• Humans
• Laparoscopy/education
• Canada
• Clinical Competence
• Mentoring
• Surgeons/education
• Program Evaluation
• Attitude of Health Personnel
• Peer Group
• Pancreatectomy
• Hepatectomy/methods
• Health Knowledge, Attitudes, Practice
• Male
• Program Development
• Female
• Education, Medical, Continuing

• Africa
• MIS
• laparoscopic surgery
• minimally invasive surgery

• Sub-Saharan Africa
• laparoscopic surgery
• limitations
• minimally invasive surgery
• opportunities
• training

• Global Health
• Global Surgery
• Surgical Education
• Surgical Simulation

• Humans
• Rwanda
• Clinical Competence
• Curriculum
• Simulation Training
• Surgeons
• Students, Medical
• Clinical Clerkship
• Education, Medical, Undergraduate

• Frugal innovation
• Gasless laparoscopy
• Global engineering
• Global surgery

• Swine
• Animals
• Feasibility Studies
• Laparoscopy/methods
• Abdominal Wall
• Carbon Dioxide
• Cholecystectomy

• R21 CA249696 NCI NIH HHS
• U01 CA269190 NCI NIH HHS
• R21 CA249696-01A1 NIH HHS
• National Institute of Health
• Duke Bass Connections Initiative
• Duke/Duke-NUS Pilot Project Grant

• Global Surgery
• Global Surgical Education
• Surgical simulation
• Surgical training

• Humans
• Kenya
• Academic Medical Centers
• Operating Rooms
• Rwanda
• Clinical Competence

• COVID-19
• Fundamentals of laparoscopic surgery (FLS)
• Surgical education
• Telesimulation

• Art
• Cross-stitching
• Education
• Suturing

• Humans
• Pilot Projects
• Fiber Optic Technology
• Intubation, Intratracheal

• colorectal surgery
• low- and middle-income countries
• research
• training

Current trends in surgical simulation favor high-fidelity, costly models that are often limited to high-income academic centers. The GlobalSurgBox overcomes many of the barriers to routine implementation and use of surgical simulators in low-income countries by circumventing the often prohibitive financial, time, and personnel investments required of current simulation prototypes.

There is a tremendous need for affordable and accessible surgical simulators in the United States and abroad. Our group developed a portable, modular, inexpensive surgical simulator designed for all levels of surgical trainees, from medical students to cardiothoracic surgery fellows, and adaptable to a variety of surgical specialties. Our goal is to provide a platform for innovative surgery simulation that applies to any learner or resource setting. We describe the development, assembly, and future directions for this simulator.

• Humans
• United States
• Students, Medical
• Clinical Competence

Telesimulation helps overcome limitations in time and local expertise by eliminating the need for the learner and educator to be physically co-located, especially important during COVID-19. We investigated whether teaching advanced laparoscopic suturing (ALS) through telesimulation is feasible, effective, and leads to improved suturing in the operating room (OR).

In this prospective feasibility study, three previously developed 3D-printed ALS tasks were used: needle handling (NH), suturing under tension (UT), and continuous suturing (CS). General surgery residents (PGY4-5) underwent 1-month of telesimulation training, during which an expert educator at one site remotely trained residents at the other site over 2–3 teaching sessions. Trainees were assessed in the three tasks and in the OR at three time points: baseline(A1), control period(A2), and post-intervention(A3) and completed questionnaires regarding educational value and usability of telesimulation. Paired t-test was used to compare scores between the three assessment points.

Six residents were included. Scores for UT improved significantly post-intervention A3(568 ± 60) when compared to baseline A1(416 ± 133) (p < 0.019). Similarly, scores for CS improved significantly post-intervention A3(756 ± 113) vs. baseline A1(539 ± 211) (p < 0.02). For intraoperative assessments, scores improved significantly post-intervention A3(21 ± 3) when compared to both A1(17 ± 4) (p < 0.018) and A2(18 ± 4) (p < 0.0008). All residents agreed that tasks were relevant to practice, helped improve technical competence, and adequately measured suturing skill. All residents found telesimulation easy to use, had strong educational value, and want the system to be incorporated into their training.

The use of telesimulation for remotely training residents using ALS tasks was feasible and effective. Residents found value in training using the tasks and telesimulation system, and improved ALS skills in the OR. As the pandemic has caused a major structural shift in resident education, telesimulation can be an effective alternative to on-site simulation programs. Future research should focus on how telesimulation can be effectively incorporated into training programs.

• Advanced laparoscopic suturing
• Laparoscopy
• Simulation
• Surgical education
• Telesimulation

• COVID-19
• Clinical Competence
• Curriculum
• Feasibility Studies
• Humans
• Internship and Residency
• Laparoscopy/education
• Prospective Studies
• Suture Techniques/education

The COVID-19 pandemic challenges our ability to provide surgical education, as our ability to gather and train together has been restricted due to safety concerns. However, the importance of quality surgical education has remained. High-fidelity simulation platforms have been developed that merge virtual reality video streams to allow for remote instruction and collaboration. This study sought to validate the use of a merged virtual reality (MVR) platform for the instruction and assessment of the fundamentals of laparoscopic surgery (FLS) skills.

This was a prospective randomized controlled non-inferiority study. Thirty participants were randomized between three groups: The standard group received in-person instruction and expert feedback, the experimental group received identical training via the MVR platform, and the control group practiced on their own, but received no feedback. All participants were pre-tested for baseline performance at the beginning of the study. Change in performance was evaluated immediately after training and one month later for retention. Ordinary one-way analysis of variance was used to evaluate the effects of time, group, and time-on-group.

The pre-test confirmed baseline homogeneity between the groups. MVR was non-inferior to standard in-person training for total FLS times on either the post-test (p = 0.632) or the retention test (p = 0.829). Performance was also identical between MVR and standard training groups for each of the individual FLS tasks. Each group improved significantly in nearly all tasks after practice; however, the standard and MVR training groups both improved significantly more than controls for the ligating loop, extracorporeal suturing, intracorporeal suturing, and total FLS task training but did not reach statistical significance for peg transfer and pattern cut tasks.

This randomized, controlled trial has demonstrated the use of an MVR platform as non-inferior to in-person instruction for the FLS program, forming the foundation for future work on remote instruction and collaboration.

The online version contains supplementary material available at 10.1007/s00464-021-08939-4.

• Laparoscopic surgery
• Surgical education
• Virtual reality

• FLS
• GOALS
• Gasless laparoscopy
• LMIC
• Laparoscopic training
• OSATS

• low-income countries
• mixed methods
• nursing education
• nursing students
• simulation-based education

• global health
• medical education
• simulation training
• telesimulation

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.

• LMIC
• Laparoscopy
• training

• Capacity building
• postgraduate medical education
• surgical

• Capacity Building
• Developing Countries
• Health Facilities
• Humans
• Income
• Leadership

The National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students.

A standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings.

Students and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25).

The faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning.

• Education
• Emergency medical technician
• Experiential learning
• Prehospital care
• Simulation

• Global health
• Global surgery
• Low- and Middle Income countries
• Paediatric surgery
• Simulation-based medical education
• Surgical education
• Surgical simulation
• Surgical training

• simulation
• simulation center
• simulators
• surgery
• ventral hernia surgery

• FLS
• Italy
• Laparoscopy
• Randomized trial
• Training
• Tutoring

• Clinical Competence
• Female
• Humans
• Internship and Residency/methods
• Italy
• Laparoscopy/education
• Male
• Mentoring
• Self-Directed Learning as Topic
• Simulation Training/methods
• Single-Blind Method
• United States

An estimated 5 billion people worldwide lack access to any surgical care, whilst surgical conditions account for 11–30% of the global burden of disease. Maximizing the effectiveness of surgical training is imperative to improve access to safe and essential surgical care on a global scale. Innovative methods of surgical training have been used in sub-Saharan Africa to attempt to improve the efficiency of training healthcare workers in surgery. Simulation training may have an important role in up-scaling and improving the efficiency of surgical training and has been widely used in SSA. Though not intended to be a systematic review, the role of simulation for teaching surgical skills in Sub-Saharan Africa was reviewed to assess the evidence for use and outcomes.

A systematic search strategy was used to retrieve relevant studies from electronic databases PubMed, Ovid, Medline for pertinent articles published until August 2016. Studies that reported the use of simulation-based training for surgery in Africa were included.

In all, 19 articles were included. A variety of innovative surgical training methods using simulation techniques were identified. Few studies reported any outcome data. Compared to the volume of surgical training initiatives that are known to take place in SSA, there is very limited good quality published evidence for the use of simulation training in this context.

Simulation training presents an excellent modality to enhance and improve both volume and access to high quality surgical skills training, alongside other learning domains. There is a desperate need to meticulously evaluate the appropriateness and effectiveness of simulation training in SSA, where simulation training could have a large potential beneficial impact. Training programs should attempt to assess and report learner outcomes.

• Paediatric surgery simulation
• Paediatric urology simulation
• Simulation based medical education (SBME)
• Surgical simulation
• Urology simulation

• Health Policy
• India
• Nurse Educators
• Self-Efficacy
• Simulation
• Tool Revision

• Laparoscopy
• Low-income country
• Pelvitrainer
• Simulation

• Adult
• Clinical Competence
• Curriculum
• Developing Countries
• Education, Medical, Graduate/economics
• Education, Medical, Graduate/methods
• General Surgery/economics
• General Surgery/education
• Humans
• Internship and Residency/methods
• Male
• Poverty/economics
• Rwanda
• Simulation Training/economics
• Simulation Training/methods
• Thoracic Surgery/economics
• Thoracic Surgery/education

• T32 HL007849 NHLBI NIH HHS

This paper presents a description of, and some reflections around, the experience of implementing simulation-based education within a nursing education programme in a low-income context. The students in the nursing education programme found the simulation sessions to be useful, motivating and a realistic learning method. Our experience may provide useful insight for other nursing education programmes in low-income contexts. It looks like a deeper knowledge about the feasibility of simulation-based education from both the teacher and student perspective is necessary.

• Education in a low-income context
• Nurse
• Nursing education
• Simulation-based education

• Clinical Competence/standards
• Developing Countries/economics
• Health Resources/supply & distribution
• Humans
• Simulation Training/economics
• Simulation Training/standards

• clinical research/practice
• donors and donation: living
• education
• kidney transplantation/nephrology
• kidney transplantation: living donor
• organ procurement
• organ procurement and allocation

Surgical management of diseases is recognised as a major unmet need in low and middle-income countries (LMICs). Laparoscopic surgery has been present since the 1980s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with high-income countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.

• Laparoscopic surgery
• Global surgery
• Low and middle-income countries
• Laparoscopic training
• Patient safety
• Laparoscopy
• Minimally invasive surgery

Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination.

• Education
• Laboratories
• Laparoscopy
• Robotics
• Surgery

• Ethiopia
• Laparoscopic
• Simulation
• Surgical education
• Training

Laparoscopic surgery has been shown to have many favorable effects on surgical outcomes and postoperative recovery times. However, the cost of currently available training programs, such as the Fundamentals of Laparoscopic Surgery (FLS), limits their adoption in developing countries. To address this cost constraint, educators at the Justinian University Hospital (JUH) in Northern Haiti used local materials to build their own laparoscopic skills box trainer. This trainer is used to teach all surgical and OB/GYN residents in their laparoscopic skills program. The progressive curriculum consists of seven modules, three of which are for all trainees and four of which are specifically for surgery and OB/GYN (2). The seven modules are arranged in the order of difficulty; they start with basic maneuvers and progress to complex skills. This report describes both the preparation of the seven models and evaluation of the skills that are learned. This approach may facilitate global access to feasible, progressive, and sustainable laparoscopic training.

• haiti
• laparoscopic

Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes.

The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC.

We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco.

These operations were performed by junior residents (post-graduate year [PGY] 4–5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien–Dindo classification) were recorded and analysed. One-way analysis of variance, Student's t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05.

One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001).

LC performed by residents appears to be safe without a significant difference in complication rate; however, seniority influences operative time. This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.