Building Surgical Capacity Through Multidisciplinary Laparoscopic Cholecystectomy Training in Kampong Cham, Cambodia.

BACKGROUND

Laparoscopy was first introduced in Phnom Penh, Cambodia in 2000, but remained largely confined to urban centers because of equipment costs, limited training opportunities, and infrastructural barriers.

METHODS

A collaborative laparoscopic training program was launched at Calmette Hospital in 2022 and expanded to Kampong Cham Provincial Hospital (KCPH) in 2023. Training included didactic lectures, simulation-based skills practice, and supervised laparoscopic cholecystectomy with graduated operative responsibility before transition to independent practice by the Cambodian surgical team. Surgical volume and outcomes were compared before (January 2022-February 2023) and after program implementation (February 2023-February 2025).

RESULTS

The year prior to program implementation, KCPH performed 55 open cholecystectomies. Following implementation, a total of 272 cholecystectomies were completed, including 249 laparoscopic and 23 open procedures, representing a 188.3% increase in average monthly cholecystectomy volume (3.93 vs. 11.33 and p < 0.001). Of the 249 laparoscopic cases, 19 (7.6%) were performed during the initial supervised training period (15 mentored and 4 proctored), 15 (6.0%) during a follow-up proctored visit 7 months later, and 215 (86.3%) independently by the KCPH surgical team. Nine laparoscopic procedures (4.2%) required conversion to open surgery, and seven patients (3.3%) experienced complications requiring reoperation or endoscopic intervention. The median length of stay was 4 days (IQR 3-5), and no perioperative mortality occurred.

CONCLUSION

Structured multidisciplinary training enabled safe adoption of laparoscopic cholecystectomy in a Cambodian provincial hospital. The program increased access, maintained safety, and offers early evidence of a replicable model for expanding minimally invasive surgery in Cambodia.