JTCVS Open (Dec 2024)

Establishment of Mongolia's first independent and sustainable minimally invasive general thoracic surgery program: A Mongolian-Canadian initiativeCentral MessagePerspective

  • Azjargal Badamkhand, MD, MHSc, MAMS,
  • Roy A. Hilzenrat, MD, MHSc, MGSC,
  • Ganzorig Baatar, MD, MPH, MAMS,
  • Mergen Dugarsuren, MD, MAMS,
  • Sharon R.Y. Ong, MD, MEd, FRCSC,
  • Ahmad S. Ashrafi, MD, FRCSC

Journal volume & issue
Vol. 22
pp. 521 – 527

Abstract

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Objective: 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. Methods: 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. Results: 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. Conclusions: 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.

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