Enhancing surgical capacity in the low- to middle-income countries

An initial report of a Global Surgery Partnership Initiative in pediatric and reconstructive urology using a mixed-method approach

Authors

  • Michael E. Chua Sickkids
  • Kate Luzelle Aba Institute of Urology, St. Luke’s Medical Center-Quezon City
  • Kay Rivera Institute of Urology, St. Luke’s Medical Center-Quezon City
  • Anh Dao Nguyen Vietnam Children’s Hospital
  • Mandy Rickard Sickkids
  • Joao Pippi Salle Sickkids
  • Armando , Lorenzo Sickkids
  • Ellen C. Chong 5Secretariat, Filipino Chinese Business Club, Inc
  • Manuel C. See IV Institute of Urology, St. Luke’s Medical Center-Quezon City

DOI:

https://doi.org/10.5489/cuaj.9286

Keywords:

global surgery, Reconstructive urology, Telementoring, augmented reality, medical education, low-resource setting

Abstract

INTRODUCTION: Pediatric and adult reconstructive urology remain underrepresented in global surgical efforts, despite their critical role in restoring genitourinary function. This global surgery initiative aimed to address the gap in specialized urologic care in low- to middle-income countries (LMICs) through a longitudinal, mentorship-based approach integrating augmented reality (AR) telementoring.

METHODS: This report describes an approach used to enhance global surgical expertise in LMICs and summarizes data documenting impact. A Global Surgery Partnership Initiative was launched by an academic surgeon from the University of Toronto to address the lack of specialized pediatric and reconstructive urologic training. Through collaboration with local institutions in the Philippines and Vietnam, the program employed a mixed-method approach that delivered longitudinal mentorship, combining virtual case conferences, in-person surgical mentoring, pilot of AR-supported telementoring, and continuous postoperative coaching. Patient outcomes were assessed and mentees self-reported pre- and post-intervention surveys evaluating comfort and technical understanding. Descriptive statistics and paired t-tests were used to analyze outcomes.

RESULTS: Thirty-eight pediatric and adult reconstructive urology cases were performed. Over time, operative times and length of stay decreased, with low complication rates (6/38, 12.7%) and Clavien-Dindo ≥3 complications (3/38, 8%). Mentee comfort and understanding significantly improved (mean comfort score: 3.06 to 6.77; technical understanding: 4.77 to 8.43; p<0.001). AR-assisted mentoring, introduced in 2022 and expanded in 2024, showed feasibility, with further enhanced intraoperative feedback and sustainability.

CONCLUSIONS: This structured, mixed-method model effectively improved surgical competencies and system-level capacity in LMICs. Unlike short-term missions, this initiativeemphasized continuity, adaptability, and sustainability. It presents a scalable framework for integrating reconstructive urology into global health programs while leveraging AR to overcome geographic and resource limitations.

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Published

2025-10-27

How to Cite

Chua, M. E., Aba, K. L., Rivera, K., Nguyen, A. D., Rickard, M., Pippi Salle, J., … See IV, M. C. (2025). Enhancing surgical capacity in the low- to middle-income countries: An initial report of a Global Surgery Partnership Initiative in pediatric and reconstructive urology using a mixed-method approach. Canadian Urological Association Journal, 20(2), 50–6. https://doi.org/10.5489/cuaj.9286

Issue

Vol. 20 No. 2 (2026): CUAJ February

Section

Original Research

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