1. Adisa Adewale MBChB, FWACS, FMCS(Nig.), D.MAS Department of Surgery, Obafemi Awolowo University, & Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife 220005, Nigeria E mail: wadisc@yahoo.com SAGES 2012 San Diego, CA

2. SAGES 2012 Disclosure Slide AO Adisa OO Lawal OA Arowolo OI Alatise Nothing To Disclose

3.  Decades of diagnostic procedures  Gynecological procedures  Visiting Surgeons  Few private centers, occasional practices

4.  Ile-Ife, South-West Nigeria.  Semi-urban, largely agrarian population.  Laparoscopy in general surgery  Initial attempt in 2008  Consistent deployment from 2009  Improvised set-up  Local adaptations

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12. OAUTHC, Ile-Ife

13.  Locally assembled set-up  Easily maintained and reproducible  Re-useable hand instruments  Improvisations for consumables  Camera cover  Endoloop  Endobag  Intracorporeal staplers  Each procedure costs 20,000 - 45,000 NGN (125-300 USD )

15. OAUTHC, Ile-Ife  181 consecutive laparoscopic surgeries  Laparoscopic cholecystectomies48  Laparoscopic appendectomies36  Laparoscopic evaluation and biopsy of intra-abdominal tumours53  Laparoscopic adhesiolysis18  Laparoscopy assisted colon surgeries 2  Laparoscopic hernia repair 6  Others18

16.  Conversion to open procedure 5/181  Cholecystectomy1  Hepatic biopsy1  Complicated appendicitis2  Colon cancer1  Port site infections 11/518  Bile duct injury 1  MortalityNil