Leveling the playing field of laparoscopic surgery through low-cost simulation-based training in Cameroon

Background Though simulation-based training improves laparoscopic surgical skills in a supportive learning environment, the clinical impact is not well known. We sought to evaluate resident utilization of laparoscopy in the operating room after training on the ALL-SAFE laparoscopic surgery training platform at a general surgery training program in Cameroon. Methodology This was a mixed-methods observational study (cross-sectional survey and a retrospective OR log review). A 14-question web-based survey on experience using ALL-SAFE and utilization of laparoscopy was administered to surgical residents and faculty at Mbingo Baptist Hospital in Cameroon. All had been exposed to five ALL-SAFE surgical modules, each representing different laparoscopic procedures over four years. Operating room records were also examined to identify the number of laparoscopic cases led by residents over the 58-month study period (January 2020 to October 2024). Results Sixteen (76.2%) surgeons completed the survey. Five (31%) respondents completed 5 modules, 5/16 (31.3%) completed 4 modules, 4/16 (25%) completed at least 1 module, and 2/16 (12.5%) completed no modules. Nine (56.3%) found the simulator easy to build and use. Eleven (69%) found the simulator helpful for training. Nine (56.3%) reported feeling comfortable performing laparoscopy after training. The number of modules completed was associated with greater comfort in using laparoscopy, R2 = 0.843, p = 0.001. Resident-led (supervisor unscrubbed) laparoscopic cases increased from 1/30 (3.3%) in 2020 to 13/32 (40.6%) in 2024, p<0.001. Conclusion The more modules a resident completed on the ALL-SAFE platform, the more confident they became in performing laparoscopic surgery. This evidence suggests that its implementation in a residency training program may have contributed to an increase in resident-led (supervisor unscrubbed) laparoscopic cases.