Laparoscopic training

Dan Kruschinski – My vision about activities regarding training of laparoscopic surgery in emerging countries

When we talk about laparoscopic training in emerging countries, we need to take in account that we speak about „Rural Surgery“:

20 % of  surgeons in developing countries are adressing the need of 80% of the population in rural areas without basic infrastructure power, water, sanitation. Dr. Olyombos has a set-up in his bush hospital in Eruwa / Nigeria: „Rain water is harvested in nursing homes for water supply, a charcoal furnace powers the autoclave, large windows which catch sunlight compensate for interrupted electric supply and the rear wheel of a bicycle doubles as a haemotocrit centrifuge.“

Laparoscopy is the golden standard in surgery with a fantastic technological progress, but on the other hand with an astronomical increase of cost and therefore can not be established in most regions of the world. especially not in rural and remote areas. 

Paradoxon of laparoscopic surgery:

Those countries in need of laparoscopic surgery in order to exclude dangerous laparotomies in katastrophic hygienic conditions and after-care situation can not afford laparoscopy because of economical reasons and exorbitant cost of laparoscopic equipment for gas laparoscopy, if  medical CO₂ is at all available. Additionally the people in rural areas are mostly the sole breadwinners for their families and need to get back to work as early as possible after surgery, so they really need the minimal invasive procedures and laparoscopy. 

The Preamble of the W.H.O. constitution states:

„The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human without distinction of race, religion, political belief, economic or social condition„

The core problems of surgery are, in the first place, a matter of attitudes. The failure to adapt to reality is paralleled by pretention.

„Whilst western technology might be the destiny of any surgeon starting laparoscopy, one must embrace it with consideration for appropriateness, equity, accessibility, availability, affordability – otherwise the practice will lack its ethical purpose: beneficence.“

Dan Kruschinski is the Preceptor of gasless Lift-Laparoscopy since 1991 with an ongoing process of establishing excellent vision with new abdominal lift devices to ensure a cost-effective laparoscopic start-up system for each surgeon in all parts of the world.

My visions is to provide each surgeon with the possibility of gasless Lift-Laparoscopy in workshops for training in emerging countries to establish a start-up set-up for laparoscopy.

The future of surgery in emerging countries lies in training and education, acknowledgement, recognition of the emerging genre of surgeons and innovation. The local surgeons are excellent, motivated and willing to start laparoscopy. Workshops on  lift-laparoscopy will provide the exhilaration of a wonderful metamorphosis in rural surgery. This has albeit been facilitated by the considerable improvement in basic facilities in several rural areas and the possibilty to reduce cost and equipment for a start-up set for laparoscopic equipment

A close teamwork and relationship within surgeons from different regions of the world will ensure a wide-ranged aspect of regional and local infrastructure and conditions.

We will establish laparoscopic training and develop training manuals in cooperation with local physicians and local manufacturers as well as endoscopic industry. We will upgrade main training centers and establish remote centers regarding availability of laparoscopy and equipment (funds, companies, manufacturers, public health, politics, WHO). We will start training surgical residents in laparoscopic surgical techniques, as well as medical personnel, OR-Team and paraplegics from various provinces in Laparoscopy. We will conduct telemedicine and internet awareness campaigns to build awareness for laparoscopy among medical personnel and the public about laparoscopic treatments.

We need to establish training programmes that allow us to perform laparoscopic training in consideration of the regional infrastructure, hygienic and economical conditions. In laparoscopic surgery we therefore need a start-up set-up with basic endoscopic techniques, where no disposables and special instruments are neccessary, suturing instead coagulating, harmonical and other energy sources, basics of surgery instead of robotic, evaluation of gasless lift-techniques instead of gas endoscopic systems, where there is no CO₂available or low budgets und utilisation of conventional laparotomic instruments in order to avoid contamination without appropriate washing and sterilisation systems for laparoscopic instruments.

The surgical care for the poor is an uphill and Herculean task, yet a task worthy of every ounce of our collective effort and energy. No one society, no one person, no one country can have the answers. It is vital that we all pool our concerns in this effort. If success is defined not by what one has attained but by the effort made in overcoming obstacles, just our sincere efforts in this cause would be by far the greatest triumph, the ultimate success story in the art and science of surgery – to ensure basic surgical care for all the poor.

Dan Kruschinski, MD

My interest to develop activities, especially in emerging countries was shown in the last couple of years with small efficient workshops all around the world in countries like India, Uzbekistan, Ukraine, Taschkent, Bali, Nigeria, Sudan, Mali, Egypt, Nepal, Lebanon, Ecuador, Chile and others.