Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda.
School of Medicine, University of Global Health Equity, Kigali, Rwanda.
Surg Endosc. 2023 Jul;37(7):5121-5128. doi: 10.1007/s00464-023-09985-w. Epub 2023 Mar 17.
The adoption and accessibility of laparoscopy have been serious issues in countries with limited resources, and for varied reasons. This study assessed resource capacity and barriers to the effective practice of laparoscopic surgery in training hospitals affiliated with the College of Surgeons of East, Central and Southern Africa (COSECSA).
A multi-country survey was conducted from January 2021 to October 2021 using a questionnaire distributed to surgeons in COSECSA hospitals located in 16 different countries. Available resources and surgical volume were assessed, and the barriers to routinely performing laparoscopy were determined.
Ninety-four surgeons working in 44 different hospitals from 16 countries participated in the survey. The majority of respondents were general surgeons (n = 75, 79.7%). Other specialties included urology (n = 12, 12.8%) and pediatric surgery (n = 7, 7.4%). Senior surgeons accounted for 60.6% of participants, more than 40% had a managerial position and approximately 20% were surgical trainees. Most respondents practiced in public hospitals (n = 66, 70.2%). A median of three surgeons per hospital performed laparoscopic surgery with, on average, two laparoscopic towers and two sets of laparoscopic instruments available. A median of 10 procedures was carried out per month. The cost of laparoscopic procedures and laparoscopic consumables were reported as being covered by some health insurance payments in 76.9% and 48.4% of cases, respectively. Cholecystectomy was the most commonly reported laparoscopic procedure performed. The five top barriers to performing laparoscopic surgery were: a lack of consumables, a limited quantity of equipment, a lack of skilled surgeons, the high cost of laparoscopic procedures and complicated cases. In addition, having access to skilled anesthesiologists and anesthesia equipment, carbon dioxide, a consistent electric power supply and equipment maintenance were cited as significant challenges.
The practice of laparoscopy is currently limited in COSECSA countries due to a scarcity of skilled staff and the lack of a funding plan to make laparoscopic services accessible. Therefore, policymakers and stakeholders should take strategic measures to respond to this need.
在资源有限的国家，由于各种原因，腹腔镜的采用和普及一直是一个严重的问题。本研究评估了东、中、南部非洲外科学院（COSECSA）附属培训医院有效实施腹腔镜手术的资源能力和障碍。
2021 年 1 月至 2021 年 10 月，对 COSECSA 医院的外科医生进行了一项多国家调查，使用问卷进行调查。评估了可用资源和手术量，并确定了常规进行腹腔镜手术的障碍。
来自 16 个国家的 44 家不同医院的 94 名外科医生参与了调查。大多数受访者是普通外科医生（n=75，79.7%）。其他专业包括泌尿科（n=12，12.8%）和小儿外科（n=7，7.4%）。资深外科医生占参与者的 60.6%，超过 40%的人担任管理职位，约 20%的人是外科学员。大多数受访者在公立医院工作（n=66，70.2%）。每家医院平均有 3 名外科医生进行腹腔镜手术，平均有 2 个腹腔镜塔和 2 套腹腔镜器械。每月平均进行 10 例手术。腹腔镜手术的费用和腹腔镜耗材的费用分别有 76.9%和 48.4%的情况下由部分健康保险支付。胆囊切除术是报告的最常见的腹腔镜手术。进行腹腔镜手术的前 5 大障碍是：耗材缺乏、设备数量有限、缺乏熟练的外科医生、腹腔镜手术费用高和复杂病例。此外，获得熟练的麻醉师和麻醉设备、二氧化碳、稳定的电力供应和设备维护也被认为是重大挑战。
由于熟练人员短缺和缺乏使腹腔镜服务普及的资金计划，COSECSA 国家目前腹腔镜手术的应用受到限制。因此，政策制定者和利益相关者应采取战略措施来满足这一需求。
