The current status of laparoscopic surgery in China

Practical Training and Research in Gynecologic Endoscopy

Minhua Zheng
Rui Jin Hospital, Shanghai Second Medical University

INTRODUCTION

The first laparoscopic cholecystectomy in China was performed in Rui Jin Hospital, Shanghai first Medical University, in October 1991. Since then a total of 2500 cases of 40 different types of operation have been performed in the hospital which has now been recognised as the leading institute of laparoscopic surgery in China.

Through our efforts in 1993-1995, laparoscopic surgery has become popular in China and is now performed extensively. Some 600 sets of laparoscopic equipment have been installed in hospitals throughout the country and more than 100,000 operations have been performed. In most hospitals laparoscopic surgery is limited to laparoscopic cholecystectomy and only a few institutions can perform laparoscopic surgery on the liver, pancreas, spleen, gastro-intestinal tract or hernia. Few gynaecologists perform laparoscopic surgery and its use in thoracic and orthopaedic surgery is limited.

Laparoscopic surgery is favoured by patients and their medical attendants because of the smooth post-operative recovery and rapid return to normal duties. However as the scope of laparoscopic surgery increases and its use becomes more wide-spread, there have been reports of an increase in the complication and mortality rates. For example, the complication rate in some hospitals for laparoscopic cholecystectomy is 6% compared with 0.8% for conventional surgery. The main complications are haemorrhage, hernia, infection and embolism.

In China laparoscopic surgery, especially laparoscopic cholecystectomy has been introduced in some medium-sized cities and thence to larger cities and tertiary teaching hospitals where a greater variety of surgical procedures with more sophisticated techniques have been developed. As in many countries, the younger surgeons have accepted the new techniques and are enthusiastic to learn laparoscopic surgery whereas the older, more conservative doctors have been slow to take on new ideas.

THE CURRENT STATUS OF LAPAROSCOPIC GYNAECOLOGICAL SURGERY IN CHINA

Gynaecological laparoscopic surgery was introduced to China by Professor Kurt Semm of Germany and Dr Jordan Phillips of the USA in 1991. In February 1992 the first case of gynaecological laparoscopy was performed in Rui Jin Hospital.

The development of gynaecological laparoscopic surgery has been slower than general laparoscopic surgery. Its use is limited to tertiary referral teaching hospitals in large cities. In 1995 more than 100 cases of laparoscopic hysterectomy were reported at the Chinese Gynaecology Annual Meeting (among them 2 cases from Rui Jin Hospital). Over 2000 cases of other gynaecological procedures have been performed including surgery for ectopic pregnancy, fibroids, endometriosis and ovarian cysts. Most of these operations have been performed with the assistance of the general surgeons.

Rui Jin Hospital is one of the leading units in china for gynaecological endoscopy. Initially gynaecologists were assisted by general surgeons but now over 270 cases have been performed by gynaecologists working alone. A co-operative programme has been developed between Rui Jin Hospital and the Department of Obstetrics and Gynaecology in the Cantonal Hospital, Geneva through Professor Campana and Dr de Candolle. Plans are being made to promote technical co-operation and exchange of staff between the two hospitals to promote training in gynaecological endoscopy.

LAPAROSCOPIC SURGICAL TRAINING IN CHINA

There has been no systematic training programme in laparoscopic surgery in China. In most hospitals the surgeons have learnt the techniques from colleagues and have practiced them in animal laboratories. Although a training module was established by the Biliary Tract Surgery Unit of the Chinese Medical Association in 1993, the programme has not yet been implemented.

The Rui Jin Hospital has been developing training programmes for laparoscopic surgery since 1992. Between 1992 and 1995 five 3-day workshops were organised. The activities of these workshops included lectures by Chinese and foreign experts, training on animals, live demonstrations and supervised surgery by the trainees. The workshops covered the fields of general surgery, urology and gynaecology. A certificate is given to the trainee on passing an examination at the end of the workshop.

FUTURE PLANS IN RUI JIN HOSPITAL FOR LAPAROSCOPIC SURGERY

The Ministry of Health of China will select institutions in Beijing, Shanghai and Guangshou as training centres for laparoscopic surgery. The Rui Jin Hospital plans to set up a laparoscopic surgery centre before the end of 1996. Its function will be to:

conduct research into laparoscopic surgery
sponsor national training courses and workshops
participate in an international laparoscopic surgery network which will include research, service and training programmes.

Chinese scientists wish to contribute to the development of a programme for training and research in developing countries.