Liz Elvira

Background: Laparoscopy was first introduced in Phnom Penh, Cambodia in 2000, but remained largely confined to urban centers because of equipment costs, limited training opportunities, and infrastructural barriers. Methods: A collaborative laparoscopic training program was launched at Calmette Hospital in 2022 and expanded to Kampong Cham Provincial Hospital (KCPH) in 2023. Training included didactic lectures, simulation‐based skills practice, and supervised laparoscopic cholecystectomy with graduated operative responsibility before transition to independent practice by the Cambodian surgical team. Surgical volume and outcomes were compared before (January 2022–February 2023) and after program implementation (February 2023–February 2025). Results: The year prior to program implementation, KCPH performed 55 open cholecystectomies. Following implementation, a total of 272 cholecystectomies were completed, including 249 laparoscopic and 23 open procedures, representing a 188.3% increase in average monthly cholecystectomy volume (3.93 vs. 11.33 and p < 0.001). Of the 249 laparoscopic cases, 19 (7.6%) were performed during the initial supervised training period (15 mentored and 4 proctored), 15 (6.0%) during a follow‐up proctored visit 7 months later, and 215 (86.3%) independently by the KCPH surgical team. Nine laparoscopic procedures (4.2%) required conversion to open surgery, and seven patients (3.3%) experienced complications requiring reoperation or endoscopic intervention. The median length of stay was 4 days (IQR 3–5), and no perioperative mortality occurred. Conclusion: Structured multidisciplinary training enabled safe adoption of laparoscopic cholecystectomy in a Cambodian provincial hospital. The program increased access, maintained safety, and offers early evidence of a replicable model for expanding minimally invasive surgery in Cambodia.

Introduction: Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana. Methods: A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related parameters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access. Results: Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%). Conclusion: Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.