Expanding laparoscopic cholecystectomy to rural Mongolia

Area of Science:

• Minimally Invasive Surgery
• Surgical Education
• Global Health

Background:

• Laparoscopic cholecystectomy, introduced in 1994, remained inaccessible to most Mongolians due to resource and training limitations.
• Gallbladder disease poses a significant health burden in Mongolia, particularly in rural areas.
• The Health Sciences University of Mongolia (HSUM) sought to overcome barriers to expand laparoscopic surgery nationwide.

Purpose of the Study:

• To assess the feasibility and safety of expanding laparoscopic cholecystectomy to rural Mongolia.
• To evaluate the impact of short-term training courses on surgical outcomes in regional centers.

Main Methods:

• Collaborative development of 2-week didactic and practical training courses by HSUM and a non-governmental organization.
• Training conducted in tertiary care centers in Ulaanbaatar and the rural city of Erdenet.
• Comparison of demographic data, operative findings, and complication rates between urban and rural sites.

Main Results:

• 36 surgeons trained, performing 410 laparoscopic cholecystectomies.
• No significant difference in intraoperative or postoperative complications between the capital and rural Erdenet.
• Complication rates were similar during teaching and non-teaching periods, indicating sustained safety.

Conclusions:

• Short-term training courses effectively enable the safe expansion of laparoscopic cholecystectomy to rural referral centers in Mongolia.
• This initiative markedly improves access to minimally invasive surgery for 50% of the population previously excluded.
• The findings support the scalability of such training programs to enhance surgical care in resource-limited settings.