IFSC sponsored DEALT Laparoscopic Workshops in Zambia in March 2019

IFSC sponsored DEALT Laparoscopic Workshops in Zambia in March 2019

Two Courses were scheduled, the first in Lusaka with the second in Ndola. Here is Paul Gartell’s report.

After many hours of planning for the trip, setbacks with instruments and sutures and last minute resolutions, Russell Lock and Paul Gartell finally set off for Lusaka on March 18th flying via Johannesburg. We were met at the airport by Raj, who had been our Lusaka contact and drove to the Best Western Hotel.

We were assured that all arrangements were in place and that we did not need to check on equipment for the workshop so spent the afternoon and evening relaxing and going through the program.

We were picked up from the hotel the following morning and driven to Lusaka University Teaching Hospital. Originally we were supposed to be working with 4 surgeons from Lusaka; but in the event only 2 surgeons were available because of exams and other commitments.

We spent the morning going through their experience and needs; and talking through presentations on safe access techniques, electro-surgery and risk avoidance in laparoscopic cholecystectomy.

In the afternoon they had arranged a laparoscopic cholecystectomy which we mentored. It was immediately obvious that they had some fairly unsafe practices which we pointed out. Also their diathermy was malfunctioning and it took 4 units before a safe set up was achieved. The operation was successfully completed after 5 hours.

The following day we reiterated some important safety aspects and then spent the rest of the morning teaching extra- and intra-corporeal knotting techniques and suturing. We were very impressed with the speed that they mastered the techniques.

In the afternoon they had arranged another cholecystectomy and we were pleased to see that our messages had got through, though the procedure still took 4 hours.

The next day we spent consolidating the new techniques and packing the training boxes for transport to Ndola. Seke Kazuma had driven down from Ndola to pick us and the boxes up before travelling back up to Ndola on the Saturday.

The 5 hour drive to Ndola was event free and we were booked into The Urban Hotel, which was in the middle of Ndola golf course in very pleasant grounds.

Sunday we spent at leisure.

On the Monday we were picked up from the hotel and made the short drive to Ndola Teaching Hospital. We were carrying 32 used or out of date laparoscopic instruments which we donated to the hospital for the course and further training.

After setting up all the audio-visual display and training boxes we then started the workshop with pre-course MCQs to assess their current knowledge of laparoscopic techniques and were amazed that the one of the surgeons, who had previously not done any laparoscopic surgery but had been on a course, scored 96%.

The workshop program took the 6 trainees through, the history of laparoscopic surgery, the equipment used and how it works, theatre set up and tips for avoiding musculo-skeletal injury to the surgeon. We then took them through the physiological effects of pneumoperitoneum, principles of safe access, port positioning and closure. We also showed a video on elctrosurgery.

After lunch we went through basic instrument manipulation hands on training and extra-corporeal knotting.

The following day was spent practicing intra-corporeal knotting and suturing. Russell was unfortunately taken ill and had to return to the hotel; but the trainees proved to be very adept at the techniques which they picked up quickly.

We then repeated the MCQ noting a great improvement by all, with our previous star now getting 100%!

They had arranged for a laparoscopic cholecystectomy to be performed on the Wednesday, but unfortunately the ports and clip appliers essential for the surgery had not arrived, so we had to postpone. We were due to drive back to Ndola early the next morning, but we agreed to reschedule and drive back later if the equipment arrived by 0900hrs on the Thursday.

It all came together in the nick of time and we watched the first laparoscopic cholecystectomy being performed in the Copperbelt region of Zambia. The procedure went well and took only 3 hours. We left as the procedure was finishing.

We drove back to Lusaka and spent the evening at the Taj Pamodzi hotel in the company of one of the local surgeons.

The following day we were taken to the airport and flew back to Johannesburg where Russell left to visit his daughter, and I flew back to Heathrow arriving at 0530hrs on the Saturday morning.

We have since heard that 2 more laparoscopic procedures have been successfully performed in Ndola.

Paul Gartell
2nd May 2019.