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Enhancing surgical capacity in the low- to middle-income countries An initial report of a Global Surgery Partnership
Michael E Chua1,2,3, Kate Luzelle Aba3, Kay Rivera3
1Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Insights
This global surgery initiative improved reconstructive urology care in low- to middle-income countries (LMICs) using mentorship and augmented reality (AR) telementoring. The program enhanced surgical skills and patient outcomes, demonstrating a sustainable model for global health.
Area of Science:
- Global Surgery
- Urology
- Medical Education
Background:
- Pediatric and adult reconstructive urology are underrepresented in global surgical efforts.
- Specialized urologic care is lacking in low- to middle-income countries (LMICs).
- A longitudinal, mentorship-based approach integrating augmented reality (AR) telementoring was developed to address this gap.
Purpose of the Study:
- To enhance global surgical expertise in reconstructive urology within LMICs.
- To evaluate the impact of a structured mentorship program combined with AR telementoring.
- To assess improvements in surgical competencies and system-level capacity.
Main Methods:
- A Global Surgery Partnership Initiative collaborated with institutions in the Philippines and Vietnam.
- A mixed-method approach included virtual case conferences, in-person mentoring, AR telementoring, and postoperative coaching.
- Patient outcomes and mentee self-reported comfort and technical understanding were assessed using descriptive statistics and paired t-tests.
Main Results:
- Thirty-eight reconstructive urology cases were performed with low complication rates (12.7%).
- Operative times and length of stay decreased over time.
- Mentee comfort (3.06 to 6.77) and technical understanding (4.77 to 8.43) significantly improved (p<0.001).
- AR-assisted mentoring proved feasible, enhancing intraoperative feedback and sustainability.
Conclusions:
- A structured, mixed-method model effectively improved surgical competencies and capacity in LMICs.
- The initiative emphasized continuity, adaptability, and sustainability, contrasting with short-term missions.
- This scalable framework integrates reconstructive urology into global health, utilizing AR to overcome limitations.
Introduction:
Pediatric and adult reconstructive urology remain underrepresented in global surgical efforts, despite their critical role in restoring genitourinary function. This global surgery initiative aimed to address the gap in specialized urologic care in low- to middle-income countries (LMICs) through a longitudinal, mentorship-based approach integrating augmented reality (AR) telementoring.
Methods:
This report describes an approach used to enhance global surgical expertise in LMICs and summarizes data documenting impact. A Global Surgery Partnership Initiative was launched by an academic surgeon from the University of Toronto to address the lack of specialized pediatric and reconstructive urologic training. Through collaboration with local institutions in the Philippines and Vietnam, the program employed a mixed-method approach that delivered longitudinal mentorship, combining virtual case conferences, in-person surgical mentoring, pilot of AR-supported telementoring, and continuous postoperative coaching. Patient outcomes were assessed and mentees self-reported pre- and post-intervention surveys evaluating comfort and technical understanding. Descriptive statistics and paired t-tests were used to analyze outcomes.
Results:
Thirty-eight pediatric and adult reconstructive urology cases were performed. Over time, operative times and length of stay decreased, with low complication rates (6/38, 12.7%) and Clavien-Dindo ≥3 complications (3/38, 8%). Mentee comfort and understanding significantly improved (mean comfort score: 3.06 to 6.77; technical understanding: 4.77 to 8.43; p<0.001). AR-assisted mentoring, introduced in 2022 and expanded in 2024, showed feasibility, with further enhanced intraoperative feedback and sustainability.
Conclusions:
This structured, mixed-method model effectively improved surgical competencies and system-level capacity in LMICs. Unlike short-term missions, this initiative emphasized continuity, adaptability, and sustainability. It presents a scalable framework for integrating reconstructive urology into global health programs while leveraging AR to overcome geographic and resource limitations.
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