Establishing a Contextually Appropriate Laparoscopic Program in Resource-restricted Environments Experience in Botswana
Establishing a Contextually Appropriate Laparoscopic Program in Resource-restricted Environments Experience in Botswana
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DOI：
10.1097/sla.0000000000000691
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发表时间：
2015-04-01
影响因子：
9
通讯作者：
Azzie, Georges
中科院分区：
文献类型：
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作者：
Bedada, Alemayehu G.;Hsiao, Marvin;Azzie, Georges
目的：在资源有限的环境中建立可持续的腹腔镜项目的可行性存在意见分歧。应博茨瓦纳当地外科医生和卫生部的要求，建立了一个培训计划，以协助当地同事进行腹腔镜手术。我们回顾了我们的多方面和不断发展的国际合作，并强调这些因素，帮助或阻碍了这个program.Methods：从2006年至2012年，一个培训计划，包括教学教学，远程模拟，腹腔镜手术认证的基础，每年的研讨会，并持续指导成立。我们评估了接受腹腔镜胆囊切除术的患者的临床结局，比较他们与接受开放式胆囊切除术的患者，并测量技术独立性和程序可持续性的指标。结果：12名外科医生参加了培训计划，并进行了270 288腹腔镜胆囊切除术。96例开放病例由这些外科医生和另外5名外科医生进行。中转开腹15例（5.2%）。腹腔镜组术后平均住院时间明显短于开腹组（1天vs 7天，P < 0.001）。随着培训计划的进展，腹腔镜手术完成的比例没有外籍外科医生出席显着增加（P = 0.001）。结论：一个上下文适当的长期合作伙伴关系可能有助于腹腔镜技能提升的同事在低收入和中等收入国家。这种类型的合作促进了地方自主权，并可能转化为与腹腔镜手术相关的更好的患者结局。在资源有限的环境中，威胁可持续性的因素可能不同于高收入国家的因素，应加以查明和解决。
Objective: Differences in opinion exist as to the feasibility of establishing sustainable laparoscopic programs in resource-restricted environments. At the request of local surgeons and the Ministry of Health in Botswana, a training program was established to assist local colleagues with laparoscopic surgery. We reviewed our multifaceted and evolving international collaboration and highlighted those factors that have helped or hindered this program.Methods: From 2006 to 2012, a training program consisting of didactic teaching, telesimulation, Fundamentals of Laparoscopic Surgery certification, yearly workshops, and ongoing mentorship was established. We assessed the clinical outcomes of patients who underwent laparoscopic cholecystectomy, comparing them with patients who underwent open cholecystectomy, and measured the indicators of technical independence and program sustainability.Results: Twelve surgeons participated in the training program and performed 270 of 288 laparoscopic cholecystectomies. Ninety-six open cases were performed by these and 5 additional surgeons. Fifteen laparoscopic cases were converted (5.2%). The median postoperative length of hospital stay was significantly shorter in the laparoscopic group than in the open group (1 day vs 7 days, P < 0.001). As the training program progressed, the proportion of laparoscopic cases completed without an expatriate surgeon present increased significantly (P = 0.001).Conclusions: A contextually appropriate long-term partnership may assist with laparoscopic upskilling of colleagues in low-and middle-income countries. This type of collaboration promotes local ownership and may translate into better patient outcomes associated with laparoscopic surgery. In resource-restricted environments, the factors threatening sustainability may differ from those in high-income countries and should be identified and addressed.