Building a Laparoscopic Urology Cancer Program in an Academic Tertiary Hospital in Southern Nigeria

PURPOSE Despite being the mainstay in early renal cancer treatment worldwide, due to the proven advantages of significantly reduced morbidity, reduced blood loss, better cosmetic appearance, and early discharge, laparoscopic cancer surgeries are rarely performed in low and middle-income countries in Nigeria This is largely due to a dearth of laparoscopic Urology cancer training programs in majority of Nigeria. This paper aims to describe the pilot implementation of a laparoscopic renal training workshop in one of the flagship tertiary teaching hospitals in the southern geopolitical zone of Nigeria, as a means of capacity building for improved renal oncologic outcomes. METHODS The 1st advanced laparoscopic Urology workshop was conducted at the University of Benin Teaching Hospital from the 11th- 15th of September 2023. Fourteen Participants were nominated across 3 hospitals that offer open renal Urologic surgeries for renal pathologies, including renal malignancies in 2 of the 6 states in the South-South region of Nigeria. Following the training, pilot implementation of laparoscopic renal cancer surgery was done in consenting patients in one of the centers. The study endpoints were implementation outcomes of reach during the training workshop and feasibility of the program, and its descriptive statistics were computed. RESULTS The reach of the training workshop among Urology consultants was 75% (n=6). The reach among Urology trainees was 67% (n=4). Laparoscopic surgery was executed in 67% (n=10) of patients. Male to female ratio was 1:1. Age range 21-67 years. Rate of conversion to open surgery was 20% (n=2). Postoperative surgical morbidity was recorded in 10% (n=1). Postoperative hospital stay was 3-5 days. There was no requirement for blood transfusion and no mortality was recorded. Participants reported a high rate of relevance of the training on their knowledge, acquisition of intended skills and intent to use the skills gained to perform laparoscopic urology surgeries. Challenges faced were lack of adequate urology laparoscopy instruments, out of pocket financing of surgeries and limited capability of the improvised lap trainers/ simulators. CONCLUSION Notwithstanding the challenges, the lap program was feasible to implement in a low resource setting. The success of the 1st advanced Urology Laparoscopic training program in UBTH projects the effectiveness of cancer training programs in low and middle income countries.