Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Souther
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and Other Interventional Techniques
Laparoscopic experience and attitudes toward a low‑cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study Norma E. Farrow1 · Sarah J. Commander1 · Christopher R. Reed1 · Jenna L. Mueller2 · Aryaman Gupta2 · Amos H. P. Loh3,4 · John Sekabira5 · Tamara N. Fitzgerald1,6 Received: 1 September 2020 / Accepted: 4 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Laparoscopic surgery has become standard of care in high-income countries but is rarely accessible in lowand 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. Keywords Low-cost laparoscopy · Global surgery · Gasless laparoscopy · Surgery in Africa * Tamara N. Fitzgerald [email protected] 1
Department of Surgery, DUMC, Duke University, Box 3815, Durham, NC 27710, USA
2
Department of Biomedical Engineering, Duke University, Durham, NC, USA
3
Department of Paediatric Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
4
Duke NUS Medical School, SingHealth Duke NUS Global Health Institute, Singapore, Singapore
5
Pediatric Surgery Unit, Mulago Hospital, Kampala
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