In 2017, the NIHR Global Health Research Group – Surgical Technologies partnered with a group of Indian surgeons involved in an initiative to train rural surgeons of North-East India in laparoscopic surgery. The geography, subtropical climate and limited infrastructure of the region made access to surgery challenging. The research focus of the group was broadly based around the six indicators as per the Lancet Commission on Global Surgery.
The India team identified key rural surgeons from four states of North-East India who had expressed an interest in gasless laparoscopic surgery. In March 2019, the project launched a three-day structured training programme, the TARGET study, in a tertiary hospital in Kolkata, India, to train and evaluate laparoscopic skills. The study consisted of didactic training and assessment of knowledge and skill acquisition. The group used validated scoring tools (MISTELS) to assess laparoscopic skills on standard and low-cost box simulators. Surgical and laparoscopic skills were assessed using OSATS and GOALS scoring systems, respectively. The training and assessment were delivered by the Indian faculty. The trainees received one-to-one training during the course. The TARGET study led to the establishment of the GILLS Regional training centre for rural surgeons at Kolkata Medical College and Hospital. The results showed a steady progression of laparoscopic skills pre and post training. The programme also gave a good exposure of the GILLS technique. Two months later, the training programme continued with proctorship for rural surgeons in their hospital facility in North-East India by the trainers who had participated in the initial TARGET study.
The Gills Registry was developed to gather clinical outcomes data. The data which is currently being analysed will provide valuable information around safety, decision-making, and cost-effectiveness.
The NIHR GHRG project has catalysed a growing community of surgeons who are interested in introducing gasless laparoscopic surgery in rural settings of India. In addition, several centres in Africa have also expressed an interest in gasless laparoscopy training.
The collaborators in India are in the process of finalising the curriculum for training in gasless laparoscopy and will seek national accreditation and validation of the training programme. The Registry will move from a regional to a national level, capturing evidence on outcomes on patients undergoing GILLS procedure in a rural setting. A final assessment of the TARGET training programme is planned to take place in the near future. All these initiatives will be led and managed by team India.
A major highlight was to attend the annual conference of the Association of Rural Surgeons of India. We meet a large community of rural surgeons and got a chance to learn about essential topics in rural surgery and establish networks for future collaboration. During the conference our group was able to deliver training sessions and research seminars to share innovation ideas. Curries made from locally grown products and the Indian cultural programme was an added bonus . The group will cherish countless memories of this wonderful experience.
In conclusion, the overall results of the project have been a massive success in establishing a sustainable training programme in gasless laparoscopy and it is hoped that the impact will be far reaching.