Programme de formation et de recherche en chirurgie laparoscopique

Programme for Training and Research in Laparoscopic Surgery

with focus on Developing Countries/Countries in Economic Transition

Organised by the
Geneva Foundation for Medical Education and Research,
in collaboration with
WHO/ Department of Essential Health Technologies and Department of Reproductive Health and Research

Coordinator: PD Dr Pierre Meyer

Introduction

Laparoscopic surgery has replaced open surgery for many interventions over the years. Laparoscopy has been associated with less minor complications as well as shorter duration of hospital stay when compared to open surgery. In industrialised countries this is often the intervention of choice when surgery is needed. However, there is still a major gap in the implementation of modern surgical methods in under resourced settings, often due to restricted availability or access of the equipment and lack of training.
GFMER, in collaboration with WHO/Department of Essential Health Technologies and Department of Reproductive Health and Research, will develop a programme for training and research in laparoscopic surgery, aiming to improve the use of laparoscopy in developing countries. These activities will include the development of:

  • a manual in laparoscopy, providing practical guidelines for laparoscopic training programmes
  • conduction and evaluation of training programmes
  • assessment of research needs and conduct of research programmes

The development of a manual for laparoscopy will be the initial step.

Manual for laparoscopic surgery

Background

Laparoscopy at the district level bears many challenges: from the availability and condition of the material used to the experience and skills of the surgeon. Providing comprehensive practical guidance, applied to the settings at the district level has long-term relevance and results in the delivery of better health care. The plan is to develop a book that is unique in the sense that it is mainly aimed at settings at the district level, and addresses practical and training issues. The correct and efficient use of laparoscopy could have implications in reducing the financial burden on the often overstretched health care systems in these regions.

Purpose

Aim: to develop a manual for laparoscopic surgery at the district level.

Objectives:

  • to provide practical, hands-on guidelines for the use of laparoscopy by combining evidence based recommendations with comments from local specialists
  • to provide guidelines for training and identify research needs in laparoscopy (as a first step for the above mentioned overall programme)
  • to provide a manual for laparoscopy that covers several areas of surgery (general surgery, gynaecology, urology)

Specific activities

  • Creation of an editorial base, which will determine the content and the structure of the manual and will have the overall responsibility of the manual
  • Identification of collaborating centres and opinion leaders in the field who will be invited to contribute
  • Consensus meeting in Geneva
  • Preparation of the manual for electronic publication in English and French
  • Development of an e-learning programme

Identification and assessment of Collaborating Centres, and preparatory activities

  • Centres, mainly in the district areas, from each WHO region will be identified. Centres need to practise already laparoscopy; with possible involvement in national training programmes. The identification of the centres will be conducted in close collaboration with WHO and its regional offices.
  • A needs assessment and evaluation for each of the centres will be performed, incl. description of the hospital/setting, number of total surgical interventions/laparoscopic interventions, number of equipment/description, current training programmes, existing guidelines, problems.  A suitable person from one of the centres will be identified to attend the Postgraduate Course in Research Training in Geneva (March/April 2004) and to perform the collection of data during this period as part of the course programme.
  • Experts from the centres will be identified and invited to contribute to the manual. This may be in form of writing a chapter, reviewing it or providing practical commentaries.

Preparation of the manual

The contents of the manual will be decided upon by the editorial group; possible authors will be defined and invited to contribute to the manual; comments from local specialists will be included. The specific chapters will provide practical guidelines based on the available evidence, including cost-benefit assessments and recommendations for local applicability. Guidelines for authors on how to prepare each chapter will be developed. The contributions will be peer reviewed and final acceptance decided upon by the editorial committee. The manual will be updated when new results are available.

The editorial process will be central (at GFMER).

General chapters:

  • The current status of laparoscopy in the different regions (with sub-chapters per region)
  • Minimal requirements/ basic equipment to perform laparoscopic procedures at the district level
  • Training for laparoscopic surgery in developing countries (status quo, accreditation procedures etc)

Specific chapters (with videos for selected interventions):

  • General considerations : general surgical principles, entry into the abdomen, handling of the instruments during the procedure (gas, pressure etc), positioning of the patient, etc.
  • General and digestive surgery : appendectomy, cholecystectomy, laparoscopy for intraabdominal abscess, hernia repair, laparoscopy for gastric/duodenal ulcer, tumor surgery
  • Gynaecology : diagnostic laparoscopy, tubal sterilisation, laparoscopy for ectopic pregnancy, operative laparoscopy for female infertility, myomectomy, laparoscopic surgery for endometriosis
  • Urology
  • Anaesthesia for laparoscopic procedures

A preliminary version of the manual will form the background document for the consensus meeting in Geneva:

Participants: editorial board, specialists from the collaborating centres, authors of the manual

Purpose of the meeting:

  • Finalisation of the content of the manual
  • Preparation of steps for launching of the manual at the collaborating centres
  • Discuss the development of guidelines for training in laparoscopy
  • Identification of areas of research

Follow –up

The final version of the manual will be made available electronically, translated into French, and form the basis of the development of an e-learning programme.

The initiation and conduct of training and research programmes will be the next steps to develop.

Presentations

Forum

A forum for exchange of experiences in laparoscopic surgery has recently been established.

Links

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Edited by Aldo Campana,