Chao Tiffany E, Mandigo Morgan, Opoku-Anane Jessica, Maine Rebecca
Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, GRB 425, Boston, MA, 02114, USA.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Surg Endosc. 2016 Jan;30(1):1-10. doi: 10.1007/s00464-015-4201-2. Epub 2015 Apr 15.
Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions.
A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed.
A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training.
LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.
腹腔镜检查可能被证明在资源有限的环境中满足手术需求是可行的。然而，关于腹腔镜检查在低收入和中等收入国家（LMICs）中的作用，尚无汇总数据。本研究旨在描述LMICs中腹腔镜检查面临的问题，并汇总已报道的解决方案。
使用Medline、非洲医学索引、开放获取期刊目录以及LILACS/BIREME/SCIELO数据库进行检索。纳入的研究为英文，发表于1992年之后，且报道了LMICs中腹腔镜检查的安全性、成本或结果。与关节镜检查、耳鼻喉科、软性内镜检查、宫腔镜检查、膀胱镜检查、计算机辅助手术、儿科、移植和肥胖症手术相关的研究被排除。通过提取分为三类的结果进行定性综合分析：在LMICs中实施腹腔镜检查的优势、挑战以及适应性措施。遵循系统评价的PRISMA指南。
共审查了1101篇摘要，纳入了58篇描述25个LMICs中腹腔镜检查的文章。腹腔镜检查在LMICs中特别具有优势，这些国家往往卫生条件差、诊断成像有限、病床较少、出血率较高、创伤率上升且家庭收入单一。缺乏训练有素的人员和设备是经常被提及的挑战。适应性策略包括使用室内空气进行机械充气、注射器抽吸、自制内镜圈套器、手辅助技术、体外打结、创新性地使用更便宜的器械以及重复使用一次性器械。基于实验室的廉价培训器和远程医疗对培训有效。
LMICs面临许多需要创新的手术挑战。腹腔镜手术在LMICs中可能是安全、有效、可行且具有成本效益的，尽管其可及性、可接受性和质量往往仍然有限。本研究可能未涵盖用英语以外的语言撰写的文章或未被纳入数据库索引的期刊上的文章。外科医生、政策制定者和制造商应关注LMICs中腹腔镜检查发展的可持续性计划、提供者的培训和留用以及监管工作。
