Minimal Access Surgical Experience in Developing Economy: A Young Trainee Stimulant

DISCUSSION

Minimal access surgery involves the use of camera-guided images to carry out procedures upon patients. Some authors prefer to use the term minimal invasive or incision surgery. It is also termed, in some instances, as key-hole surgery and also button-hole operation. These are for easy comprehension or clarity of terminology for trainees and clients or patients. The author preferred minimal access surgery to be a more comprehensive term just like his trainer.⁶ However, endo-luminal, laparoscopy, and some other related procedures within the scope of this minimal access surgery were considered here. Hence, this review is expected to stimulate a young trainee surgeon to set up a career choice in minimal access surgery in a developing economy. The issue of the learning curve has been overemphasized and attention should be drawn to commonly performed procedures. Those who have high demanding practice, are easily available, and give a good outcome should be of prime importance in the scale of preference.

A glance at the results of the above procedures shows that endoscopic procedures were more than laparoscopies. This could be the result of high demand for upper and lower gastrointestinal endoscopies. This could also have been a result of associated lower costs. Most laparoscopic procedures appear to be more expensive than endo-luminal procedures as can be seen in the index report. More studies are required to elucidate MAS in developing countries. A young trainee should be aware of this fact, as acquiring skill in endo-luminal procedures could hasten experience in MAS. More data and studies will be required to compare activities of those with endo-luminal experience before laparoscopic procedures in low-income countries. Most hernia procedures are still done under regional or local anesthesia in low or medium-income countries, thereby, reducing the demand for laparoscopies that most often utilize general anesthesia.

Although the author recorded a nil conversion rate and nil case fatality rate, this may be due to a limited number of cases performed. It might also be due to adequate training that the author underwent at a good training center.⁶ The act of conversion should always be borne in mind and discussed with the patient. The surgeon should be familiar with the anatomy of the area. He may not necessarily know how to repeat the open type of the operation but should have a colleague who can perform the open type around especially while operating in a developing economy. Also, a more senior minimal access surgeon, laparoscopist, or endoscopic surgeon is a good asset.

This result showed a gradual shift from mild to more complex minimal access procedures. Some cases, such as appendicectomy and laparoscopic cholecystectomy may be termed basic laparoscopic procedures. However, the author has encountered two instances where laparoscopic cholecystectomy was not the usual norm. He could remove giant calculi in the procedure via laparoscopy.⁷ Laparoscopic fundoplication or retrieving a sharp foreign body is an advanced procedure. Some authors have reported retrieval of sharp foreign bodies.⁸,⁹ The young trainee surgeon should have acquired the skill of intra-corporeal suturing technique. He should have mastered the act, especially during laparoscopic cholecystectomy, appendicectomy, and the likes.

The laparoscopic surgical cases had a female to male ratio of 12:1 with females being more beneficiaries. This may be a result of the diagnostic dilemma of young female patients presenting with abdominal pain. Cosmetic incisions may be another paramount reason as most females prefer these incisions. Furthermore, less pain, early return to work, and resumption of activity are all-inclusive in the avalanche of minimal access procedures.

A young trainer is therefore required to undergo extensive training at a good center, develop passion, exhibit yearn, and develop firm practicing habits to enhance necessary skills after taking a bold step.