Initiating Ethiopia's first minimally invasive surgery program: a novel approach for collaborations in global surgical education

Background: Complex lung diseases are among the leading causes of death in Ethiopia. Access to thoracic surgery is limited, and before 2016, no thoracic surgeons were trained in minimally invasive surgery (MIS). A global academic partnership was formed between the University of Toronto and Addis Ababa University (AAU). Here, we describe implementation of the first MIS training program in sub-Saharan Africa and evaluate its safety. Methods: We conducted a retrospective cohort analysis of open v. MIS thoracic and upper gastrointestinal procedures performed at AAU from Jan. 1, 2016, to June 1, 2021. Baseline demographic, diagnostic, operative and postoperative outcomes, including length of stay (LOS) and complications, were compared. In our bilateral model of surgical education, training was provided in Ethiopia and Canada over 2 years with focus on capacity building through egalitarian forms of knowledge exchange. Program features included certification in fundamentals of laparoscopic surgery, highfidelity lobectomy simulation and hands-on training. Results: Overall, 41 open and 56 MIS cases were included in the final statistical analysis. The average LOS in the MIS group was 5.2 days v. 11.0 days in the open group (p < 0.001). The overall complication rate was 18% in the MIS group v. 39% open (p = 0.020). Conclusion: Here we demonstrated the successful initiation of sub-Saharan Africas first MIS program in thoracic and upper gastrointestinal surgery with a > 50% reduction in LOS and overall complications. We envision the MIS program as a template to continue expanding global partnerships and improving surgical care in other resourcelimited settings.