Department of Surgery, Obafemi Awolowo University, Ile-Ife 220005, Nigeria.
Surg Endosc. 2013 Feb;27(2):390-3. doi: 10.1007/s00464-012-2463-5. Epub 2012 Jul 18.
Establishing and sustaining the routine practice of laparoscopy in resource-limited settings is extremely challenging. We present our experience implementing laparoscopic surgery at the Obafemi Awolowo University Teaching Hospital in Western Nigeria and the associated modifications that were necessary for success.
We reviewed all laparoscopic cases performed at our institution from January 2009 through December 2011. Operating surgeons were trained locally. Laparoscopic equipment and instrumentation was procured by both local and foreign sources.
One hundred eighty-one procedures were performed in 175 patients whose ages ranged between 18 and 72 years. The procedures included cholecystectomies (n = 48, 24.5 %), appendectomies (n = 36, 20 %), diagnostic laparoscopies for staging and biopsy of intra-abdominal masses (n = 53, 30.9 %), adhesiolyses (n = 18, 11.6 %), hernia repairs (n = 6, 3.2 %), colorectal surgeries (n = 2, 1.3 %), and others (n = 18, 8.4 %). Diagnostic procedures were performed as day cases. Duration of stay for hospital admissions was 1-3 days. There were four conversions to open operation due to technical difficulties with equipment. No deaths were recorded. Local adaptation techniques facilitated cost reduction. Overall, there was improvement in the acceptance of the laparoscopic procedures among our patients and coworkers.
Our local institution has successfully adopted laparoscopic techniques to treat surgical diseases. Specific improvisations have helped establish and sustain this technology. We advocate similar local adaptations to increase the use of laparoscopic surgery in hospitals located in limited resource settings.
在资源有限的环境中建立和维持腹腔镜常规实践极具挑战性。我们介绍了在尼日利亚西部奥巴费米·阿沃洛沃大学教学医院实施腹腔镜手术的经验，以及为取得成功而进行的必要修改。
我们回顾了 2009 年 1 月至 2011 年 12 月在我们机构进行的所有腹腔镜手术。手术医生在当地接受培训。腹腔镜设备和器械通过本地和外国渠道采购。
在 175 名年龄在 18 至 72 岁的患者中进行了 181 例手术。手术包括胆囊切除术（n = 48，24.5%）、阑尾切除术（n = 36，20%）、诊断性腹腔镜检查以分期和活检腹腔内肿块（n = 53，30.9%）、粘连松解术（n = 18，11.6%）、疝修补术（n = 6，3.2%）、结直肠手术（n = 2，1.3%）和其他手术（n = 18，8.4%）。诊断性手术作为日间手术进行。住院时间为 1-3 天。由于设备技术困难，有 4 例转为开放性手术。无死亡病例。本地适应技术有助于降低成本。总体而言，我们的患者和同事对腹腔镜手术的接受程度有所提高。
我们的本地机构已成功采用腹腔镜技术治疗外科疾病。具体的改进有助于建立和维持这项技术。我们提倡类似的本地适应措施，以增加位于资源有限环境中的医院对腹腔镜手术的使用。
