Normally, it requires a large body cut to treat internal organs such as gallbladder, liver, pancreas, and bile duct, through surgery. But now, it is done through minimally invasive surgery, an emerging medical technology that King Faisal Hospital (KFH), Kigali is championing in Rwanda.

Minimally invasive surgery, also known as keyhole surgery, is a surgical procedure in which doctors use a variety of techniques to operate with less damage to the body than with open surgery.

Laparoscopy — surgery done through one or more small incisions using small tubes and tiny cameras and surgical instruments such as endoscopes — is thought to be one of its first types.

Images from the endoscope are projected onto monitors in the operating room so that surgeons can get a clear (and magnified) view of the body part to be operated.

The procedure has minimal post-operative discomfort since the incisions are much smaller, quicker recovery times, less pain and bleeding after operation, shorter hospital stays, and much smaller scars compared to standard open surgery.

Medical personnel during an endoscopic surgery at King Faisal Hospital, Kigali. Photo: Courtesy.

"[For instance], performing colectomy – a surgical procedure to remove part or all of one’s large intestine – after our colleague endoscopists have discovered a colon tumor, would take 10 days to two weeks for the patient to be discharged. But, with laparoscopy, the patient will be discharged three days after the operation,” said Dr. Augustin Limgba.

Limgba has been offering medical services in Belgium and has been periodically coming to Rwanda for training medical personnel in minimally invasive surgery and treat patients with such a technique at KFH and other leading hospitals in Rwanda.

But, since January 2021, Limgba, is a permanent employee of King Faisal Hospital, where he is General/Minimally Invasive Surgeon.

In the last three years that he has been supporting Rwanda’s minimally invasive surgery training program, he said 400 patients were treated using the technology in the country.

"My presence in Rwanda – on a long-term basis means that there is sustainability in the service offered to the patient, and training as well as capacity building for medical personnel in a permanent way,” he said.

A Cameroonian national, Limgba is also Rwanda’s first minimally invasive weight-loss surgeon, carrying out the operation for people suffering from excessive obesity so that they become healthy.

Minimally invasive surgery works hand in hand with endoscopy, a medical procedure used to examine a person’s digestive tract or gastrointestinal disorders and support their right treatment.

Dr Innocenti Dadamessi, Interventional Endoscopy Gastroenterologist in France, has been providing healthcare at King Faisal Hospital.

He said that colonoscopy – endoscopic examination of the large bowel – helps in diagnostics, and protecting people from future life-threatening diseases such as colon cancer.

"When colonoscopy is performed and determines that there are polyps [small clumps of cells that form on the lining of the large intestine], they will be removed or treated. That will protect the person from potential cancer in the future,” he said.

Dr Edgar Kalimba, Deputy CEO of King Faisal Hospital said that the hospital has plans to set up a specialized digestive medical surgical unit.

The unit, he explained, will facilitate collaboration between gastroenterologists (who use endoscopy) and minimally invasive surgeons in the treatment of complicated cases.

Local treatment reduces healthcare cost

Last year, KFH acquired a new high-tech endoscopic machine used for advanced endoscopic diagnostic and therapeutic procedures. The machine, the hospital said, is the first of its kind in Rwanda and will allow it to treat some patients without the need for them to travel abroad.

Dr. Kalimba said that there are many gastrointestinal diseases that do not require that the patients go abroad for treatment as it used to be before, thanks to the availability of this advanced treatment in the country.

"In October, 2020, 35 patients were treated [for digestive tract diseases], and the same number of patients were treated in December 2020,” he said.

Kalimba said that the medical bill paid by the patient for such treatment in Rwanda is cheaper as "it is about 20 percent to 25 percent the cost they would incur when they got it abroad.”

Plans for regional hub

According to Kalimba, KFH’s vision is that advanced and needed treatment be offered in Rwanda as it seeks to progressively reduce the number of Rwandans who go to seek the treatment abroad.

Also, he said, the hospital seeks to train its medical personnel through use of experts from around the world such that within three or five years, they will have highly advanced skills, with a sustainable training program.

 "As we have such doctors, and the required equipment, it will be possible that we will be receiving patients from other countries so that they get treated from Rwanda instead of going to seek the treatment abroad such as in European countries,” he said.

Yves Inayo Nzaba, a Congolese national, said he was suffering from pancreatic disease and he could not get treatment in his native country, which made him come to see the doctor at King Faisal Hospital.

"Before the treatment, I had much pain, but my condition has improved,” he said one day after he received a minimally invasive operation.

"I am delighted that I have received the treatment here in our neighboring country, Rwanda. If King Faisal [Hospital] was not there, I would spend more on treatment far away [in countries outside Africa].