LAPAROSCOPIC SURGERY IN THE DEVELOPING-WORLD - AN OVERVIEW OF THE INDIAN SCENE

We present experience of laparoscopic surgery commencing in 1972 with diagnostic laparoscopy in a Surgical Unit in Bombay, By 1990 we had co mpleted 2800 diagnostic laparoscopies with no mortality, 0.08% complic ation rate, 85% positive diagnosis and an instrument cost of about Rs, 35 (US $ 1.2) per patient, We have over the past 5 years performed 89 0 laparoscopic cholecystectomies (LC) with no mortality, no blood tran sfusion, and one CBD injury, With reusable equipment, monopolar diathe rmy and selective cholangiography, LC is cost-efficient in a developin g country, Over this period over 60 laparoscopic appendectomies were p erformed, with the use of catgut ligatures and self-made endo-loops. L aparoscopic appendectomy is cost-effective under our conditions, We ha ve done 46 hernia repairs, and by contrast find it far more expensive and with inferior results to standard hernia repair. Advanced laparosc opy for ulcer and reflux disease, bowel resection, retroperitoneal and thoracic laparoscopy are being given a trial in several centres in th e developing world.