Abstract
Background:Healthcare equipment funded by international partners is often not properly utilized in many developing countries due to low levels of awareness and a lack of expertise. A long-term on-site training program for laparoscopic surgery was established at a regional hospital in Ghana upon request of the Ghana Health Service and local surgeons.Objective:The authors report the initial 32-month experience of implementing laparoscopic surgery focusing on the trainees’ response, technical independence, and factors associated with the successful implementation of a “new” surgical practice.Methods:Curricular structure and feedback results of the trainings for doctors and nurses, and characteristics of laparoscopic procedures performed at the Greater Accra Regional Hospital between January 2017 and September 2019 were retrospectively reviewed.Findings:Comprehensive training including two weeks of simulation workshops followed by animal labs were regularly provided for the doctors. Among the 97 trainees, 27.9% had prior exposure in laparoscopic surgery, 95% were satisfied with the program. Eleven nurses attained professional competency over 15 training sessions where none had prior exposure to laparoscopic surgery. Since the first laparoscopic cholecystectomy in February 2017, 82 laparoscopic procedures were performed. The scope of the surgery was expanded from general surgery (n = 46) to gynecology (n = 33), pediatric surgery (n = 2), and urology (n = 1). The volume of local doctors as primary operators increased from 0% (0/17, February to December 2017) to 41.9% (13/31, January to October 2018) and 79.4% (27/34, November 2018 to September 2019), with 72.5% of the cases being assisted by the expatriate surgeon. There were no open conversions, technical complications, or mortalities. Local doctors independently commenced endoscopic surgical procedures including cystoscopies, hysteroscopies, endoscopic neurosurgeries and arthroscopies.Conclusion:Sensitization and motivation of the surgical workforce through long-term continuous on-site training resulted in the successful implementation of laparoscopic surgery with a high level of technical independence.
Highlights
Despite the fact that approximately 25~30% of the global burden of disease is surgical, surgical care in the field of global health is often not prioritized [1]
Training of the nursing staff for the use and maintenance of the equipment Theater nurses at the Greater Accra Regional Hospital (GARH) did not have any prior exposure to laparoscopic surgery before 2016
A steep increase in primary operators among local doctors reflected the progression of technical independence, which is essential for long-term sustainability but difficult to attain over a short time period [21]
Summary
Despite the fact that approximately 25~30% of the global burden of disease is surgical, surgical care in the field of global health is often not prioritized [1]. Mongolia’s success in its nationwide expansion of laparoscopy revealed its impact in achieving “sustainable progress” for healthcare providers and gaining patients’ trust in healthcare [8] This implies that the impact of introducing an advanced surgical treatment modality improves surgeons’ surgical skills or patients’ direct benefits, and more importantly, motivates the surgical workforce and strengthens the health system as a whole [3, 8]. A long-term on-site training program for laparoscopic surgery was established at a regional hospital in Ghana upon request of the Ghana Health Service and local surgeons. Conclusion: Sensitization and motivation of the surgical workforce through long-term continuous on-site training resulted in the successful implementation of laparoscopic surgery with a high level of technical independence
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