The History of Laparoscopic General Surgery in the Caribbean

Abstract

Objective: The first world witnessed a laparoscopic revolution in the 1990s. At the start, laparoscopic surgery was heavily criticized and ridiculed. Despite this, the specialty has blossomed where almost any procedure can be done laparoscopically with the now obvious tremendous benefit to the patients. The objective of this paper is to examine where the Caribbean is placed relative to the rest of the world in terms of laparoscopic surgery and to understand why we are here. Design and Methods: The literature written on laparoscopy in the region was reviewed and contributions were taken from key surgeons in three main islands, Trinidad and Tobago, Barbados and Jamaica. Results: Though the first laparoscopic cholecystectomy in the Caribbean, in most islands, took place in the early 1990s like the rest of the world, there was relative dormancy for at least a decade in Trinidad and Tobago and even longer in other islands with regards to implementing advanced procedures or increasing case volumes. Reasons for this included lack of funding, lack of operating time in public facilities, lack of information of the public and the medical fraternity but most importantly lack of trained laparoscopic surgeons. This last factor was proven to be the key one in Trinidad and Tobago in 2003, Jamaica 2005 and Barbados 2011, when the return of trained personel engineered the transition from basic to advanced laparoscopy. Conclusion: Despite the delay of approximately 10 years in Trinidad and Tobago and 15 years in other islands, the return of trained surgeons has seen a rapid increase in case variety and volumes in laparoscopy. The wheels of motion of the laparoscopic revolution in the Caribbean have finally begun. RESUMENObjetivo: El primer mundo fue testigo de una revolución laparoscópica en los años 1990. Al comienzo, la cirugía laparoscópica fue muy criticada y ridiculizada. A pesar de ello, la especialidad ha florecido, siendo el caso que ahora casi cualquier procedimiento puede hacerse laparoscópicamente, con evidentes grandes beneficios para los pacientes. El objetivo de este trabajo es examinar donde se encuentra el Caribe en relación con el resto del mundo en lo que se refiere a la cirugía laparoscópica, y asimismo el por qué nos hallamos en ese lugar. Diseño y Métodos: Se examinó la literatura sobre laparoscopia escrita en la región, y se tomaron contribuciones de cirujanos claves de tres islas principales, a saber, Trinidad y Tobago, Barbados y Jamaica. Resultados: Aunque las primeras colecistectomías laparoscópicas en la mayoría de las islas del Caribe, tuvieron lugar a principio de los años 1990 como en el resto del mundo, hubo un período de relativa inactividad por espacio de casi una década en Trinidad y Tobago, y aun por más largo tiempo en otras islas, en relación con la implementación de procedimientos avanzados o el aumento del volumen de casos. Las razones para esta relativa inactividad incluyeron la falta de fondos, la falta de tiempo de operación de los centros públicos, la falta de información del público y l...

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

“…This “laparoscopic revolution” was fueled by advancements in hardware, instrumentation, and technology. However, the Caribbean did not follow the global trend toward laparoscopy 2. As an example, only 23% of all cholecystectomies were attempted by the laparoscopic approach in the most populous country in the English-speaking Caribbean in the year 2013 3.…”

“…This situation existed because most Caribbean countries were low- or middle-income nations that did not have the financial resources to support laparoscopic practice 2,4. There were also many “self-imposed obstacles” such as deficiencies in surgical leadership,5 lack of prioritization by policy makers,2,5 and the “sole practitioner culture”6 that prevailed in the Caribbean.…”

Pancreatic pseudocyst: combined single incision laparoscopic cystogastrostomy and cholecystectomy in a resource poor setting

“…We practice in a low resource environment where the laparoscopic revolution is still in its infancy and procurement of specialized equipment is not prioritized [9]. Therefore, we did not have any specialized equipment at our disposal.…”

Advancement of laparoscopic surgery in Guyana: a working model for developing countries

“…Since the 1990s, there was a global thrust toward laparoscopic surgery that was shown to improve surgical outcomes,5 but this was not realized in Guyana. The first recorded laparoscopic operation in Guyana was a cholecystectomy performed by Persaud and Amir in 2002 at a private hospital 3.…”

“…The lobby group recognized that the cost of consumables for advanced laparoscopy was a major limitation across the entire Caribbean region 5. They also recognized that surgeons in the Caribbean had become innovative in order to reduce the number of consumables required for laparoscopic operations 8–14.…”