Badamkhand Azjargal, Hilzenrat Roy A, Baatar Ganzorig, Dugarsuren Mergen, Ong Sharon R Y, Ashrafi Ahmad S
Department of Thoracic Surgery, National Cancer Center of Mongolia, Ulaanbaatar, Mongolia.
Division of General Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.
JTCVS Open. 2024 Oct 9;22:521-527. doi: 10.1016/j.xjon.2024.09.026. eCollection 2024 Dec.
The advent of video-assisted thoracoscopic surgery in Mongolia has faced funding and accessibility challenges, leading to languid adoption. A Mongolian-Canadian collaboration was inaugurated to support the development of a self-sustainable, self-governed minimally invasive thoracic surgery (MITS) program in Mongolia.
A multidisciplinary Canadian thoracic surgery team collaborated with the National Cancer Center of Mongolia Thoracic Surgery service from 2016 to 2023. The team engaged in patient rounds, MITS procedures, and service education. Program and patient outcomes were reviewed.
Thirty-four patients underwent MITS procedures as part of the Mongolian-Canadian collaboration. Median age was 51 years (range, 16-76 years), and 41% (14 out of 34) were men. Lung, esophageal, and mediastinal procedures composed 50% (17 out of 34), 21% (7 out of 34), and 21% (7 out of 34) of procedures, respectively. Conversion rate, median operative time, and hospital length of stay were 0%, 172.5 minutes, and 8 days, respectively. The complication rate was 9% (3 out of 34) with 3% (1 out of 34) being Clavien-Dindo >3 requiring re-operation. Thirty-day mortality was 0%. Mongolia's thoracic surgery team progressed from surgical assists to primary operators and a self-governed program. In 2023, the National Cancer Center of Mongolia's thoracic surgery service independently conducted 72% (50 out of 69) of esophagectomies and 91% (48 out of 53) of pulmonary resections via minimally invasive technique compared with 0% in 2015.
The Mongolian-Canadian collaboration demonstrated successful transfer of MITS proficiency through global noncolonialist surgical partnership, consequentially shifting the national thoracic surgical paradigm. Continued collaboration will focus on sustainability and supporting local surgeons in regional dissemination of MITS proficiency with the aim of globalizing thoracic surgical excellence.
电视辅助胸腔镜手术在蒙古国的出现面临资金和可及性挑战，导致其采用率不高。启动了一项蒙加合作项目，以支持在蒙古国发展一个能够自我维持、自我管理的微创胸外科（MITS）项目。
一个多学科的加拿大胸外科团队在2016年至2023年期间与蒙古国国家癌症中心胸外科服务部门开展合作。该团队参与患者查房、MITS手术及服务培训。对项目及患者结果进行了评估。
作为蒙加合作项目的一部分，34例患者接受了MITS手术。中位年龄为51岁（范围16 - 76岁），41%（34例中的14例）为男性。肺部、食管及纵隔手术分别占手术的50%（34例中的17例）、21%（34例中的7例）及21%（34例中的7例）。中转率、中位手术时间及住院时间分别为0%、172.5分钟及8天。并发症发生率为9%（34例中的3例），其中3%（34例中的1例）为Clavien - Dindo >3级需要再次手术。30天死亡率为0%。蒙古国胸外科团队从手术助手发展成为主刀医生，并形成了一个自我管理的项目。2023年，蒙古国国家癌症中心胸外科服务部门通过微创技术独立完成了72%（69例中的50例）的食管切除术和91%（53例中的48例）的肺切除术，而2015年这一比例为0%。
蒙加合作通过全球非殖民主义外科伙伴关系成功实现了MITS技术的转移，从而改变了该国胸外科手术模式。持续合作将聚焦于可持续性，并支持当地外科医生在区域内传播MITS技术，目标是在全球范围内实现卓越的胸外科手术。
