Optimizing international neurosurgical outreach missions: 15-year appraisal of operative skill transfer in Lima, Peru

Abstract

Background: While several medical outreach models have been designed and executed to alleviate the unmet need for international neurosurgical care, disparate strategies have evolved. There is a need to determine the optimal pediatric neurosurgical outreach model through which resources are efficiently utilized while imparting the largest possible impact on global health. This study evaluates the efficacy of an international pediatric neurosurgery outreach model at transferring operative skill in a sustainable and scalable manner in Lima, Peru over a 15-year duration. Methods: Three 1-week neurosurgical missions were carried out (2004–2006) in Lima, Peru to teach neuroendoscopic techniques and to provide equipment to host neurosurgeons, equipping the hosts to provide care to indigent citizens beyond the duration of the missions. Follow-up data were obtained over a 15 year span, with collaboration maintained over email, two in-person visits, and video-conferencing services. Results: Since the outreach missions in 2004–2006, the host neurosurgeons demonstrated sustainability of the neuroendoscopic instruction by independently performing neuroendoscopic operations on a growing caseload: at baseline, 0 cases were performed in 2003, but since 2012 and onwards, 40–45 cases have been performed annually. Scalability is illustrated by the fact that the institution established a rigorous neuroendoscopy training program to independently pass on the techniques to resident physicians. Conclusion: The described international pediatric neurosurgical outreach model, centered around teaching operative technique as opposed to solely providing care to citizens, allowed operative skill to be sustainably transferred to surgeons in Lima, Peru. Having served the neuroendoscopic needs of hundreds of citizens, the strategic design is replicable and should be mirrored by future medical endeavors seeking to substantially impact the deficit in global surgical care.

Current trends and challenges: The landscape of perioperative mortality in intracranial surgeries in low‐ and middle‐income settings: A narrative review

“…1,13,32 34,35 The rise of minimally invasive neurosurgical methods, notably neuroendoscopy, offers potential to reduce complications and optimize postoperative care. 36 Nevertheless, it remains indispensable for neurosurgeons in LMICs to be endowed with meticulous training and unimpeded access to requisite surgical apparatus for these procedures. The schematic delineation of strategies geared toward the attenuation of intracranial mortality in LMICs is elucidated in Figure 2.…”

“…These integrations enhance resource efficiency, empower patients, and facilitate continuous knowledge and skill transfer 34,35 . The rise of minimally invasive neurosurgical methods, notably neuroendoscopy, offers potential to reduce complications and optimize postoperative care 36 . Nevertheless, it remains indispensable for neurosurgeons in LMICs to be endowed with meticulous training and unimpeded access to requisite surgical apparatus for these procedures.…”

The humanitarian aid of neurosurgical missions in Peru: A chronicle and future perspectives

“…[10] Moreover, a recent 15-year followup described the establishment of a new neuroendoscopy training program for residents, thus, exemplifying the sustainable outreach model of INCA in Peru. [20] A Peruvian-Canadian collaborative effort…”