Laparoscopy in Rwanda: A National Assessment of Utilization, Demands, and Perceived Challenges.

Authors:
Faith Robertson
Faith Robertson
Harvard Medical School
Zeta Mutabazi
Zeta Mutabazi
School of Medicine and health sciences/University of Rwanda
Dr
Kigali, Kigali City | Rwanda
Patrick Kyamanywa
Patrick Kyamanywa
University of Virginia School of Medicine
United States
Georges Ntakiyiruta
Georges Ntakiyiruta
University of Virginia Health System
United States
Sanctus Musafiri, PhD
Sanctus Musafiri, PhD
National University of Rwanda
Professor (Associate)
Respiratory Medicine
Kigali, Rwanda | Rwanda
Tim Walker
Tim Walker
Geelong Hospital
Australia
Constance Mukabatsinda
Constance Mukabatsinda
Centre Hospitalier Universitaire

World J Surg 2019 Feb;43(2):339-345

Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.

Background: Laparoscopy has proven to be feasible and effective at reducing surgical morbidity and mortality in low resource settings. In Rwanda, the demand for and perceived challenges to laparoscopy use remain unclear.

Methods: A mixed-methods study was performed at the four Rwandan national referral teaching hospitals. Retrospective logbook reviews (July 2014-June 2015) assessed procedure volume and staff involvement. Web-based surveys and semi-structured interviews investigated barriers to laparoscopy expansion.

Results: During the study period, 209 laparoscopic procedures were completed: 57 (27.3%) general surgery cases; 152 (72.7%) ob/gyn cases. The majority (58.9%, 125/209) occurred at the private hospital, which performed 82.6% of cholecystectomies laparoscopically (38/46). The three public hospitals, respectively, performed 25% (7/28), 15% (12/80), and 0% (denominator indeterminate) of cholecystectomies laparoscopically. Notably, the two hospitals with the highest laparoscopy volume relied on a single surgeon for more than 85% of cases. The four ob/gyn departments performed between 4 and 87 laparoscopic cases (mostly diagnostic). Survey respondents at all sites listed a dearth of trainers as the most significant barrier to performing laparoscopy (65.7%; 23/35). Other obstacles included limited access to training equipment and courses. Equipment and material costs, equipment functionality, and material supply were perceived as lesser barriers. Twenty-two interviews revealed widespread interest in laparoscopy, insufficient laparoscopy exposure, and a need for trainers.

Conclusion: While many studies identify cost as the most prohibitive barrier to laparoscopy utilization in low resource settings, logbook review and workforce perception indicate that a paucity of trainers is currently the greatest obstacle in Rwanda.

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http://dx.doi.org/10.1007/s00268-018-4797-1DOI Listing
February 2019
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References

(Supplied by CrossRef)
Article in Surg Endosc
MM Tiwari et al.
Surg Endosc 2011
Article in Dis Control Prior
P Shankar et al.
Dis Control Prior 2015
Article in Surg Endosc
N Stylopoulos et al.
Surg Endosc 2003

SN Bickler et al.
2015
Article in J Laparoendosc Surg
YY Basha et al.
J Laparoendosc Surg 1995
Article in Surg Endosc
C Bendinelli et al.
Surg Endosc 2002
Article in Wien Klin Wochenschr
Z Brekalo et al.
Wien Klin Wochenschr 2007
Article in Postgrad Med J
S Bal et al.
Postgrad Med J 2003
Article in Ann Surg
S Contini et al.
Ann Surg 2010
Article in East Cent Afr J Surg
MJJ Galukande et al.
East Cent Afr J Surg 2011
Article in World J Surg
R Price et al.
World J Surg 2013

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