There is a global shortage of trained surgeons, particularly in low-resource countries: every year, approximately 17 million people die because they lack access to surgery.1 In parts of Africa, India, and South America, procedures considered routine in most of North America and Europe are often unavailable for millions, due to the surgeon shortage.
The Intuitive Foundation—and its President, Dr. Catherine Mohr—aim to reduce the global burden of disease, with a specific goal of creating scalable systems that help governments and institutions in low-resource countries increase their numbers of potential surgeons.
The Intuitive Foundation launched the Global Surgical Training Challenge (GSTC) in 2020 to stimulate the creation of novel, low-cost surgical education training modules. These open-source modules help surgical practitioners learn and assess new skills to improve the health of their communities.
The competition started with 42 teams from 44 countries and took place over three years, narrowing to four finalist teams. Ethiopia-based ALL-SAFE won the grand prize, splitting the purse of $1 million with the runner-up for its surgical self-training modules for healthcare workers to help them learn to perform minimally invasive surgeries of the abdomen and pelvis. The Nigeria-based Tibial Fracture Fixation team was the runner-up.
In August of 2022, Dr. Mohr and her team made site visits to the four GSTC finalists—as well as to clinical evaluation partners for simulation modules—starting in India, and extending to Nigeria, Rwanda, Ethiopia, and Sudan.
The pandemic afforded educators a new way of thinking about making training more widely available.
“Medical education and credentialing had been forced during the pandemic to embrace distance learning because travel wasn’t possible,” Mohr said. “Everybody had to adapt. We saw huge changes in telemedicine. We’re a year ahead of where I thought we’d be in terms of having this conversation, because I don’t have to get people to the point where they realize that distance and decentralization is not only okay—it is probably preferable.”
After the Global Surgical Training Challenge completed in December 2022, the team took the learnings and evolved the program into a forum for developing self-administered skills assessment.
This Surgical Education Learners Forum (SELF) develops and evaluates training modules for clinicians in low-resource settings. SELF training modules enable clinicians to independently learn and self-assess specific skills. Modules are free-to-use and publicly available.
Mohr has been engaging in conversations at major conferences on the future of surgical education, and has now expanded those conversations to include emergency and critical care.
“It's a huge cultural change, a huge endeavor in a methodical, ethical, and rigorous way—to show that this is safe and ethical, and that people can train themselves with confidence and competence.”
By regulation, Intuitive does not provide instruction on the practice of medicine; the introduction of new technology requires careful management, and hospitals, medical institutions, and medical boards have responsibility and discretion over surgeon credentialing and hospital privileges.
“There is real soul searching around how do we make these things available in low resource environments?” Mohr said. “How do we keep them maintained? All of that. It's a wicked problem, because it's got so many moving parts, and so many different places where different systems that have different value structures need to interact.”
Mohr visited many operating rooms to see the places where care was delivered, and the visit to Sudan brought home the message that quality is about systems.
“It's not necessarily about the availability of resources,” said Mohr. “People took huge pride in the care they were delivering and clearly took a lot of care to keep things clean and to keep things stocked. It wasn't fancy stuff, it was the basics.
“We saw desperately poor places where I wouldn't be worried about getting an operation in their OR. And we saw other places where they had higher resources, but things were a mess; you just sort of looked at it and you thought people have given up. Quality is about systems, not about resources.”
Sharing knowledge—and tools—empowers facilities to formulate their own systems.
“It's respectful of the people to whom you are giving these tools,” said Mohr. “You are saying ‘this is for you to do with as you want to solve your problems,’ as opposed to ‘I'm going to come in and reserve the use of these tools for people that have been trained in my Western medical world.’ You’re enabling people to build their own systems and trusting them to build quality systems if they have the right materials to do so.”
With the groundwork in place, surgical robotics becomes an increasing possibility.
“Surgical care is about well-trained clinicians and a well-trained team having access to tools, and being able to be there when the patient needs them.”
In the long run, building excellent systems of training means that when the physical plant infrastructure is ready, it can support robotic surgery systems.
“The poor need minimally invasive surgery even more than the wealthy do because there's no social safety net,” Mohr said. “More often when someone is having surgery, they're needing to return to a job and they don't have the leisure of recuperating for weeks.
“So first, you've got to build these robust systems. Once you've got the systems, you start to bring the more sophisticated tools that allow people to give their patients better outcomes. So robotics fits in down the road,” she said.
“But robotics really is just a tool. The fundamentals are education and practice and teamwork.”
Important safety information
Serious complications may occur in any surgery, including surgery with a da Vinci system, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection, and internal scarring that can cause long-lasting dysfunction/pain.
Risks specific to minimally invasive surgery, including surgery with a da Vinci system, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; a longer operative time, the need to convert to an open approach, or the need for additional or larger incision sites. Converting the procedure could result in a longer operative time, a longer time under anesthesia, and could lead to increased complications.
Contraindications applicable to the use of conventional endoscopic instruments also apply to the use of all da Vinci instruments.
For important safety information, including surgical risks and considerations, please also refer to www.intuitive.com/safety. For a product’s intended use and/or indications for use, risks, full cautions and warnings, please refer to the associated user manual(s).
Individual outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics, and/or surgeon experience.