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首页> 外文期刊>Surgical Endoscopy >Sustaining a laparoscopic program in resource-limited environments: results and lessons learned over 13 years in Botswana
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Sustaining a laparoscopic program in resource-limited environments: results and lessons learned over 13 years in Botswana

机译：在资源限制环境中维持腹腔镜计划：在博茨瓦纳13岁以上的结果和经验教训

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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.
机译：缺乏可持续性的背景指标，缺乏对资源有限环境下纵向腹腔镜手术项目的独特挑战、成功、失败和经验教训的坦率描述。我们开始评估博茨瓦纳最大的三级教学医院马里纳公主医院腹腔镜胆囊切除术项目的安全性和可持续性。方法我们评估了2013年1月至2018年12月接受腹腔镜胆囊切除术的患者的临床结果，并与接受开腹胆囊切除术的患者进行比较。对技术独立性和可持续性因素进行了测量和讨论。结果共行腹腔镜胆囊切除术226例，开腹胆囊切除术39例。四名接受过首次腹腔镜手术培训的外科医生完成了48.2%的腹腔镜手术。其他地方接受过培训的11名外科医生完成了剩下的手术。总的来说，94.2%的LC是在没有外籍外科医生的情况下进行的。转化率为25/226（11.1%）。LC组有3例胆管损伤（3/226，1.3%），OC组无一例。OC组有1例死亡（1/39，2.6%），LC组无一例死亡。在所有利益相关者之间建立信任关系被认为是成功的主要关键，而制定基于系统的战略被认为是最重大的持续挑战。结论博茨瓦纳于2006年至2012年建立的腹腔镜胆囊切除术项目已进入可持续发展阶段，其特点是腹腔镜的使用增加，当地外科医生的独立手术能力增强，同时保持患者安全。在资源有限的环境中维持腹腔镜手术有着特殊的挑战，各国可能会有所不同。

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