LAUSR

Study Objective To measure the effect of a simulation curriculum designed for instituting gynecologic laparoscopy in low and middle-income settings on competent gynecologic surgeons with novice laparoscopic skills Design Prospective, single center, implementation study Setting Hopital Universitaire de Mirebalais in Haiti (HUM), a 300-bed hospital operating with the Haitian Ministry of Health and Partners in Health, a Boston-based non-profit organization. Patients or Participants Four recent OB/GYN residency graduates and three attending OB/GYN physicians at HUM. The physicians had minimal experience with laparoscopy but were skilled abdomino-pelvic surgeons. Interventions A 5-day gynecologic laparoscopy curriculum was instituted. Trainees participated in increasingly complex simulations interspersed with didactic learning. Simulations included assembling and operating laparoscopic equipment, completing a laparoscopy specific surgical checklist, positioning patients, placing trocars, operating on a box trainer, and troubleshooting surgical complications and equipment malfunctions. Finally, participants completed bilateral salpingectomies on selected patients at HUM with at-the-elbow instructors. The trainees underwent pre- and post-training tests with simulation box training on 3 laparoscopic skills tasks; peg transfer, rubber band manipulation, and circle cut. Measurements and Main Results There were no operative complications. Two evaluators independently scored de-identified pre- and post-test videos of box trainer tasks using a modified OSATS scale (Objective Structured Assessments of Technical Skills). Both were fellowship trained gynecologic surgeons who regularly teach laparoscopy. The mean increase in OSATS scores after training was 4.3 out of 25 possible points (SD 2.7, R 0-8). A Wilcoxon signed rank test of equality of matched pairs was significant. (Prob > |z| = 0.0001.) Conclusion An intensive, short-term curriculum designed for instituting gynecologic laparoscopy in low and middle-income settings significantly increased the measurable laparoscopic skill of 7 gynecologic surgeons who were novices to laparoscopy. Further implementation science regarding the development of gynecologic laparoscopy in low and middle-income settings is needed.