G. E. Hsiung1,2, G. Ortega4, F. Abdullah1,2, D. Rhee5, K. A. Barsness1,2 1Northwestern University,Department Of Surgery,Chicago, IL, USA 2Ann And Robert H. Lurie Children’s Hospital Of Chicago,Division Of Pediatric Surgery,Chicago, IL, USA 3Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA 4Howard University College Of Medicine,Outcomes Research Center, Department Of Surgery,Washington, DC, USA 5Memorial Sloan-Kettering Cancer Center,Division Of Pediatric Surgery,New York, NY, USA
Introduction:
There is a paucity of evidence regarding the existing utilization of minimally-invasive surgery in resource-limited settings. With an estimated one-third of the global burden of disease still attributed to treatable surgical conditions and a growing prioritization of surgical care among the global community, we sought to determine the local usage of minimally-invasive surgical techniques and to develop and implement a minimally-invasive surgical curricula in a resource-limited setting.
Methods:
After IRB exemption was determined, a 25-item needs assessment questionnaire was designed with expert consultation to determine the utilization and availability of minimally-invasive surgical equipment and techniques for five operations (appendectomy, hernia repair, small bowel resection, Nissen fundoplication and cholecystectomy). During a minimally-invasive surgery course held in May 2016 in Accra, Ghana, twenty participants received technical and non-technical instruction using a pre-designed curriculum that included didactics and operative mentorship. Participants took a 10-item pre-test that assessed their comfort level with minimally-invasive surgery, as well as a post-test upon successfully completing the curricula.
Results:
Although the curricula was developed for physicians, only 20% of participants were physicians while 80% of participants were nurses representing 5 hospitals in two countries – Ghana and Nigeria. More than three-fourths of participants were not comfortable with performing the five operations we inquired about and one-third of participants did not feel comfortable with patient selection for minimally invasive surgical procedures. Only 10% of participants had performed more than 20 laparoscopic procedures. The leading three barriers to performing minimally-invasive surgery were expense, unfamiliarity with surgical technique and lack of equipment. All participants were interested in participating in ongoing telementoring.
Conclusion:
There is the desire for more training and education in minimally-invasvie surgery even in resource-limited settings. Lessons learned included the importance of performing a priori needs assessment in designing a curricula that would meet the local needs based on resource availability and training.