Starting a laparoscopic surgery programme in the second largest teaching hospital in Ghana

Background: Komfo Anokye Teaching Hospital (KATH) is the second largest hospital in Ghana. Two years have elapsed after performance of the first laparoscopic cholecystectomy. Objectives: To examine our experience and lessons learned. Design: Retrospective review. Setting: Komfo Anokye Teaching Hospital (KATH). Subjects: We reviewed leadership support, the role of a surgeon champion, training of physician and OR staff, influence of surgeons from outside Ghana and equipment status. The results of laparoscopic cholecystectomies performed from 2010-2012 were compared with information available from open cholecystectomies over the same period. Results: Evidence of leadership support included equipment purchase and invitation of outside experts yearly from 2008. A KATH surgeon champion was identified in 2010. A dedicated OR team received training and exhibited excellent ownership of equipment preparation. Since 2010, 25 laparoscopic cholecystectomies have been performed, 17 independently by a single surgeon. Average operative time was 1.41 hours and length of stay (LOS) 1.5 days. Conversion rate was 4.0%(1/25). Complication rate was 20.0%(5/25), none involving haemorrhage or injuries to bile ducts or bowel. Median patient satisfaction score was 5 on a scale of 1-5 where 5 is most satisfied. Complication rates and hospital stay were lower than for open cholecystectomy (20.0%vs34.5%, p>0.05 and 1.5days vs 6.6days, p<0.001 respectively). Operative times were on average 27min onger for laparoscopic cholecystectomy (p<0.01). Conclusion: Laparoscopic cholecystectomy at KATH has become a reality with less complications rates, shorter LOS, and trends towards improved patient satisfaction. Expanding laparoscopic surgery in Ghana requires its inclusion into residency training programmes and public education about its benefits for both patients and physicians.