SAGES Go Global International Proctoring Course (IPC): its impact in 2 rural institutions in Argentina

Alberto Raul Ferreres, MD, FACS, hon, PhD1, Rosana Trapani1, Julieta Camelione, MD1, Marcelo Fasano, MD1, Anibal Rondan, MD1, Pablo Miguel, MD1, Jacqueline Narvaez2, Ramon Berguer, MD2, Jeffrey Hazey, MD3. 1University of Buenos Aires, 2SAGES, 3University of Ohio

Introduction: SAGES Go Global was founded in 2006 and since then, has held more than 25 IPCs all over the world. The aim of this endeavour is to provide a self sustainable model for the development and expansion of laparoscopic surgery in rural and distant areas. Our objective is to present the impact of this Program in 2 rural institutions in Argentina.

Methods and Procedures: Between June 2nd and 6th, 2014 an IPC Course was hosted at our Institution, it offered the  “Train the Trainers Course” (TTC) to our faculty and also trained 4 surgeons _ from two rural institutions and not previously exposed to laparoscopic surgery_ in laparoscopic cholecystectomy (LC). The training included 3 stages: a) day 1: lectures and videos, b) day 2 and 3: operating room (OR) activity at the host institution and c) day 4 and 5: OR activity at each of the 2 rural hospitals. Tracking and assessment of the surgical activity of the 4 trainees was gathered through a prospective database of the period june 2014- june 2015.

Results: The TTC allowed the training of 5 members of our Faculty and the 4 trainees. Two of them belong to Institution I (General Rodriguez, distant 65 km from the city of Buenos Aires) and the other two to Institution II  (Lujan, distant 70 km). Each of them completed 4 LCs under strict supervision during days 2 and 3, with alternate dry-lab activity in laparoscopic simulators. Day 4 and 5 corresponded to surgical procedures in both institutions under supervision by a team composed by 2 faculty members, a surgical scrub nurse and a coordinator. Eight LCs were performed by each trainee in his/her own institution under direct supervision.

The year activity after the initial IPC was:  institution I: 69 LC (surgeon A: 44 cases and surgeon B: 25) and institution II: 81 LC (surgeon C: 49 cases, surgeon D: 32).Average operative difficulty was 3, average operative time was 120 minutes (range 100-141) in the first semester and 44 (range 37-51) in the second one. No major complications were achieved, with no conversions and the mortality rate was 0%.

Conclusions: SAGES GoGlobal IPC represents a valid alternative and a strong educational methodology for the training of novice surgeons in LC. This Program has an undeniable humanitarian aspect, allowing usually underserved populations with the benefit of the standard of care for the treatment of symptomatic cholelithiasis.

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