Enhancing Laparoscopic Skills at the New International Center for Surgical Simulation in Zimbabwe

Two Stanford Surgery faculty members recently participated in a new teaching initiative at the University of Zimbabwe’s International Center for Surgical Simulation (UZICSS). This center offers novel learning opportunities and advanced surgical skills acquisition though simulation. It resulted from an academic partnership between University of Zimbabwe, Queen Mary University Virtual Reality Surgical Simulation Centre in the UK, Karl Storz Endoskope-Germany, and Stanford. The academy is dedicated to promoting patient safety through multi-specialty surgical education and research.

Dr. Wendy, Su, clinical associate professor of pediatric surgery, and Dr. Cara A. Liebert, clinical assistant professor of general surgery, returned from their trip to Harare, Zimbabwe where they participated in a Laparoscopic Surgical Training Course on April 5-8, 2023. The course teaches core principles of laparoscopic surgery and technical skills.

Q: Dr. Su, welcome home! Can you tell us about this project? How did the idea develop, and how was Stanford Surgery part of this global collaboration? 

This project is the brainchild of Prof. Godfrey Muguti, a professor of surgery and professorial chair in the Department of Surgical Sciences at the University of Zimbabwe, as well as the immediate past president of the College of Surgeons of East, Central and Southern Africa (COSECSA). [He is also Clinical Professor of Surgery in the Department of Surgery at Stanford.] Prof. Muguti has been the driving force in establishing UZICSS. Throughout the years he strived to build bridges and global collaboration programs to enhance surgical skills and clinical education in his region. It was through these relationships that he was able to orchestrate the formation of this project. 

I was privileged to meet Prof. Muguti on his most recent visit to San Francisco to receive an award at the ReSurge International 2023 Transformations Gala. Prof. Muguti was excited to share with us that his dream project was about to be realized after four years of hard work. There was a group of 20 learners between students, junior and senior surgeons attending the workshop at Harare. The curriculum included a symposium and dry lab and wet lab experiences. After six months of online and hands-on training, the participants receive a certificate of laparoscopic surgery.

He also noted that this center will be open all year long to train surgeons from countries in the COSECSA region. His aim is to reduce patient harm in hospitals from treatment and surgery, which happens to be the third leading cause of death globally, and to save lives by making good training available and enabling reliable skills acquisition in a stress-free simulation environment.

Prof. Muguti shared with me how he felt when he watched the building take shape and new equipment installed. On the first day of the symposium, when the space was filled with the enthusiastic and excited faces, eager to learn, the promises of progress became real.

The workshop was facilitated by international and local faculty. About ten educators came to teach at the workshop from the United Kingdom, the United States, South Africa, and Namibia, as well as the local Zimbabwean laparoscopic experts.

It was an honor for me to participate in this inaugural workshop side-by-side with my colleague Dr. Liebert and the other international faculty. What amazed me was the similarity and complimentary nature of our symposium presentations regarding the importance of surgical education through simulation to maximize safety and outcome.

Q: Tell us about the resources and infrastructure at the University of Zimbabwe. Was it a successful course? Is it expected to be an annual training?

A very successful and promising center, indeed. It was better than I expected. When we arrived, everything was ready. The building and the lab were already set up and the quality of equipment is as good as we have here at Stanford. Everything is new; I hope they can keep the equipment maintained along the way, so they last a very long time.

We understood that this was a new experience for the operating room support staff and even the nurses from the hospital, who were there to assist us, so we gave them some advice on how to improve the set-up and what the surgeon might need before and during the procedure. I was impressed by how quick they learned and prepared everything the next day just as we requested; we witnessed the improvement in just 24 hours. It was a team effort. We were all doing our best to teach each other and contribute to establishing a proper system that they can follow in the future to insure smooth and effective procedures. 

As this first group continues their training with the curriculum, there will be a second group to attend a similar symposium in six months.   

Q: Have you participated in previous international initiatives? Do you think that it is an experience every surgeon should have, if given the opportunity?

To me, it is a re-activation of a very long interest in global health. I spent five weeks at Karanda Mission Hospital in rural Zimbabwe 200 miles north of the capital Harare as an international medicine elective during medical school 25 years ago. After I completed my fellowship training, I participated in a couple of medical missions to southwestern China with the American Medical Dental Society. This trip to Harare is my first University-sponsored global health teaching experience, and it has rekindled my enthusiasm to be more involved. I hope that it’s the first of many.

I think it’s time we get more exposed to the needs of healthcare systems in other countries. It was an eye-opening experience for me. In the United States, our patients always expect to receive minimally-invasive surgeries as the standard of care for many common procedures. It is something we take for granted here, while in low- and middle-income countries the availability of and access to minimally-invasive procedures are very limited, partly due to the lack of resources and partly due to training. Governments should realize that although equipping and staffing centers to provide laparoscopic surgery requires a lot of investment, it will eventually be better economically because patients will be able to get back to their work much faster.

Q: Tell me about the students. Any interesting stories you can share with us?

They were so excited. They always wanted to learn more, and here’s are a few stories for you:

 On the first day of the wet lab, we had to finish early at 4 PM because we ran out of carbon dioxide in a number of the stations. But the next morning when we came in, we found that the CO2 we needed was delivered overnight. Apparently, Prof. Muguti called up several contacts to obtain the CO2 canisters. The learners were eager to compensate for the time they lost in the evening before, so they refused to take their breaks for lunch or tea. (Tea is a big cultural thing in Zimbabwe, morning and afternoon tea are essential for the wellbeing of mind and body, but they just wanted to go on with their work to make up for the time lost the day before!)

At the end of the second day, Prof. Muguti came to the lab and said to the group “Today is Good Friday, you should finish at 4, and go home early today.” He came again at 4 PM, and they were still working so he told them they had 15 minutes to finish, but the 15 minutes turned to almost an hour!

My group was four trainees, and they were collaborating to do their first laparoscopic cholecystectomy. They didn’t want to leave until they completed the procedure. Seeing that level of dedication and enthusiasm was very impressive. We were all joking about it later, because it’s the only time we saw them decline a request from Prof. Muguti!  

I was also touched when I learned that one of the trainees in the group was a recent graduate of the University of Zimbabwe Surgery Residency but is originally from a city that is several hours south of the capital. He returned to practice in his hometown after he completed surgical training. He told me that he attended this course to gain more advanced laparoscopic skills. Once he finishes this course, he will share the techniques he learned with surgeons in his hometown. He said it’s his duty and obligation to serve his people and local communities when they don’t have access to the advances technology that is available in big cities.

While most people have access to internet and can easily search for the resources they need, we should keep in mind that these privileges are not always easy or available in LMICs, especially in rural areas.

Global collaborations are mutually beneficial: there is so much to learn when our residents travel to train in LMICs in exchange programs, and at the same time to share with others the technology and techniques we learn in the US medical and educational institutions. It is definitely a win-win situation, and we should continue doing it.