Advancing Minimally Invasive Surgery Techniques in Rwanda

Minimally Invasive Surgery (MIS) is continuing to evolve worldwide, as both technical advances and the skills of surgeons are becoming more sophisticated. In comparison to traditional open surgery, often requiring the patient to incur invasive large incisions, MIS procedures allows doctors to insert a camera through a small incision, or sometimes no incision at all. The camera then enables the doctor to guide surgical instruments inserted into the body with the aid of a video on screen. While traditional surgical methods often require longer recovery periods, MIS draws several benefits to the patient including increased safety, fewer infections, reduction in the loss of blood, and shorter hospital stays.

Since 2017, efforts remain ongoing to strengthen MIS capabilities in Rwanda. ARES-PFS2018, a training project supported by the Belgium government, has afforded the University of Rwanda the opportunity to offer professional trainings, including a postgraduate Diploma in Minimally Invasive Surgery. To ensure successful implementation of the diploma program, a laboratory was erected to serve as a MIS training platform in Rwanda university teaching hospitals. In partnership with Medtronic in Belgium, a worldwide medical device company, the laboratory was built to house a simulation lab and a wetlab. The lab serves as a site in which students and residents can gain skills and train on nonhuman models such as pigs, prior to moving to the clinical training phase to perform laparoscopic surgery on patients.

In January 2019, a curriculum was developed and implemented to build the capacity of young Rwandan surgeons with the premise of training future MIS trainers. Ten Rwandan physicians were selected, including general surgeons, gynecologists, and urologists from The University Teaching Hospital of Kigali (CHUK), King Faisal Hospital (KFH), and The University Teaching Hospital of Butare (CHUB). The Training of Trainers (ToT) program is a 5-year project, which was initially rolled out at CHUK.

MIS was first introduced at CHUK in 2015. At the time, only two doctors in the hospital were able to perform the laparoscopic surgical technique, and there was no formal training in place to develop the technical skills for additional doctors. MIS is now becoming a common practice in eligible procedures, and the number of cases performed in the first 8 months of the training program has increased compared to previous years.

 “We are building the capacity for minimally invasive surgery with this 5-year project, and CHUK will become a center of excellence for training young doctors in laparoscopic surgery. When doctors finish their curriculum, they need the skills to be able to perform laparoscopic surgery. It’s not only important in developing and advancing this technology, but it also gives young specialists the full package to be able to perform various surgical techniques,” Dr. Theobald Hategekimana, Director General of CHUK, said.

Designed to enhance the capabilities of surgeons and to advance minimally invasive procedures, surgeons will now be able to perform various kinds of urological, gynecological, abdominal, general, ear, nose, and throat (ENT), and arthroscopic surgeries. From January 2015 to August 2019, there has been a total of 303 MIS cases performed at CHUK. The most common cases being general surgery at 89.44%, followed by urological procedures at 5.28%.

This week, in a Minimally Invasive Surgery and Biotechnology preconference workshop, the ten selected candidates unveiled their newly acquired surgical skills. The candidates were accompanied by Cameroonian colleagues of the sister MIS project, Professional Master in Laparoscopy. The workshop was supervised by surgical experts from Belgium and took place in three teaching hospitals, including CHUK, King Faisal, and Rwanda Military Hospital in Kanombe. Dr. Augustin Limgba, a gastrointestinal surgeon from Cameroon who is now based in Belgium, led the training and worked with general surgeons to operate on a total of 120-150 patients throughout the week.

Following the workshop, the joint Minimally Invasive Surgery (MIS) and the 3rd Rwanda Biotechnology Conference opened yesterday at Kigali Convention Center and will be held through September 27th. Dr. Jacob Souopgui, of Cameroon, serves as the co-chair of the conference, along with University of Rwanda Director of the Center for Human Genetics, Professor Leon Mutesa. Dr. Jacob was recently appointed by the Government of Rwanda as Chairperson of Board of Directors at King Faisal and is presently one of the team leaders of the Belgian institutional support of the University of Rwanda to oversee technology platform implementation in the field of biotechnology and life sciences.

The theme for this year is “Transforming Rwanda’s Development by Investing in People’s Skills”, with an emphasis on Minimally Invasive Surgery and Biotechnology. The conference is held biennially in Rwanda and is sponsored through collaboration of the University of Rwanda and ARES-CCD (Academy of Research and High Learning, “Académie de Recherche et d’Enseignement Supérieur), Belgium.

The conference brings over 300 participants including Ministers of Health in Africa, scientists, physicians, academic, researchers, government agencies, philanthropists and funding agencies dedicated to advancing technology for Minimally Invasive Surgery and Biotechnology in Africa. In addition, the opening ceremony included a live streaming of a cholecystectomy, which was performed by Dr. Augustin and a team of Rwandan and Cameroonian surgeons at King Faisal Hospital. Conference participants were invited to ask questions in real time to Dr. Augustin and his team.