Disseminating surgical experience for sustainable benefits: the Urolink experience

Venn, Susan; Mabedi, Charles; Ngowi, Bartholomeo Nicholaus; Mbwambo, Orgeness Jasper; Mteta, Kien; Payne, S. R.

doi:10.1111/bju.15733

Cited by 5 publications

(5 citation statements)

References 27 publications

(32 reference statements)

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“…It has long been known that there is significantly reduced morbidity, and lower complication rates, from endoscopic surgery than from open stone removal [36], or open nephrectomy [37], skills that many LMIC urologists have been shown to rapidly acquire with increasing exposure to the procedures [35]. Longitudinal mentoring has been shown to be the essential component for providing some sustainability in those skills [11,35,38,39], so that they can be further disseminated regionally to other surgeons for much wider patient benefit [37]. The coronavirus disease 2019 (COVID-19) pandemic resulted in a drastically reduced ability to travel so that on-site surgical missions or short-term surgical trips (STSTs) to LMICs could not take place.…”

Section: Open Vs Minimally Invasive Stone Surgery: the Importance Of ...mentioning

confidence: 99%

Stone disease in low‐ and middle‐income countries: could augmented reality have a role in its management?

et al. 2022

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Urolithiasis is a global phenomenon. Cystolithiasis is common in parts of Africa due to low protein intake and dehydration from endemic diarrhoeal illnesses. Nephrolithiasis is less prevalent than in high‐income countries, probably due to a variety of lifestyle issues, such as a more elemental diet, higher physical activity, and less obesity. Although renal stones are less common in low‐ and middle‐income countries (LMICs), the social and economic impacts of nephrolithiasis are still considerable; many stones present late or with complications such as upper urinary tract obstruction or urosepsis. These may lead to the development of chronic kidney disease, or end‐stage renal failure in a small proportion of cases, conditions for which there is very poor provision in most LMICs. Early treatment of nephrolithiasis by the least invasive method possible can, however, reduce the functional consequences of urinary stone disease. Although extracorporeal lithotripsy is uncommon, and endoscopic interventions for stone are not widespread in most of Africa, percutaneous nephrolithotomy and ureteroscopic renal surgery are viable techniques in those regional centres with infrastructure to support them. Longitudinal mentoring has been shown to be a key step in the adoption of these minimally invasive procedures by local surgeons, something that has been difficult during the coronavirus disease 2019 (COVID‐19) pandemic due to travel restriction. Augmented reality (AR) technology is an alternative means of providing remote mentoring, something that has been trialled by Urolink, the MediTech Trust and other global non‐governmental organisations during this period. Our preliminary experience suggests that this is a viable technique for promulgating skills in LMICs where appropriate connectivity exists to support remote communication. AR may also have long‐term promise for decreasing the reliance upon short‐term surgical visits to consolidate competence, thereby reducing the carbon footprint of global surgical education.

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Section: Open Vs Minimally Invasive Stone Surgery: the Importance Of ...mentioning

confidence: 99%

Stone disease in low‐ and middle‐income countries: could augmented reality have a role in its management?

et al. 2022

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“…The biggest challenges faced when carrying out a TURP are often technical, such as making connections between components of the diathermy, the supply of disposables such as the loops and maintenance of the endoscopes and diathermy equipment. Bipolar resection is now firmly established in all of the countries Urolink and the Medi Tech Trust are associated with; the provision of a sustainable supply of resection loops is the greatest challenge to the development of endoscopic resection across the regions these centres act as training hubs for [42]. The need for mentoring alone has been found to be all that is often required when teaching TURBT or DVIU to skilled surgeons in LMICs.…”

Section: Teaching Endoscopic Surgerymentioning

confidence: 99%

“…Longitudinal involvement in LMIC centres helps for both durable relationships between the trainer and the learner, and the sustainability of the techniques in the resource-poor environment [42].…”

Section: Teaching Endoscopic Surgerymentioning

confidence: 99%

“…HIC surgeons need to be appropriately skilled to teach the procedures in their entirety and comfortable with the LMIC operative environment, which is often much less well‐resourced than they are used to. Longitudinal involvement in LMIC centres helps for both durable relationships between the trainer and the learner, and the sustainability of the techniques in the resource‐poor environment [42].…”

Section: Teaching Endoscopic Surgerymentioning

confidence: 99%

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The feasibility of endourological surgery in low‐resource settings

et al. 2022

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One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa (SSA) has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients that established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically or restricted by the abilities of the surgeons in SSA. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them, and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. However, they are largely dependent upon the supply of equipment from non-governmental organisations in highincome countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.

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“…A longitudinal continuity in partnerships between HIC paediatric urologists and LMIC paediatric surgeons is crucial to their sustainability, as has been demonstrated in adult collaborations [60]. The challenge of maximising the utility of limited resources and the necessity to use the full-breadth of medical knowledge in the absence of substantial subspecialisation [19,61] is both invigorating and educative to HIC surgeons, whilst helping educate LMIC surgeons in their home environment.…”

Section: Innovation Applicationmentioning

confidence: 99%

Paediatric urology in Sub‐Saharan Africa: challenges and opportunities

et al. 2022

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The need for paediatric urological care in low-and middle-income countries in sub-Saharan Africa (SSA) is enormous due to a burgeoning paediatric-aged population and a disproportionate burden of congenital malformations. There are formidable challenges in the provision of a skilled workforce and appropriate infrastructure, resulting in a huge unmet need with consequent effects on the long-term health and prosperity of the population. Constraints of funding, geography, culture, surgical and anaesthetic skills, and instrumentation means that many conditions present late and with complications that could have been avoided by an earlier attendance. It also means that the management of congenital malformations, e.g., bladder exstrophy and congenital obstructive posterior urethral membrane, differ substantially from that seen in the developed world, with the outlook for children with renal failure being particularly bleak. Collaborations between paediatric urologists from high-and low-income countries are beginning to help with the development of a surgical infrastructure customised to paediatric care, and with the training of specific paediatric urological knowledge and skills. These collaborations, whilst welcome, still require substantial expansion to achieve more equitable access to appropriate paediatric urological care for children in SSA. Future efforts have to focus on the creation of sustainable and equal partnerships between urologists from low-and high-income healthcare environments, with an emphasis on providing sustainable management, appropriate to local need and available resources. The provision of shared learning, utilising the benefits of global digital communication, will improve mutual understanding of needs in a resource-poor environment and the involvement of trainees from both income settings can help perpetuate long-term collaborations.

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Disseminating surgical experience for sustainable benefits: the Urolink experience

Cited by 5 publications

References 27 publications

Stone disease in low‐ and middle‐income countries: could augmented reality have a role in its management?

Stone disease in low‐ and middle‐income countries: could augmented reality have a role in its management?

The feasibility of endourological surgery in low‐resource settings

Paediatric urology in Sub‐Saharan Africa: challenges and opportunities

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