Programme for Training and Research in Laparoscopic Surgery
with focus on Developing Countries/Countries in Economic Transition
Organised by the
Coordinator: PD Dr Pierre Meyer
Activity report 2004
In 2003, the Geneva Foundation for Medical Education and Research (GFMER) initiated the ‘Programme for Training and Research in Laparoscopy’ in collaboration with the WHO Department of Essential Health Technologies and partner institutions with the aim to improve the use of laparoscopy in developing countries/countries in economic transition (CET).
Laparoscopic surgery has been associated with less minor complications and shorter duration of hospital stay when compared to open surgery. It has therefore replaced open surgery for many interventions over the years in developed countries. Due to the lack of training and equipment, this is rarely the case in resource-constrained countries. However, the use of laparoscopy could have implications in reducing the financial burden on the often overstretched health care systems in these regions while at the same time improving the well-being of patients.
In order to address this gap, the programme has set out to support developing
countries/CET in improving laparoscopy. Through a top-to-bottom approach,
it shall be ensured that the services are widely accessible and sustainable
in these countries. Initially, only centres already performing laparoscopy
are considered for collaboration, which will in most of the cases be tertiary
care or university hospitals. Once the capacity of these centres is built
and staff sufficiently trained, laparoscopy is anticipated to be introduced
at the periphery of the health care system. The advantages and feasibility
of mobile laparoscopy units as the provider of laparoscopy services at remote
locations shall be examined (see box 1).
1. Practical training
The objective of this component is to build the capacity of collaborating institutions in the performance of different laparoscopic interventions - an essential prerequisite for the quality, dissemination and sustainability of the programme in the respective countries.
The practical training will consist of lab-based training with help of pelvic trainers which is an effective, simple and affordable teaching method in laparoscopy. In addition, specialist surgeons (i.e. general surgery, obstetrics and gynaecology, and urology) will be visiting collaborating institutions in order to provide practical training in the operating theatre for a number of laparoscopic interventions that were decided upon prior to the surgeons’ mission and based upon the situation analysis (see ‘Assessment tool’).
The GFMER has begun to identify institutions for collaboration in the programme for laparoscopic surgery. This process is greatly facilitated through the participation of researchers from potential collaborating institutions in the annual Postgraduate Course in Research Training in Reproductive Health which offers an opportunity to initiate work relationships including the collection of baseline data regarding the current use of laparoscopy in their respective country (Terms of Reference for Initiation of Collaboration). Contacts have been established with China (Shanghai and Beijing), Brazil, and Romania, and are being further developed.
2. Assessment Tool
A framework for assessment of the status regarding laparoscopy in selected countries has been produced. With help of this tool, it will be possible to estimate the current capacity and needs of participating institutions prior to developing and implementing relevant training activities. Detailed data on hospital settings, number and kind of operations, existing training programmes and equipment are collected in order to adapt the programme according to the local needs (Framework for Assessment).
3. Laparoscopy Catalogue
In collaboration with specialists in laparoscopic surgery from Geneva, an overview of currently performed laparoscopic procedures in general surgery, gynaecology and urology has been developed. Interventions are grouped according to the degree of difficulty (i.e. diagnostic, basic, advanced procedures, and interventions for which experts’ opinion vary and more research is required). Indications are provided for each of the suggested interventions (Laparoscopy Catalogue).
4. Manual for Laparoscopy
Practical guidance that is applied to resource-constrained settings has long-term relevance and results in the delivery of better health care. Therefore, as one of the core activities of the programme, the GFMER is developing a manual that will address general practical and training issues in laparoscopy with emphasis on the specific situation in secondary and primary level health care settings of targeted countries.
Aside from evidence-based recommendations from experts in the field of laparoscopy, the manual will benefit from the considerable input of specialists from developing countries. The involvement of specialists who are well-versed in health-related issues frequently encountered in clinics in developing countries is key for establishing recommendations that are relevant in these settings.
Among the core activities are:
To date, the guidelines for authors are in preparation and a preliminary outline of the chapters has been completed (see box 2). Further efforts are focusing on establishing contacts with potential authors and agreement of terms for their contribution.
Text prepared by Annette Reinisch
Edited by Aldo Campana,