CHALLENGES AND PROSPECT OF LAPAROSCOPIC SURGERY IN A LOW RESOURCE SETTING : OUR EXPERIENCE AT FMC BIRNIN-KEBBI PRESENTED BY DR YUSUF TANKO SUNUNU (MBBS, FWACS, FMAS, DMAS) & DR ADAMU N AISHA (MBBS, FWACS, FMAS, DMAS) LAPAROSCOPIC SURGICAL UNIT FMC BIRNIN KEBBI AT SOGON ASABA 2014 PRE-CONFERENCE WORKSHOP

Outline Introduction Result of our Experience Challenges Overcoming Challenges Prospects Conclusion

Introduction Technological advancement has made it possible for many "open surgical" procedures to be done via endoscopic route. Laparoscopy has advantages of; Less postoperative pain Shorter duration of hospital stay Early return of patients to normal activities. Less post operative adhesion formation Precise definition of anatomy and pathology

Despite above advantages practice of laparoscopy in Nigeria is still rudimentary and is mainly diagnostic. Possible reasons are;  underfunding of healthcare  Cost of the service  Inadequacy of trained personnel  Reluctance of locally based Gynaecologist to change from the traditional method of surgery

Our Experiences Laparoscopic Surgical Unit was established in April, 2012 A total 60 surgeries have been done with 42 (70%) Gynaecological Out of the forty two cases 22 (57.14%) were operative and 18 (42.8 6%) were diagnostic The patient age ranges from16 to 37 years and mean age was 25.8 Complication were minimal with only 2 cases of Subcutaneous emphysema Conversion rate was 7.1% (N = 3)

Procedures Laparoscopy and dye test Laparoscopic ovarian drilling Lippes loop retrieval Adhesiolysis Ovarian cystectomy Laparoscopic Salpingectomy for ectopic pregnancy Laparoscopic bilateral tubal ligation Laparoscopic assisted Myomectomy Hysteroscopic adhesiolysis for Ashermans Syndrome nit has received 3 gynaecologists for hands on training

Challenges Patient factors Cost of the service to the patients leading to poor patient’s compliance Unyielding cervix Late presentation and so non-suitability of most patients that could benefit from laparoscopic surgery Provider factors include –  No centre provide all ranges of minimal access gynaecological procedures  Having to negotiate the a learning curve  Lack of interest for the procedure among other cadre of staff

Logistic issues  Maintenance of equipment – costly, expertise not readily available  Constant supply of electricity Systemic factors Independent laparoscopic surgical unit vs. combine theatre units Cost of providing laparoscopic surgical services to the hospital

Overcoming the Challenges Locally improvise instruments Use of reusable instruments as much as possible Use of hybrid or clone laparoscopic machine Subsidising cost to the patients Provision of alternative sources of power supply Proper patient selection Respect for learning curve Encouraging team work among Gynaecologist, surgeons and other stake holders

Prospect Prospect for laparoscopy in gynaecological practice in Nigeria is good However may require ; Institutional collaborations Incorporation of laparoscopy in our postgraduate training curricula Capital investment in man power development and equipments Creating awareness among patients Formation of National and Regional Association of Laparoscopic surgeons

Conclusion Despite challenges practise of laparoscopic surgery in a low resource setting is possible. It requires more interest in acquisition of new skills by our surgeons, more financial commitment from our health care managers, and a raised awareness on its advantages to our patients/clients. With these achieved, the prospect of laparoscopic surgery in low resource settings is good

Teckno Laparoscopic Tower and Machine

Laparoscopic Session

Slow leaking ectopic gestation uss findings

Day 5 post op following laparoscopic salpingectomy

Improvised fluid delivery system for hysteroscopy

Thank you for listening

References Perissat J. Laparoscopic surgery: A pioneer's point of view. World J Surg 1999;23: Garry R. Gynaecological Endoscopy. The next 10 years; Editorial, Gynae. Endos. 2002; 11:1-3. Bittner R. Laparoscopic surgery – 15years after clinical introduction. World J Surg 2006; 30: 1190– 1203.