Low cost laparoscopic surgery

REGULAR surgery on the internal organs involves making a big cut through the abdomen, exposing the work area. Laparoscopic surgery on the other hand is a way of doing surgery by making small holes in the abdomen and using a camera to see the organs. The surgery is done with long instruments placed through these holes.

As with any technological advancement, we can expect the cost to be more. However, at the Spanish Town Hospital, we have seen where these procedures can be done at a fraction of the cost in developed countries. It requires more skill, but the advantages of laparoscopic surgery, ie, significantly less pain, much smaller scars and a quicker return to home and work, outweigh the cons. The surgery can also be had without breaking the bank. Here are two such stories.

RJ was a 34-year-old female who came in complaining of belly pains. A definite diagnosis could not be made by questioning and examining her. So the usual options were to get an ultrasound, or to operate on her through a big cut down the middle of her abdomen. She could not afford the ultrasound and decided on laparoscopic surgery when we told her that that option was available.

So through three tiny holes we examined her insides and removed her appendix.

Equipment that is normally used in private care and developed countries and which would have added over $100,000 to the cost of the surgery, were of course not available to us. So with the same materials used for regular surgery, the procedure was safely done. She did well and is now home, proud of her tiny scars.

KN was stabbed in his abdomen by an assailant who probably was trying to kill him. He was rushed to the Spanish Town Hospital where he was seen by the doctors in the accident and emergency department. He needed an ultrasound, which he could not afford. Against the doctors’ advice, he left the hospital, arranged the funds, and did the ultrasound before returning to the hospital. The scan showed that the knife had punctured the diaphragm, which is the muscle separating the chest from the belly, and had damaged his spleen, a rather dangerous organ to be injured. He had been bleeding internally, although luckily, it had stopped before he lost too much blood.

Now if the hole in the diaphragm is not repaired, it gets bigger over time and the stomach and other organs move into the chest, collapsing the lung. So we had to close that hole. To do so normally meant he would get a big cut down the middle of his abdomen. He, however, was terrified of this and we proposed fixing it laparoscopically, the first such operation in Jamaica.

He gladly agreed. So without using any expensive suturing device or staples, we were able to repair the hole and send him home pain-free the next day. That laparoscopic procedure actually worked out cheaper than regular surgery because it used the same suturing materials as open surgery and KN did not have to spend four or more extra days in hospital recovering from the surgery.

We saved on hospitalisation time, we saved on drugs like painkillers, and most important for him, KN can go back to work in a week!

Jamaican surgeons have found ways to limit the cost of laparoscopic surgery without compromising the safety of the patient. As such, this relatively new way of doing surgery is a viable option not only to the woman who wants to keep her beach body intact, but to anybody who wants less pain and discomfort and a quicker recovery after surgery.

Dr Alfred Dawes is a consultant general, laparoscopic and obesity surgeon at Premier Heart and Surgery Centre, and managing director, Mahogany Health and Fitness. Contact him at alfred.dawes@gmail.com.