Safe scale-up of simulation-based training for minimally invasive surgery

The study by the NIHR Global Health Research Unit on Global Surgery and GlobalSurg Collaborative1 in The Lancet Global Health about safety and equity in scaling minimally invasive surgery worldwide has very important take-home messages and implications. The study, involving more than 52 000 patients undergoing minimally invasive cholecystectomy across 109 countries, conclusively demonstrates that national income level is not independently associated with complication rates. Among the 40-fold variation in complication rates observed between hospitals, the study identifies three critical, modifiable, hospital-level factors associated with safer outcomes: structured safety and communication strategies, on-site CT diagnostics, and, most notably, the establishment of local simulation-based training facilities.