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Sustaining a laparoscopic program in resource-limited environments: results and lessons learned over 13 years in Botswana

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Abstract

Background

Metrics of sustainability and frank descriptions of the unique challenges, successes, failures, and lessons learned from a longitudinal laparoscopic program in resource-limited environments are lacking. We set out to evaluate the safety and sustainability of the laparoscopic cholecystectomy program at Princess Marina Hospital, the largest tertiary and teaching hospital in Botswana.

Methods

We assessed the clinical outcomes of patients who underwent laparoscopic cholecystectomy, comparing them with patients who underwent open cholecystectomy from January 2013 to December 2018. Technical independence and sustainability factors were measured and discussed.

Results

Two hundred and twenty-six laparoscopic cholecystectomies (LC) and 39 open cholecystectomies (OC) were performed. Four surgeons who trained as part of the inaugural laparoscopic program performed 48.2% of LC. Eleven surgeons who trained elsewhere performed the remainder. Overall, 94.2% of LC were performed without expatriate surgeons. The conversion rate was 25/226 (11.1%). There were 3 bile duct injuries in the LC group (3/226, 1.3%) and none in the OC group. There was one mortality in the OC group (1/39, 2.6%) and none in the LC group. Fostering a trusting relationship among all stakeholder was identified as the major key to success, while the development of a system-based strategy was identified as the most significant ongoing challenge.

Conclusion

The laparoscopic cholecystectomy program in Botswana initially established between 2006 and 2012 has moved into its sustainability phase, characterized by increased usage of laparoscopy and greater independent operating by local surgeons, all while maintaining patient safety. Sustaining a laparoscopic program in resource-limited environments has particular challenges which may differ from country to country.

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Acknowledgements

We thank the personnel at the Princess Marina Hospital Medical Records Unit in their assistance in data retrieval.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Princess Marina Hospital, University of Botswana, River Walk, Village, PO Box 45759, Gaborone, Botswana

    Alemayehu Ginbo Bedada

  2. Division of General Surgery, Royal Columbian Hospital, Vancouver, BC, Canada

    Marvin Hsiao

  3. Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada

    Georges Azzie

Authors
  1. Alemayehu Ginbo Bedada
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  2. Marvin Hsiao
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  3. Georges Azzie
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Contributions

All three authors designed the study. AGB collected the data. AGB and MH analyzed the data. AGB wrote the first draft manuscript. All three authors interpreted the data and agreed to publish the current version of the manuscript.

Corresponding author

Correspondence to Alemayehu Ginbo Bedada.

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Disclosure

Alemayehu Ginbo Bedada, Marvin Marvin, and Georges Azzie have no conflict of interest.

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Bedada, A.G., Hsiao, M. & Azzie, G. Sustaining a laparoscopic program in resource-limited environments: results and lessons learned over 13 years in Botswana. Surg Endosc 35, 3716–3722 (2021). https://doi.org/10.1007/s00464-020-07854-4

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  • DOI: https://doi.org/10.1007/s00464-020-07854-4

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