Implications of technological advancement of surgery in low and middle-income countries' a narrative review.

Countries that are striving to keep pace with emerging technologies in surgical practices and still not able to cope with exemplary international standards are in dire need of resources to build and strengthen their healthcare system. This review focusses on the impeding factors that hinder in adaptation of advanced technology and machinery in the health care industry. Considering the immense potential for current surgical technologies to transform the delivery of healthcare, their implementation in LMICs confronts considerable challenges due to lack of infrastructure, human capital and inadequate resources. To address these difficulties, various entities, including healthcare institutions, government and non-governmental organisations, and foreign partners, must work together. Building capacity through intended education and training initiatives, building infrastructure, and collaborative partnerships are critical for overcoming hurdles to effective deployment of surgical technology in low-income communities of the world.

Use of Robotic Anastomosis Competency Evaluation (RACE) for assessment of surgical competency during urethrovesical anastomosis.

INTRODUCTION: We sought to evaluate the Robotic Anastomosis Competency Evaluation (RACE), a validated tool that objectively quantifies surgical skills specifically for urethrovesical anastomosis (UVA), as a tool to track progress of trainees, and to determine the predictive value of RACE. METHODS: UVAs performed by trainees at our institution were evaluated using RACE over a period of two years. Trainees were supervised by an experienced robotic surgeon. Outcomes included trainee-related variables (RACE score, proportion of UVA performed by trainee, and suturing speed), and clinical outcomes (total UVA duration, postoperative urinary continence, and UVA-related complications). Significance was determined using linear regression analysis. RESULTS: A total of 51 UVAs performed by six trainees were evaluated. Trainee RACE scores (19.8 to 22.3; p=0.01) and trainee proportion of UVA (67% to 80%; p=0.003) improved significantly over time. Trainee suture speed was significantly associated with RACE score (mean speed range 0.54-0.74 sutures/minute; p=0.03). Neither urinary continence at six weeks nor six months was significantly associated with RACE score (p=0.17 and p=0.15, respectively), and only one UVA-related postoperative complication was reported. CONCLUSIONS: Trainee RACE scores improved and proportion of UVA performed by trainees increased over time. RACE can be used as an objective measure of surgical performance during training. Strict mentor supervision allowed safe training without compromising patient outcomes.