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

Surgical Endoscopy volume 35, pages 6539–6548 (2021)Cite this article

Abstract

Background

Laparoscopic surgery has become standard of care in high-income countries but is rarely accessible in low- and middle-income countries (LMICs). This study assessed experience with laparoscopy and attitudes toward a low-cost laparoscopic system among surgeons in sub-Saharan Africa.

Methods

A survey assessing current laparoscopic practice and feedback on a low-cost laparoscopic system was administered to attendees of the College of Surgeons of East, Central, and Southern Africa (COSECSA) Scientific Conference between December 4 and December 6, 2019 in Kampala, Uganda.

Results

Fifty-six surgeons from 14 countries participated. A majority were male (n = 46, 82%) general surgeons (n = 37, 66%) from tertiary/teaching hospitals (n = 36, 64%). For those with training in laparoscopy (n = 33, 59%), 22 (67%) reported less than 1 year of training and over half (n = 17, 52%) reported 1 month or less. Overall, a minority (n = 21, 38%) used laparoscopy in current practice, with 57% (n = 12) of those performing laparoscopy less than once per week. The most common laparoscopic surgeries performed were cholecystectomy (n = 15), diagnostic laparoscopy (n = 14), and appendectomy (n = 12). Few surgeons were performing more complex cases (n = 5). Barriers to laparoscopy included poor access to training equipment (n = 34, 61%), mentors (n = 33, 59%), laparoscopic equipment (n = 31, 55%), equipment maintenance (n = 25, 45%), access to consumable supplies (n = 21, 38%), and cost (n = 31, 55%). Fifty-two participants (93%) were interested in increasing their use of laparoscopy; the majority felt that a low-cost laparoscope (n = 52, 93%) and lift retractor for gasless laparoscopy (n = 46, 82%) would serve an unmet need in their practice.

Conclusions

While the use of laparoscopy is currently limited in COSECSA countries, there is a significant interest among surgeons to increase implementation. A low-cost, durable laparoscopic system was viewed as a potential solution to the current barriers and could improve implementation in LMICs.

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Acknowledgements

This work was supported by the Bass Connections Program at Duke University and by a Duke/Duke-NUS Pilot Project Grant.

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Authors and Affiliations

  1. Department of Surgery, DUMC, Duke University, Box 3815, Durham, NC, 27710, USA

    Norma E. Farrow, Sarah J. Commander, Christopher R. Reed & Tamara N. Fitzgerald

  2. Department of Biomedical Engineering, Duke University, Durham, NC, USA

    Jenna L. Mueller & Aryaman Gupta

  3. Department of Paediatric Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore

    Amos H. P. Loh

  4. Duke NUS Medical School, SingHealth Duke NUS Global Health Institute, Singapore, Singapore

    Amos H. P. Loh

  5. Pediatric Surgery Unit, Mulago Hospital, Kampala, Uganda

    John Sekabira

  6. Duke Global Health Institute, Duke University, Durham, NC, USA

    Tamara N. Fitzgerald

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  1. Norma E. Farrow
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Correspondence to Tamara N. Fitzgerald.

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Disclosures

Dr. Mueller is an employee of Calla Health Foundation. Dr. Mueller, Mr. Gupta, and Dr. Fitzgerald have patents pending for laparoscopic technology designed for low- and middle-income countries. Dr. Farrow, Dr. Commander, Dr. Reed, Dr. Loh, and Dr. Sekabira have no conflicts of interst of financial ties to disclose.

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Appendix: Survey questions

Appendix: Survey questions

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Farrow, N.E., Commander, S.J., Reed, C.R. et al. Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study. Surg Endosc 35, 6539–6548 (2021). https://doi.org/10.1007/s00464-020-08151-w

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Keywords

  • Low-cost laparoscopy
  • Global surgery
  • Gasless laparoscopy
  • Surgery in Africa