Setting Up a Gynaecological Endoscopy Unit with Limited Resources – Surgical Experiences & Challenges

Abstract

Background: Minimally invasive gynaecological surgery has become a cornerstone of modern practice in developed nations, yet its adoption in many developing regions remains limited. Tripura, a small and geographically isolated state in North‑Eastern India, illustrates the challenges of introducing endoscopic techniques amidst infrastructural and resource constraints. Objective: To document the surgical experiences and challenges encountered while establishing a gynaecological endoscopy unit with limited resources. Materials & Methods: A prospective study was conducted at a 20‑bed polyclinic and nursing home in Agartala, Tripura, between June 2013 and April 2020. Women diagnosed with gynaecological conditions requiring surgical intervention were evaluated through detailed history, clinical examination, and investigations. Surgeries were performed during scheduled camps by a multidisciplinary team comprising a mentor surgeon, assistants, anaesthesiologist, operating theatre staff, and scrub nurse. Data were systematically recorded and analysed using SPSS version 20. Results: Across 135 surgical camps, 798 patients were enrolled, of whom 726 underwent endoscopic procedures. The average number of surgeries per camp was 5.37, with patients aged 15 to 65 years. Total Laparoscopic Hysterectomy for symptomatic leiomyoma was the most frequently performed procedure. Operative times ranged from 35 to 250 minutes. Haemorrhage, shoulder tip pain, and port‑site infections were the most common intra‑operative, immediate, and late complications, respectively. The mean hospital stay was 28 ± 14 hours. Major challenges included limited access to advanced equipment, lack of maintenance facilities, shortage of trained personnel, poor patient acceptance, and financial constraints. Conclusion: Despite significant resource limitations, gynaecological endoscopy can be successfully practised through structured training, mentorship, and improvisation. Regular practice shortens the learning curve and enhances surgical skills, paving the way for wider adoption of minimally invasive techniques in resource‑constrained settings.