|Abstract Summary |
There is controversy as to whether Laparoscopic Surgery (LS) should be promoted in rural surgery, on the assumption that the cost-benefit-ratio is questionable. This study was conducted to explore the present situation in rural India and the prospective development as seen by our surgical colleges.
In Summer 2009 a telephone survey was carried out among the members of the Association of Rural Surgeons of India (ARSI). Amongst the 450 members we were able to complete 40 questionnaires.
Statistical and descriptive analysis was performed. The lengthy questionnaire partially caused incomplete answers and inconsistent data, so results have to be taken with caution:
80% of the questioned surgeons are practising LS. The median cost of open cholecystectomy is 10000 INR (~140 Euro) with LS being 40-50% more costly. The main reason given is the invested equipment of 7-10 Lakh (~10 000 to 14 000 Euro). But there is no correlation to be seen between investment and the higher cost of LS.
Difficulties encountered practising LS are financing equipment, repair, acceptance by patients and lack of training. Complications or conversion-rate caused no greater difficulties. The main benefit is seen in short hospital stay and reduced pain with 70% of surgeons seeing a positive cost-benefit-ratio.
In the next 5 years investment in LS is planned to be doubled, whereas 30% do not intend to make any investment in LS mainly due to high cost or lack of training.
Aspects considered difficult to obtain when installing LS equipment are durable equipment at low cost with easy maintenance.
In conclusion, there is an unexpected high development of LS among rural surgeons in India however, there is an extensive need for durable equipment at low cost with easy maintenance and training opportunities.
Full Article here !
Dr. Elias Engelking*
Hugstetter Str. 19
Paper published on www.india2005.org/15701.html
*Resident in Surgery at the Evangelisches Diakonie Krankenhaus, Freiburg, Germany. www.diak-fr.de
A synopsis of the project including the questionnaire can be found here.