LAUSR

BACKGROUND Endosurgery has several advantages over open surgery in the context of global surgery. Simulation-based training (SBT) is a highly effective educational modality for pediatric endoscopic surgery. This study assessed the effectiveness of SBT using a disease-specific simulator for laparoscopic percutaneous extraperitoneal closure (LPEC) in low- and middle-income countries (LMICs). METHODS We developed a disease-specific simulator for LPEC surgery that reproduces an infant's small pelvic cavity and lower abdomen. We held a workshop for LPEC surgery in Kathmandu, Nepal. The workshop consisted of lectures, hands-on training using the LPEC simulator, and live surgery for LPEC. To assess the effectiveness of the workshop, skill evaluation tests were conducted before and after the workshop. In addition, a follow-up survey was conducted 8 months after the workshop to investigate whether or not LPEC surgery was implemented. RESULTS Twenty-three participants completed the workshops. The skill evaluation tests using the LPEC simulator revealed that participants' skills had improved significantly after the workshop with regard to task completion time (650.4 ± 363.4 vs. 389.0 ± 179.1 s, p < 0.01). In live surgery, the first LPEC surgery in Nepal was successfully performed by a local pediatric surgeon without intraoperative complications. Five institutions out of 6 responded to the follow-up questionnaire survey (response rate: 83.3%). LPEC surgery was implemented in 4 out of 6 institutions (66.7%). In the 8 months following the workshop, a total of 725 surgeries for pediatric inguinal hernia were performed at 5 hospitals, of which 68 (9.4%) were LPEC surgeries. There were no intraoperative complications or recurrences during these 68 LPEC surgeries. CONCLUSIONS SBT using a disease-specific simulator is effective for safe introduction of new pediatric endoscopic surgical procedures in LMICs.