FROM SIMULATION TO SCALPEL: AN EVIDENCE-BASED LADDER FOR SAFE LAPAROSCOPIC AUTONOMY IN RESOURCE-LIMITED SURGICAL TRAINING tasnimabida.30@gmail.com

 

FROM SIMULATION TO SCALPEL: AN EVIDENCE-BASED LADDER FOR SAFE LAPAROSCOPIC AUTONOMY IN RESOURCE-LIMITED SURGICAL TRAINING

2

Bangladesh

Poster with Discussion

Laparoscopic surgery has a steep learning curve, yet most early-career surgeons especially from lower middle income countries (LMICs), lack a structured roadmap from simulation to safe operative autonomy.This is the first synthesis merging global meta-analysis data with LMIC pilot outcomes into an actionable skills-to-autonomy framework.

A mixed-method approach was adopted. First, we conducted a meta-analysis review of published randomized controlled trials (RCTs) (n = 8, total 612 trainees) assessing pre-clinical laparoscopic simulation training. Second, we implemented a pilot “Basic Laparoscopic Skills” course at a skill-lab in Dhaka with 12 novice surgical trainees. Standardized box trainer tasks (peg transfer, pattern cutting, intracorporeal knot tying) were performed before and after structured simulation modules. Task completion time, error rate, and self-reported confidence were recorded. A general reduction of inadvertent and hesitant movements during laparoscopic instrument maneuvering was also noted at the end of simulation exercises.

The global meta-analysis showed a 15–20% pooled reduction in operative time for common index procedures (p < 0.01) after simulation-based training. In local pilot, mean completion times improved by 19.7% across all tasks, with error rates reduced by 25–33% and median confidence scores increasing from 3.0 to 4.5/5. The effect sizes were consistent with global findings.

Structured laparoscopic simulation yields significant performance gains even in resource-limited settings including task efficiency, error reduction, and trainee confidence. We present the “Simulation-to-Scalpel Ladder”, the first evidence-based,LMIC-tailored framework mapping simulation milestones to surgical responsibilities.Scaling this ladder could shorten the safe autonomy timeline worldwide.