Advancing laparoscopic surgery in low- and middle-income countries (LMICs): pilot implementation of the Global Laparoscopic Advancement Program (GLAP) with Fundamentals of Laparoscopic Surgery (FLS) certification in Ethiopia.

Abstract

Background: Laparoscopic surgery adoption in low- and middle-income countries (LMICs) faces significant challenges due to limitations of resources and trained professionals. The Global Laparoscopic Advancement Program (GLAP) of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), through the Global Affairs Committee (GAC), aims to overcome these barriers through sustainable collaborative training in LMICs. Building on GLAP's success in Mexico, Costa Rica, and Namibia, this study aims to evaluate the feasibility of GLAP training combined with FLS certification for surgeons in Ethiopia.

Methods: In December 2023, the GAC collaborated with the Surgical Society of Ethiopia and the College of Surgeons of East, Central, and Southern Africa to conduct two GLAP sessions. These sessions focused on simulation-based education, Fundamentals of Laparoscopic Surgery (FLS), and other SAGES fundamental courses. Participants completed surveys assessing their surgical backgrounds, simulation experience, and curriculum development interest. Participants took the FLS exam at completion of the program.

Results: The GLAP Ethiopia course trained 47 general, pediatric, urologic, and gynecologic surgeons with diverse training backgrounds in laparoscopic surgery-of those trained, 20.8% received formal training in residency and 8.3% in fellowship, whereas 23.4% had no experience. While most (70.2%) learned laparoscopy through observation, 60.4% rarely or had never practiced on simulators, and 36.1% lacked laparoscopic mentors. At the end of the training, 23 participants took the FLS exam; 65% passed both the cognitive and skills portions.

Conclusion: Laparoscopy adoption in Ethiopia remains limited by insufficient structured formal training programs, a shortage of expert trainers, and inadequate equipment. The implementation of GLAP has proven feasible and provides valuable additional training opportunities for the region. Furthermore, the GLAP curriculum and training platform may improve participant performance and success in FLS certification.