Laparoscopic surgery in the developing world. An overview of the Indian scene

We present experience of laparoscopic surgery commencing in 1972 with diagnostic laparoscopy in a Surgical Unit in Bombay. By 1990 we had completed 2800 diagnostic laparoscopies with no mortality, 0.08% complication rate, 85% positive diagnosis and an instrument cost of about Rs. 35 (US $ 1.2) per patient. We have over the past 5 years performed 890 laparoscopic cholecystectomies (LC) with no mortality, no blood transfusion, and one CBD injury. With reusable equipment, monopolar diathermy and selective cholangiography, LC is cost-efficient in a developing country. Over this period over 60 laparoscopic appendectomies were performed, with the use of catgut ligatures and self-made endo-loops. laparoscopic appendectomy is cost-effective under our conditions. We have done 46 hernia repairs, and by contrast find it far more expensive and with inferior results to standard hernia repair. Advanced laparoscopy for ulcer and reflux disease, bowel resection, retroperitoneal and thoracic laparoscopy are being given a trial in several centres in the developing world.