The Responsible Use of Minimally Invasive Surgery in Remote Areas of Brazil: Feasibility and Safety of a Temporary Gynecologic Operative Expedition

Objective: To evaluate the feasibility and safety of a novel model for providing minimally invasive surgical (MIS) care to underserved populations. Design: A prospective pilot study with patients affected by diverse benign pathologies of the female urogenital tract undergoing MIS in the context of a temporary expedition. Methods: In 2013, the Bandeira Científica Project implemented the use of MIS in one of the most underserved areas of Brazil. Results: During 4 days, 54 different procedures were performed on a cohort of 30 selected women. The mean age of the patients was 44.5 years (SD 8.3), while body mass index averaged 28.4 kg/m2 (SD 4.3). The primary indications for surgery were as follows: 14 symptomatic uterine leiomyomatosis/adenomyosis, 6 stress urinary incontinence, 6 endometriosis, and 4 pelvic floor defects. Forty percent of the patients underwent laparoscopy, 53% vaginal surgery, and 7% combined procedures. The mean estimated blood loss and operative time were 148 cc (0–1000) and 94 (24–180) minutes, respectively. No casualty or conversion to laparotomy occurred. The median hospital stay was 1 day (1–2). Significant complications occurred in two cases (6%); one postoperative bleeding and one pelvic infection. A satisfaction survey revealed that 100% of the participants were very satisfied. Conclusion: This series demonstrates that it may be feasible and secure to establish temporary MIS services in remote/distant locations. The correct selection of local facilities allied to the provision of modern equipment and experienced surgeons is essential to guarantee safety for patients. (J GYNECOL SURG 31:255)