Laparoscopic surgery: Minimal access, maximum assets

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By SOLA OGUNDIPE

Once upon a time, quite a number of  gynaecological surgeries done in the country was through cutting wide open the abdomen to get access to  the ovaries, womb, uterus, or fallopian tubes  amongst others can now be done laparoscopically.

In the past, this technique was not so readily available, but  today, the feasibility of laparoscopic  or “key hole” surgery in Nigerian hospitals has taken root.

Laparoscopic  surgery or “minimally invasive” surgery is fast gaining ground in Nigeria just like the rest of the world. It is cheaper, less complex and presumed safer  than open access surgery and, hence,  brightened the future of obstetric surgery.

The Obafemi Awolowo University Teaching Hospital Complex, OAUTHC, Ile Ife, Osun State is one of the pioneers of this technique in government hospitals in the country.

Dr. Segun Badejoko, of the Department of Obstetrics & Gynecology, OAUTHC, has performed at least 46 laparoscopic surgeries at the institution.

“We can now use laparoscopy to do virtually everything done through open surgery in gynaecology previously,” he remarked in a chat.

“From operation of the uterus fibroid to operation for fallopian tubes blockage difficulty in getting pregnant due to tube blockage, or at the early stage of ovarian cancer, the patient can be operated upon laparoscopically. If the womb has to be removed for any reason, it can be done laproscopically. It is something that is quite useful and the future of practice in gynecologist is brighter.”

Badejoko opines that the trauma of opening somebody up with a wide incision and the challenge of recovery after the procedure, makes laparoscopy a very welcome modality.

“The opening is minimal just like a key hole and it allows body recover much faster unlike opening the womb through the normal traditional method, such patient would have been on admission for five to seven days but in laparoscopy, the patient smiles home the following day or the same day.

Badejoko who joined OAUTHC in July 2011, notes that one of the commonest gynaecological problems diagnosed and treated laparoscopically is infertility. “Many  patients come here due to inability to conceive. The  most common cause of infertility often in our environment is when the tubes are blocked due to infections and the advantage of laparoscopy is that when you use it to diagnose, you can also use it to treat.

“Another common problem is fibroid. We are able to operate laparoscopically on fibroids that are not too big. We have made land mark achievement in this area. The OAUTHC was the  first Teaching Hospital to perform  hysterectomy, that is, the removal of the womb totally through laparoscopy without any assistance with any modern method and with a wholly locally composed medical team.

“Generally, laparoscopy takes longer than open surgery because you are working through a tiny opening and you do not have so much space and freedom , but laparoscopy tends to be cheaper than open surgery because it is associated with to shorter hospital stay. In this hospital as at now, laparoscopy surgery is still cheaper than open surgery. A patient recently paid less than N50,000 for her laparoscopy surgery and this same procedure in the US will cost about $13,000 (over N2 million). Another advantage is that the blood loss is minimal in laparoscopy.

“The first procedure we did was for a pre-cancerous change in the cervix which was detected through the hospital’s routine screening policy. It required complete removal of the womb.

“The second case was a 48 years old woman who had very heavy menstrual bleeding every month due to fibroid.  Considering her age we decided to remove her womb completely. She conceded to the hysterectomy which  removal of the womb laporoscopically and she was  happy and went home the following morning.

On the training of professionals in acquiring this skills in public hospitals, Badejoko lamented the high cost of establishing  minimal access surgery units.  “It is quite high and that has made it difficult to provide or establish this sub-specialty in public hospitals.

“In private hospitals which are purely profit driven their patients pay an average of N2.0-3.0 million  for this surgery, but government hospitals, on the other hand, are not able to compete well because the patients cannot pay huge medical fees.”

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