Closing gap: Improving laparoscopy access

As a urologist it has always been a privilege for me to operate on my patients.

However, every time I create a large incision and leave a big scar on a patient’s abdomen, I am a little disheartened about the severity of surgical trauma the patient suffers and the cosmetic effects of that big scar on the patient.

This is especially troubling as I know that with laparoscopy (key hole surgery), they would recover much quicker and have a less noticeable scar.

In most parts of the world, operating on the body through big surgical cuts which was recognised as the “gold standard” of practice in the mid- 20th Century, has been replaced by the use of devices to operate through very small (key hole) surgical cuts.

Surgery performed in the abdomen using this key hole technique is known as laparoscopy.

Laparoscopy is commonly used for abdominal surgeries like gall bladder removal, appendix removal, hernia repair and many others.

When compared to surgery using big cuts, laparoscopy is beneficial as it results in reduced blood loss, requires less for pain management, leads to decreased wound complications, and facilitates faster mobilisation and recovery – which also reduces the length of hospital stay and facilitates early return to work.

Laparoscopy

Laparoscopy uses magnification and this decreases the risk of injury to vital structures in the abdomen, especially in children in whom important tiny structures like the vas deferens can easily get injured during open hernia surgery.

As patients spend less time in hospital, fewer consumables and human resources are spent on them and hospital beds are freed up for other patients awaiting surgery, reducing hospital expenditure and thus, improving revenue for the hospitals.

In a country challenged by limited access to blood transfusion, clean water and poor living conditions, surgeries requiring small cuts should be prioritised.

Moreso, if one imagines that for almost every patient on hospital admission in this country, there are at least two relatives staying with him at the hospital, often under very poor living conditions, to assist with his care, laparoscopic surgery is very valuable as patients and their caregivers return home and to work earlier than after big cut surgery.

The limited use of laparoscopic surgery in Ghana is mainly due to the lack of skilled expertise and unavailability of laparoscopic equipment.

These are key areas that need to be addressed to advance laparoscopy in the country and unlock its full potential.

Training, education

Training and education are paramount for the successful implementation of laparoscopy in Ghana.

There is evidence that surgery residents who receive training in laparoscopy are more likely to perform laparoscopic surgeries when they graduate as compared to those who do not receive any training in laparoscopy.

The examples of Botswana and Nepal show that even in resource poor countries, the training of surgeons in laparoscopy influences the provision of laparoscopic equipment in the hospitals and eventually leads to the widespread use of laparoscopic surgery to the benefit of surgery patients.

International Surgery Day

This is the week of the May 25, which is International Surgery Day and also the 60th anniversary of the formation of the Organisation of African Unity (the precursor to our African Union).

It is a day steeped in our history because it signifies the importance of collectively working together for Africa’s development.

On Africa Day, it is important to recognise the role that medical advancements such as laparoscopy can play in improving the health and well-being of African populations, and in promoting economic growth and development across the continent.

By investing in the development and adoption of advanced medical technologies like laparoscopy, Africa can work towards achieving its goals of improving healthcare and reducing poverty as espoused in Agenda 2063: The Africa We Want.

College Physicians, Surgeons

The Ghana College of Physicians and Surgeons needs to equip locally trained surgeons with laparoscopy skills.

Ghanaian surgeons practicing abroad should collaborate with the College and help train local surgeons on some of these new techniques.

Government and healthcare facilities should invest in laparoscopic infrastructure and equipment.

To reduce costs, we can develop similar technology that is equally effective but more affordable.

This may require extensive collaboration between the medical society and biomedical engineers to develop home-grown technology fit for purpose.

Finally, Ghanaians should inform themselves of current global trends in surgery and demand for the most effective technologies from their healthcare providers as lack of patient demand has also contributed to the slow development of surgical technologies like laparoscopy in Ghana.

In the immortal words of Dr Kwame Nkrumah, our first president and one of the founding fathers of African Unity, “Our independence is meaningless unless it is linked up with the total liberation of the African continent”, it’s time for Ghana to lead West Africa with advanced medical technologies like laparoscopy.

— The writer is an urologist at Cape Coast Teaching Hospital; Global Surgery Advocacy Fellow with Operation Smile, University of Global Health Equity & Nkafu Policy Institute