrow, Norma E.; Commander, Sarah Jane; Reed, Christopher Robert; Mueller, Jenna L.; Gupta, Aryaman; Loh, Amos Hong Pheng; Sekabira, John; Fitzgerald, Tamara N.

doi:10.1007/s00464-020-08151-w

Cited by 19 publications

(19 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The included studies generally attributed less attention on reporting the training of surgeon and its impact on the outcomes. Several barriers to laparoscopic training already exist in low resource setting, and focussed training in gasless laparoscopy could simplify adoption of laparoscopy over open surgery [ 5 , 10 , 87 , 88 ]. In the absence of CO 2 pneumoperitoneum, several reviews and recently conducted RCT by Mishra and colleagues highlighted fewer peri-operative complications and better physiological tolerance with gasless technique [ 13 , 17 , 18 , 89 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

Background In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. Methods A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. Secondary outcomes: operative times and length of stay. The inverse variance random-effects model was used to synthesise data. Results 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45–2.40] or gynaecological surgery RR 0.66 [0.14–3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26–60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD − 18.74 [CI − 29.23, − 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD − 3.94 [CI − 5.93, − 1.95] and gynaecology MD − 1.75 [CI − 2.64, − 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. Conclusion Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Cholecystectomy and appendectomy were more common, with few surgeons using laparoscopy for complex cases. 15 Long-term outcomes are not as well understood among women with Mullerian anomalies who become pregnant. Among women with a unicornuate uterus, bicornuate uterus, or didelphys, the risk of preterm labor has been reported to be as high as 50%, 39%, and 33% respectively.…”

Section: Long-term Reproductive Considerationsmentioning

confidence: 99%

Diagnosis and Management of Mullerian Anomalies Across Differing Resource Settings: Worldwide Adaptations

Dietrich

2022

Journal of Pediatric and Adolescent Gynecology

View full text Add to dashboard Cite

“…A modified version of laparoscopy, gasless laparoscopy, has been proposed as an alternative to carbon dioxide laparoscopy and overcomes some of the barriers highlighted above [ 10 , 11 ]. It can be performed under spinal anaesthesia for selective abdominal procedures and without the need of carbon dioxide pneumoperitoneum [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…In the North-East of India, surgical provision is 5500 procedures per 100,000 population each year, with around one in eight procedures being potentially amenable to laparoscopic surgery [ 19 , 20 ]. There is an increasing interest amongst rural surgeons in India in gasless laparoscopy as a means to improve surgical outcomes [ 11 , 21 ]. A prerequisite is the need for formal training in the technique to ensure its safe implementation.…”

Section: Introductionmentioning

confidence: 99%

Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study

Aruparayil

Gnanaraj

Maiti³

et al. 2021

International Journal of Surgery Open

View full text Add to dashboard Cite

Background Benefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. Methods A 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. Results Seven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. Conclusion Structured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.

show abstract

Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study

Cited by 19 publications

References 43 publications

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

Diagnosis and Management of Mullerian Anomalies Across Differing Resource Settings: Worldwide Adaptations

Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study

Contact Info

Product

Resources

About