Objective:This study evaluates the economic and clinical impacts of minimally invasive surgery (MIS) compared to open surgery (Open S) for four common procedures-appendectomy, cholecystectomy, hernia repair, and ovarian cystectomy-at two major teaching hospitals in Rwanda, RMRTH and CHUK. The aim is to assess direct costs, hospital stays, complications, and recovery times for MIS versus Open S and to explore the role of health insurance in MIS accessibility. Methods:A retrospective analysis was conducted on data from 206 patients treated between 2019 and 2022, with 100 undergoing Open S and 106 receiving MIS. Data included direct costs, hospital stay lengths, post-operative complications, and recovery times. The study also examined the correlation between MIS utilization and health insurance. Results:The average patient age was 41.7 years, with nearly equal gender distribution (52.4 % male, 47.6 % female). Most patients (79.1 %) had Community-Based Health Insurance coverage. Laparoscopic cholecystectomy showed significant economic advantages, with shorter stays, fewer complications, and faster recovery (p < 0.02). MIS for hernia repair offered quicker recovery but incurred higher costs. For appendectomy and ovarian cystectomy, there was no significant cost difference between MIS and Open S. A strong positive correlation was found between MIS adoption rates and health insurance, supporting improved access. Conclusion:MIS in Rwanda shows promise for economic savings, better patient outcomes, and expanded access through insurance. However, challenges like high consumable costs and limited expertise need to be addressed to fully optimize MIS benefits in Rwanda's healthcare system.

Background Enhanced recovery after surgery (ERAS) programs have demonstrated efficacy in optimizing perioperative care and improving patient outcomes in various surgeries. However, their implementation and outcomes in resource-limited settings remain underexplored. This study aimed to assess the implementation of an ERAS protocol for laparoscopic cholecystectomy in such a setting. Methods This prospective non-randomized controlled trial involved 100 patients undergoing laparoscopic cholecystectomy at the University Teaching Hospital of Kigali, Rwanda. The first 50 patients on the ERAS pathway were prospectively evaluated and retrospectively compared to the last 50 patients operated on before ERAS implementation. Data on demographics, preoperative information, intraoperative compliance, postoperative events, and patient feedback were collected and analyzed. Results ERAS implementation resulted in a significant reduction in hospital length of stay (LOS) (p < 0.001) without increase in complications. Compliance with ERAS principles, including preoperative education and perioperative management, was more than 90%. ERAS also reduced costs due to quicker recovery and shorter hospital LOS. Conclusion The implementation of ERAS for laparoscopic cholecystectomy in a limited-resource setting is feasible and safe, suggesting the possibility of its potential adoption in other abdominal procedures. A high level of adherence to the ERAS pathway can be achieved with effective patient education and the dedication of healthcare providers.

OBJECTIVE:The resource-limited environment in Sub-Saharan countries, with a lack of expert trainers, impedes the progress of laparoscopic training. This study aimed to identify the opportunities and limitations of laparoscopic surgery training in the College of Surgeons of East, Central, and Southern Africa (COSECSA) countries. DESIGN AND SETTING:A multicountry online survey was conducted from January 2021 to October 2021 in COSECSA-accredited training hospitals within 16 countries. Available resources and challenges faced in order to set up well-structured laparoscopic training programs were explored. RESULTS:Ninety-four surgeons answered the questionnaire. The average resources reported per hospital were 3 trained laparoscopic surgeons, 2 laparoscopic towers, and 2 sets of laparoscopic instruments. The training of the majority of these surgeons has been in local institutions (53%), a further 37% within African countries and only 10% outside Africa. Approximately 45% of them declared that laparoscopic modules were planned within the University Curricula, while only 18% of surgeons recognized that laparoscopic modules are only planned within the COSECSA program. About 57% of participants reported that at the end of residency training, graduating surgeons were not able to perform basic laparoscopic procedures. The quoted barriers included: limited laparoscopic equipment, absence of simulation lab, lack of qualified trainers, lack of training programs and time for teaching by skilled doctors, and lack of institutional support. CONCLUSIONS:The well-structured set up of laparoscopic training programs in the COSECSA region is hindered due to the lack of qualified personnel and insufficient resources for the acquisition of equipment and simulation laboratories. Ongoing efforts to set up laparoscopic programs through the development of adaptive curricula, innovative strategies for reduction of equipment cost and adequate training of surgeons are crucial for patient safety and the development of laparoscopy.

Background The adoption and accessibility of laparoscopy have been serious issues in countries with limited resources, and for varied reasons. This study assessed resource capacity and barriers to the effective practice of laparoscopic surgery in training hospitals affiliated with the College of Surgeons of East, Central and Southern Africa (COSECSA). Methods A multi-country survey was conducted from January 2021 to October 2021 using a questionnaire distributed to surgeons in COSECSA hospitals located in 16 different countries. Available resources and surgical volume were assessed, and the barriers to routinely performing laparoscopy were determined. Results Ninety-four surgeons working in 44 different hospitals from 16 countries participated in the survey. The majority of respondents were general surgeons ( n = 75, 79.7%). Other specialties included urology ( n = 12, 12.8%) and pediatric surgery ( n = 7, 7.4%). Senior surgeons accounted for 60.6% of participants, more than 40% had a managerial position and approximately 20% were surgical trainees. Most respondents practiced in public hospitals ( n = 66, 70.2%). A median of three surgeons per hospital performed laparoscopic surgery with, on average, two laparoscopic towers and two sets of laparoscopic instruments available. A median of 10 procedures was carried out per month. The cost of laparoscopic procedures and laparoscopic consumables were reported as being covered by some health insurance payments in 76.9% and 48.4% of cases, respectively. Cholecystectomy was the most commonly reported laparoscopic procedure performed. The five top barriers to performing laparoscopic surgery were: a lack of consumables, a limited quantity of equipment, a lack of skilled surgeons, the high cost of laparoscopic procedures and complicated cases. In addition, having access to skilled anesthesiologists and anesthesia equipment, carbon dioxide, a consistent electric power supply and equipment maintenance were cited as significant challenges. Conclusion The practice of laparoscopy is currently limited in COSECSA countries due to a scarcity of skilled staff and the lack of a funding plan to make laparoscopic services accessible. Therefore, policymakers and stakeholders should take strategic measures to respond to this need.

Background: Laparoscopic surgery is the gold standard for many abdominal surgeries. Laparoscopic programs in low- and middle-income countries (LMICs) and in sub-Saharan Africa face many constraints, although its use is safe, feasible, and clinically beneficial. The authors assessed patient-reported outcomes and the experience of patients operated on at the University Teaching Hospital of Kigali (CHUK). Methods: This is a retrospective cross-sectional study combining medical data from medical files and information collected from telephone calls to 288 patients who underwent laparoscopic cholecystectomy at CHUK from January 2015 to December 2020. Results: Among 446 laparoscopic surgeries performed at CHUK over 6 years, cholecystectomies accounted for 64.6 % of cases (288/446). Postoperative complications and mortality after laparoscopic cholecystectomy were low, respectively 1.7 % and 0.7 %, while the median length of stay was 3 days. About 74 % of surveyed patients had never heard of laparoscopic surgery prior to their procedure. Knowledge of laparoscopic surgery was associated with patient education level (p < 0.001). Half of patients had not been involved in the choice of the surgical technique. Overall satisfaction was over 95 % and >90 % of patients consider laparoscopic surgery as the best surgical approach in Rwanda, and for this reason they declared to be ready to promote this new technology despite its higher cost. However, patients reported some weaknesses and made recommendations for improving public awareness of laparoscopy and its benefits, patient-provider relationships, training of surgical workforce, laparoscopic equipment, and infrastructure. Conclusion: Laparoscopic cholecystectomy can be performed with a low rate of postoperative complications in a resource-limited setting like Rwanda. Patient satisfaction was high, but efforts should be made to improve public awareness of laparoscopic surgery, improve surgical capacity, laparoscopic equipment, and infrastructure.

Introduction: The brachial plexus is highly variable, which is a well-known anatomical fact. Repeated observations on anatomical variations, however, constitute current trends in anatomical research. Case series: In an anatomical dissection course, three uncommon variations in the brachial plexus were identified in three young adults' cadavers. In one case, the musculocutaneous nerve gave a branch to the median nerve, while the median nerve gave or received musculocutaneous branches in the two remaining corpses. Conclusion: Anatomical variations of the brachial plexus do occur in our setting. The cases we presented are about anatomical variations of branching patterns of the median and musculocutaneous nerves. Knowledge of those variations is essential for surgery and regional anesthesia of the upper limbs.

Introduction The knowledge of anatomy is essential for surgical safety and impacts positively on patients' outcomes. Surgeons operating on the liver and bile ducts should keep in mind the normal anatomy and its variations as the latter are common. Case Presentation We conducted a structured surgical dissection course of the supra-colic compartment of the abdominal cavity on 2nd and 3rd October 2020. While dissecting a 46years-old male cadaver, we encountered unusual anatomical variations of the hepatic arterial branching, the biliary tree, and arterial supply to the common bile duct. The common hepatic artery was dividing into two branches: a common short trunk for the left hepatic artery and the right gastric artery (hepato-gastric trunk) and a common trunk for the right hepatic artery and gastroduodenal artery (hepato-gastroduodenal trunk). The right hepatic duct was duplicated with a main right hepatic duct and an additional smaller duct. The bile duct was supplied by an artery coming from the abdominal aorta. Conclusion We described three unusual anatomical variations: a variation of the hepatic arteries branching pattern, an aberrant right hepatic duct, and blood supply to the bile duct from the abdominal aorta. Surgeons should be aware of these rare variations.

Introduction Teaching of human anatomy has undergone significant changes in the past three decades. At the University of Rwanda, anatomy is being taught using team-based learning (TBL). While student-generated multiple choice questions (MCQs) stimulate deeper thinking on a given topic, their impact on anatomy learning is not known. This study aimed to find out the impact of student-generated MCQs on the current anatomy teaching method at the University of Rwanda. Methods In this comparative interventional study, two similar chapters on anatomy were selected; one was taught using TBL while for the other one, in addition to TBL, students were encouraged to set MCQs while studying. Pre- and post-test scores were analyzed using SPSS 23 and the Student’s t-test was used to compare the mean scores obtained. Results Thirty-one medical students were recruited. Pre-test mean scores were 25.10 and 25.19 out of 50 for chapters 1 and 2, respectively. Although the students’ post-test scores improved after teaching for each chapter, the improvement was much greater for chapter 2 than for chapter 1, with mean scores of 39.97 and 32.45 out of 50, respectively (P<0.05). Despite such improvement, almost half of the students found that setting MCQs was not easy. Conclusion This study found that student-generated MCQs can be used as a simple and cost-effective tool to enhance TBL of anatomy.

Computer‐based three‐dimensional (3D) teaching tools are increasingly used in human anatomy instruction; however, these tools may compromise learning since some learners have problems comprehending them. Previous studies indicate that a person’s spatial ability is predictive of their ability to learn from 3D teaching tools. Most studies investigating this relationship have been performed on a North American population, so this effect is relatively unknown in other parts of the world. Spatial ability can be shaped by daily activities such as travel, sport, and entertainment. Rwandese people may have developed their spatial ability differently than North Americans and, therefore, learn differently from 3D teaching tools. This study investigates the role of spatial ability in comprehending a 3D computer‐based teaching tool in a Rwandese student population. 73 students at the National University of Rwanda have been recruited. Participants performed an anatomy knowledge test, 3 standardized spatial tests, and a pre and post spatial anatomy task with a 3D teaching tool as an intervention. The results of this study may help to design computerized, 3D teaching tools that are tailored to educational facilities in Rwanda. When developing 3D teaching tools it is important to take learner characteristics into account to create tools that are sensitive to the population that is learning from them.

The abductor pollicis longus (APL) muscle has been largely reported to be a subject of numerous variations affecting the origin, the number of bellies and tendons, and the patterns of tendons insertions. We report a bilateral APL muscle duplication as a variation encountered during dissections of the forearm and hand of an adult female cadaver. The APL muscle presented with two bellies and each belly had a distinct tendon. The main belly originated as usual from the posterior aspect of the lateral border of the ulna, the interosseous membrane and the middle third of the radius while the additional belly was arising from a retinaculum‐like fascia formation attached at the lateral border of the radius and covering the extensor carpi radialis longus and brevis and both tendons inserted as usual on the base of the first metacarpal bone. The tendon from the additional belly was the most laterally inserted and therefore thought to be the main abductor, whereas the tendon from the main belly was thought to be the best extensor of the trapezo‐metacarpal joint. The presence of additional APL tendons has been regarded as a determinant in the development of De Quervain's stenosing tendovaginitis and the awareness of the existence of such anatomical variations may be important for reconstructive surgery as a potential source of transplant material.

Patients presenting late with an unreduced posterior dislocation of the elbow are still a problem in developing countries and a challenge for surgeons. In developing countries, socio‐economical and cultural factors may affect the medical care of traumatic injuries.Due to misconception, ignorance and poverty, patients go to local bonesetters to tradition treatment such as massage and manipulation which only aggravate the situation. Unreduced is defined as those posterior dislocated elbow not treated within 3 weeks after injury. These elbows are often fixed in extension and have no sufficient ranges of movements which allow activities of daily living.Between January 2008 and June 2008, 15 cases of late‐presenting unreduced posterior dislocation of elbow were treated in the department of Surgery at Butare Teaching Hospital. They were 7 males and 8 were female, the age from 12 years to 72 years (mean, 31), the dislocated elbows were right for 7 patients and left for 8 patients. The time since the injury range 4 to 8 (mean, 5) months. All patients had no‐functional movements for the daily activities as the elbows were fixed in 10° to 50° (mean, 25°) of flexion.All patients were operated and open reduction were performed using the posterior approach of the elbow. The triceps was lengthened using a Z musculoplasty technique which, for our best of knowledge, is not yet described. In our previous cases we find difficulty to repair the triceps muscle when applying the common V‐Y musculoplasty technique. In this poster we present the anatomical basis of the Z musculoplasty of the triceps<