[Endoscopic gynecologic surgery in Africa. Luxury of necessity?].

Abstract

Per- and postoperative mortality remain high in black Africa, with rates of the order of 30 to 40% according to teams. Three essential causes are generally reported: infection, hemorrhage and anesthetic complications. There can be no doubt as to the advantages of celiosurgery over open surgery: low postoperative morbidity, less than 1% serious complications, real savings in treatment costs by shortening of average hospital stay and time off work. Celio-surgery is technology-dependent and operator-dependent. The cost of equipment remains prohibitive and its maintenance delicate and expensive, potentially hampering the implantation and spread of this new technique in Africa, which also lacks specifically trained staff as well as an appropriate technical infrastructure. Nevertheless, the experience of teams in Cameroon and Gabon are encouraging with 110 and 220 patients respectively treated by celio-surgery without complications. A veritable journeyman-apprentice approach is necessary for the learning of these new techniques by teams in developing countries, in several possible ways (locally or abroad), in order that the population as a whole can enjoy the benefits of the reproducible therapeutic and diagnostic advances of new techniques (celio-surgery, MAP, antenatal diagnosis, medical imaging).