Ten years of laparoscopic cholecystectomy: A comparison between a developed and a less developed country

Brekalo, Zdrinko; Innocenti, Paolo; Duzel, Goran; Liddo, Guido; Ballone, Enzo; Šimunović, Vladimir J.

doi:10.1007/s00508-007-0906-0

Cited by 15 publications

(28 citation statements)

References 11 publications

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“…[12] These programmes are a priority for developing country health systems. [345] In Morocco, initial education and training of future general surgeons are provided by a residency programme of 6 years following medical school that includes laparoscopy training since 1992. Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training.…”

Section: Introductionmentioning

confidence: 99%

Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country

et al. 2017

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INTRODUCTION:Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes.OBJECTIVE:The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC.DESIGNS AND SETTINGS:We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco.PARTICIPANTS:These operations were performed by junior residents (post-graduate year [PGY] 4–5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien–Dindo classification) were recorded and analysed. One-way analysis of variance, Student's t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05.RESULTS:One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001).CONCLUSION:LC performed by residents appears to be safe without a significant difference in complication rate; however, seniority influences operative time. This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.

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Section: Introductionmentioning

confidence: 99%

Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country

et al. 2017

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“…Several studies in developing nations have documented both the feasibility and safety of performing laparoscopic cholecystectomies. [9][10][11] With careful patient selection, the safety of sameday laparoscopic cholecystectomy has also been established. 1,12,13 The majority of this experience has been carried out in tertiary care centers and has not been well studied in rural centers.…”

Section: Discussionmentioning

confidence: 99%

A Successful Model for Laparoscopic Training in Mongolia

Vargas

Price

Sergelen

et al. 2013

International Surgery

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The benefits of laparoscopic surgery have not been available to the majority of Mongolians. Mongolian surgical leaders requested assistance in expanding laparoscopy. A capacity-building approach for teaching laparoscopic cholecystectomy throughout Mongolia is reviewed. A laparoscopic cholecystectomy training program was developed. The program included a didactic course and an intensive 2-week practical operating experience. Courses were taught in Ulaanbataar and at 3 of the 4 regional diagnostic referral and treatment centers from 2006 to 2010. During this training period, a total of 303 teaching laparoscopic cholecystectomies were performed. There was one common bile duct injury and one duodenal injury. The conversion rate was 2.0%. This program has been successful in creating a self-sustaining practice of training. The traditional surgical approach to gallbladder disease in Mongolia has been challenged and has, in turn, been a stimulus for improvement in the medical community.

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“…Laparoscopy programs in LMICs face numerous limitations including a lack of skilled providers; increased operating time; limited resources, equipment, and maintenance capacity; and absence of safe procedure guidelines [679111213212425]. To date, the primary model to develop a laparoscopy program in a LMIC is via partnering with a surgical program in a HIC, where the HIC institution facilitates personnel training, equipment procurement, and clinical guideline development [1289102125].…”

Section: Current Laparoscopy Program Shortcomingsmentioning

confidence: 99%

“…This model fails to address the aforementioned shortcomings, resulting in foreseeable challenges. Programs offering intermittent in-country clinical support may result in inadequate training and program discontinuation after training concludes [1212425]. General or gynecologic surgery teams implementing programs in isolation create resource inefficiencies and reduced economies of scale [14924].…”

Section: Current Laparoscopy Program Shortcomingsmentioning

confidence: 99%

Improving Access to Laparoscopy in Low-Resource Settings

Rosenbaum

Maine

2019

Annals of Global Health

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Laparoscopy has numerous clinical benefits compared to laparotomy. However, a functional laparoscopy program requires significant investment and, as a result, remains unavailable for the majority of the world’s population in low- and middle-income countries. The effort to bring laparoscopy to low-resource settings has produced variable outcomes resulting from the challenges inherent to a complex surgical program. This paper highlights these shortcomings and identifies opportunities to improve future laparoscopy programs.

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Ten years of laparoscopic cholecystectomy: A comparison between a developed and a less developed country

Cited by 15 publications

References 11 publications

Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country

Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country

A Successful Model for Laparoscopic Training in Mongolia

Improving Access to Laparoscopy in Low-Resource Settings

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