Lessons learned during the COVID-19 pandemic using virtual basic laparoscopic training in Santa Cruz de la Sierra, Bolivia: effects on confidence, knowledge, and skill.

BACKGROUND: An international surgical team implemented a virtual basic laparoscopic surgery course for Bolivian general and pediatric surgeons and residents during the COVID-19 pandemic. This simulation course aimed to enhance training in a lower-resource environment despite the challenges of decreased operative volume and lack of in-person instruction. METHODS: The course was developed by surgeons from Bolivian and U.S.-based institutions and offered twice between July-December 2020. Didactic content and skill techniques were taught via weekly live videoconferences. Additional mentorship was provided through small group sessions. Participants were evaluated by pre- and post-course tests of didactic content as well as by video task review. RESULTS: Of the 24 enrolled participants, 13 were practicing surgeons and 10 were surgery residents (one unspecified). Fifty percent (n = 12) indicated "almost never" performing laparoscopic surgeries pre-course. Confidence significantly increased for five laparoscopic tasks. Test scores also increased significantly (68.2% ± 12.5%, n = 21; vs 76.6% ± 12.6%, n = 19; p = 0.040). While challenges impeded objective evaluation for the first course iteration, adjustments permitted video scoring in the second iteration. This group demonstrated significant improvements in precision cutting (11.6% ± 16.7%, n = 9; vs 62.5% ± 18.6%, n = 6; p < 0.001), intracorporeal knot tying (36.4% ± 38.1%, n = 9; vs 79.2% ± 17.2%, n = 7; p = 0.012), and combined skill (40.3% ± 17.7%; n = 8 vs 77.2% ± 13.6%, n = 4; p = 0.042). Collectively, combined skill scores improved by 66.3% ± 10.4%. CONCLUSION: Virtual international collaboration can improve confidence, knowledge, and basic laparoscopic skills, even in resource-limited settings during a global pandemic. Future efforts should focus on standardizing resources for participants and enhancing access to live feedback resources between classes.

Hiato Interescalénico Anterior: su importancia en los síndromes de compresión neurovascular del miembro superior / Interescalene anterior hiatus syndrome: its importance in the syndromes of neurovascular compression of the upper limb

El Síndrome del Hiato interescalénico Anterior está incluido en el Síndrome de compresión neurovascular de la salida superior del tórax junto con la costilla cervical, la estrechez del desfiladero costoclavicular y la compresión del músculo pectoral menor. Una de las posibles causas de este síndrome es la existencia de bandas musculares o músculos accesorios entre el escaleno anterior y el medio que producirían compresión del plexo braquial y la arteria subclavia en el hiato interescalénico anterior.

Hiato Interescalénico Anterior: su importancia en los síndromes de compresión neurovascular del miembro superior / Interescalene anterior hiatus syndrome: its importance in the syndromes of neurovascular compression of the upper limb

El Síndrome del Hiato interescalénico Anterior está incluido en el Síndrome de compresión neurovascular de la salida superior del tórax junto con la costilla cervical, la estrechez del desfiladero costoclavicular y la compresión del músculo pectoral menor. Una de las posibles causas de este síndrome es la existencia de bandas musculares o músculos accesorios entre el escaleno anterior y el medio que producirían compresión del plexo braquial y la arteria subclavia en el hiato interescalénico anterior.(AU)