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Open Access 31-08-2023 | Laparoscopy

Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve

Authors: N. Aruparayil, J. Gnanaraj, A. Mishra, L. Bains, N. Corrigan, J. Brown, T. Ensor, R. King, B. Shinkins, D. Jayne

Published in: Surgical Endoscopy | Issue 11/2023

Abstract

Background

A program of gasless laparoscopy (GL) has been implemented in rural North-East India. To facilitate safe adoption, participating rural surgeons underwent rigorous training prior to independent clinical practice. An online registry was established to capture clinical data on safety and efficacy and to evaluate initial learning curves for gasless laparoscopy.

Methods

Surgeons who had completed the GL training program participated in the online RedCap Registry. Patients included in the registry provided informed consent for the use of their data. Data on operative times, conversion rates, perioperative complications, length of stay, and hospital costs were collected. Fixed reference cumulative sum (CUSUM) model was used to evaluate the learning curve based on operative times and conversion rates published in the literature.

Results

Four surgeons from three rural hospitals in North-East India participated in the registry. The data were collected over 12 months, from September 2019 to August 2020. One hundred and twenty-three participants underwent GL procedures, including 109 females (88.6%) and 14 males. GL procedures included cholecystectomy, appendicectomy, tubal ligation, ovarian cystectomy, diagnostic laparoscopy, and adhesiolysis. The mean operative time was 75.3 (42.05) minutes for all the surgeries. Conversion from GL to open surgery occurred in 11.4% of participants, with 8.9% converted to conventional laparoscopy. The main reasons for conversion were the inability to secure an operative view, lack of operating space, and adhesions. The mean length of stay was 3 (2.1) days. The complication rate was 5.7%, with one postoperative death. The CUSUM analysis for GL cholecystectomy showed a longer learning curve for operative time and few conversions. The learning curve for GL tubal ligation was relatively shorter.

Conclusion

Gasless laparoscopy can be safely implemented in the rural settings of Northeast India with appropriate training programs. Careful case selection is essential during the early stages of the surgical learning curve.

Available only for authorised users

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Title: Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve
Authors: N. Aruparayil
J. Gnanaraj
A. Mishra
L. Bains
N. Corrigan
J. Brown
T. Ensor
R. King
B. Shinkins
D. Jayne
Publication date: 31-08-2023
Publisher: Springer US
Keywords: Laparoscopy
Cholecystectomy
Published in: Surgical Endoscopy / Issue 11/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10392-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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