DREAM 2020: Development of laparoscopic surgery and endoscopy in the university hospital of Kinshasa, DRC

Introduction : Nowadays, laparoscopic surgery is widely disseminated in developed countries, even in small primary hospitals. The spreading of laparoscopy in developing countries has not been as successful. The technological nature of laparoscopy, and the required specific laparoscopic tools and medical skills, may render the initiation of this approach difficult for the developing countries. Aim : We hypothesized that laparoscopy may be developed in the Cliniques Universitaires de Kinshasa (CUK), University of Kinshasa (UNIKIN) and may be cost-effective for the population, considering the reduction of the cost of the associated medications and of the length of hospital stay. The final aim of this program is to bring the benefits of laparoscopy to the population of DRC, by allowance of adequate training of the UNIKIN anaesthetists and surgical trainees, who in the future might have the opportunity to apply their knowledge in their own professional practice. We hypothesized also that the availability of adequate and modern equipment may reduce the incentive for the brain drain and may help to keep some highly trained doctors within DRC. Methods : In partnership with the university of Liege and the financial support of Wallonia region, a complete CUK team, including a surgeon (2 years training in Belgium), an anaesthetist and nurses, was trained in Belgium and then after in DRC. The laparoscopic equipment, adapted to the African conditions, was sent to Kinshasa, and three theoretical and practical missions of a Belgian team were organised over one year. Results : The CUK team performed 57 surgical laparoscopic procedures in the first 12 months, including 18 appendicectomies, 13 cholecystectomies, 8 hernia repairs, 5 laparoscopy explorations for peritoneal carcinoma assessment and biopsy, 3 procedures for catheter of peritoneal dialysis, 2 minors gynecologic procedures, 2 management of generalized peritonitis, 2 adhesiolysis, 2 abscess drainages, 1 rectal prolapse, and 1 cystocoele. No mortality and no postoperative infection were observed. After 12 months of local use, all the medical material was in perfect condition. In addition to surgery, this program allowed the improvement of the quality of anesthaesia for non laparoscopic procedure. Conclusion : This program demonstrated the development, accessibility and durability of such new approaches in developing countries. The interest for laparoscopy was demontrated in several hospitals of Kinshasa. The next step will include the development of GI endoscopy and abdominal imaging. The needs of the DRC population are profound. The DRC medical schools, isolated from the developed countries for more than 30 years, are in great need for support. All the University and non-University GI teams or individuals willing to join such a project, are welcome.