SUCCESSFULLY ESTABLISHING LAPAROSCOPIC SURGERY PROGRAMS IN DEVELOPING-COUNTRIES - CLINICAL-RESULTS AND LESSONS LEARNED

Background: Laparoscopic surgery has not been widely established in de veloping countries due to the lack of access to training and lack of m oney. We describe our experience using on-site training programs to ef ficiently teach and propagate laparoscopic surgery in Leon, Nicaragua; La Pat, Bolivia; and Santa Cruz, Bolivia. Methods: A group of well-tr ained and motivated local surgeons was identified in each country as t he initial target for teaching. Participants were taught basic and adv anced laparoscopic surgery during on-site didactics, animal laboratori es, and proctoring sessions. Follow-up courses were held until the tar get group of surgeons was capable of independently teaching and superv ising laparoscopic surgery among other surgeons in each country. Resul ts: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Pat, Bolivia, a total of eight surgeons were f ully trained and proctored in laparoscopic cholecystectomy. In La Pat and Santa Cruz, Bolivia, a total of seven surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have unde rgone laparoscopic cholecystectomy or advanced procedures with a morbi dity similar to that reported in literature series in the United State s. Conclusions: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and saf ely taught in developing countries. Many lessons were learned in how t o safely and efficiently use laparoscopic equipment and instruments wi thin strict financial constraints.