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Show Continuing didactic and practical laparoscopic training courses in Mongolia: the introduction of a low-cost laparoscope and virtual reality broadcast of laparoscopic cholecystectomy Jade Nunez, Sandag Erdene, Sarnai Erdene, Ulzii-Orshickh, Togtokhbayar Baljinnyam, Nanjid Bikhaniragchaa, Jonathan Nellermoe, Orgoi Sergelen, John Langell, Ashok Khandkar, and Raymond Price BACKGROUND Between 2005 and 2013, use of laparoscopic cholecystectomy increased from 2% to 58% in Mongolia. Expensive and poorly functioning equipment continue to present challenges. The University of Utah's Centers for Global Surgery and Medical Innovation developed a low-‐cost laparoscope hoping to provide high-‐ quality low-‐cost alternatives. METHODS A FDA approved combination camera, scope and light source that costs $85 to manufacture was developed at the University of Utah. Fourteen units were used to perform 21 laparoscopic cholecystectomies at a rural regional hospital in Mongolia in September 2016. Demographic patient data, diagnosis and post-‐ operative course were collected. Mongolian surgeons completed a survey after each operation focused on the surgeon's experience with the low-‐cost laparoscope. One case was broadcasted live in virtual reality with simultaneous questions and answers online. RESULTS Survey of Tov Aimag Surgeons using Xenoscope Visualization Ease of Use Excellent (3)-‐ 15 Excellent (3)-‐ 20 Good (2)-‐ 3 Compared to Standard Would use if available? Better (2)-‐ 19 Yes (1)-‐ 20 Good (2)-‐ 0 Same (1)-‐ 1 No (0)-‐ 1* Poor (1)-‐ 2 Poor (1)-‐ 0 Worse (0)-‐ 1* Inadequate (0)-‐ 1* Inadequate (0)-‐ 1* Weighted Avg Score= 2.5/3.0 *Scope did not work Weighted Avg Score= 2.8/3.0 Weighted Avg Score= 1.9/2.0 Twenty-‐one laparoscopic cholecystectomies were performed by students, proctored by instructors from MNUMS and the University of Utah. 11 surgeon students hailed from 4 Aimags (states). 14/21 patients (66.7%) were female. Thirteen patients lived within one kilometer of the hospital, eight patients traveled as far as 200 km (128 km, mean). Mean operative time: 71 minutes. Two patients had dif[icult anatomy; two had thickened gallbladder walls. There were 3 complications: one intraoperative bleeding; two postoperative surgical site infections. CONCLUSION Weighted Avg Score= 0.95/1.0 The introduction of a low-‐cost laparoscope shows immense potential to facilitate expansion of laparoscopic surgery in Mongolia and other resource-‐limited countries. Virtual reality live broadcasting of surgery may aid in remote-‐area education. |
