LaparoscopiX

ARISE

LaparoscopiX

An app and box trainer to improve access to expert mentorship, permitting practice by surgical trainees of laparoscopic skills anywhere, at any time.

Baltimore, MD, USA

USA

Not registered as any organization

The benefits of laparoscopic surgery have been repeatedly validated, especially in global health settings. With perioperative mortality rates in low- and middle-income countries (LMICs) up to 25x those of high-income countries (HICs), laparoscopic surgery can reduce complication rates by over 50%, length of stay by 45%, and costs by 30%. Laparoscopy is the standard of care for many procedures in HICs; however, uptake by LMICs has been hampered by various systemic barriers, one of the largest being a scarcity of laparoscopically-trained personnel. In both HICs and LMICs, laparoscopic experience is typically gained through practice in the operating room (OR) under direct supervision of attending surgeons. However, most hospitals in LMICs do not have laparoscopic equipment; in Rwanda, there are only four hospitals with laparoscopic equipment, three of which are clustered in Kigali, the capital city. Furthermore, access to laparoscopic mentorship is limited – of the three laparoscopically-capable public hospitals in Rwanda, there are only six OB/GYNs with laparoscopic expertise. In contrast, in the United States, every OB/GYN gets certified in laparoscopy. And with few laparoscopic cases available, laparoscopically-capable clinicians often begin losing their skills in as soon as 6 months post-training, reducing the laparoscopic workforce further.

ARISE uses the LaparoscopiX app and box trainer to independently guide trainees through practice of basic laparoscopic simulation skills. During training sessions, trainees use comprehensive training guides to practice laparoscopic skills without an in-person mentor, and record videos of their practice. At the end of each session, they self-assess their performance using the validated Global Rating Scale (GRS). Self-evaluations are used to prescribe a personalized training schedule using spaced repetition; by practicing harder skills more frequently, and easier skills less, trainees learn and retain laparoscopic skills more quickly and effectively. Trainees save videos of their progress onto their personal library on the app. If trainees require further guidance, they can upload their videos to their mentor network. Mentors asynchronously provide feedback to trainees, grading tasks using GRS while providing actionable feedback through text and audio notes. Trainees can also consult the AI Tutor, which uses self-evaluations and mentor reviews to suggest personalized feedback and learning materials. By enabling self-directed basic skills acquisition, ARISE allows laparoscopic mentors to prioritize their teaching time towards advanced skills development in the OR, and trainees to develop their confidence and basic laparoscopic skills at their own schedule during the earliest stages of laparoscopic training.

In Rwanda, all OB/GYN residents are members of a single national residency program, rotating across 13 training hospitals. Laparoscopic learning is typically performed through the apprenticeship model, with training occurring in the OR under experienced attending surgeons. However, of the affiliated training hospitals, only three are laparoscopically-capable, with only six total OB/GYNs sufficiently experienced in laparoscopy to train residents. At the University Teaching Hospital of Kigali (CHUK), Rwanda’s main laparoscopically-capable public hospital, only two laparoscopic OB/GYN procedures are performed each week – compared to over 100 each week at the Johns Hopkins Hospital System. Without regular exposure to experienced mentors and caseloads, residents cannot adequately train in laparoscopy through the apprenticeship model. At hospitals accredited by the College of Surgeons of East, Central, and Southern Africa, of which Rwanda is a member state, residents could not perform basic laparoscopic procedures, with exposure to only 10 laparoscopic cases by graduation - far short of the 175-case minimum required in U.S. programs. With ARISE, residents develop basic laparoscopic skills despite the current limitations of the apprenticeship model, allowing them to build their skills efficiently, focus limited laparoscopic OR time towards advanced skill acquisition, and retain skills while rotating at laparoscopically-limited hospitals.