Every year 313 million operations are performed around the world – surgery is an indispensable part of healthcare.i, ii, iii Sixty percent of all surgery is conducted in high income countries where the infrastructure, financing, and highly skilled human resources are concentrated, but where only 15% of the population live.i, iv An additional 143 million operations are needed annually to meet basic health needs, most urgently in low resource settings, but also to achieve equity across communities in all countries.v This lack of access to essential and emergency surgery results in at least 1.5 million deaths each year,vi which is equivalent to the number of deaths from HIV, malaria, multi-drug resistant TB, and complications from pregnancy combined.
And this lack of access is set to get worse. Over 1/3 of the world’s population lives in regions without a sufficient surgical workforce. Trauma, pregnancy-related complications, and general surgical emergencies constitute up to 80% of preventable deaths due to lack of surgical access. In parts of Asia and Africa, the surgical workforce needs to be expanded 10-100x to meet basic needs.iv At the same time, healthcare staffing shortages are increasing worldwide. The World Health Organization has labeled the healthcare workforce shortage in Europe a “ticking time bomb”, with 40% of medical doctors (MDs) retiring within the next decade.vii, viii In the UK, the Royal College of Physicians noted that 52% of staff posts remained unfilled in the National Health Service.ix In the United States the current surgical workforce only meets 75% of demand in rural and suburban areas, with a projected shortage of over 16,000 surgical specialists in the next decade.
Of the 143 million “missing” operations required to save lives and prevent disability, we estimate that up to 30 million involve abdominal and pelvic conditions that could be treated using minimally invasive techniques. To date, laparoscopic surgery has improved the ability to deliver such operations while simultaneously reducing postoperative infections, length of stay, postoperative pain, and even long-term complications such as internal scarring. Moreover, it lends itself to advanced simulation, quantitative assessment, and validation that could dramatically expand the number of surgeons available.
To deliver 30 million abdominal and pelvic operations will require training an additional 100,000 surgeons. At current rates of training, this is unachievable. The number of MDs as a proportion of the population has remained essentially the same for the last 30 years; and in low- and middle-income countries, woefully inadequate.xii We need a fundamental change.
Program goals:
- Demonstrate the capability to train non-MD practitioners to deliver routine laparoscopic surgery with equivalent outcomes to MD surgeons using a next- generation simulation, validation, and certification program of 3 years or less.
- Shorten the timeline needed to train MD surgeons – by a full year – through the use of new tools that accelerate skills acquisition of minimally invasive techniques and enable objective quantification of competence.
- Reduce postoperative complications and mortality by >50% through advanced sensing, monitoring, and pattern recognition strategies, especially during periods of rapid expansion of services, thus increasing the confidence of surgeons, hospitals, patients, and families.
By combining these three advances, the program aims to double the number of surgical providers per year to an additional 100,000 within a decade, thus increasing the provisioning of minimally invasive abdominal operations by 30 million and simultaneously reducing global postoperative deaths by 1 million.
Abstracts Due: Oct. 27, 2022
Duke University is a member of the Wellcome Leap Health Breakthrough Network. Duke Faculty interested in this opportunity may wish to consult with Foundation Relations (Jennifer.Gallina@duke.edu or Stephen.Murray@duke.edu) for additional information before applying.
We are soliciting abstracts and proposals for work over three (3) years (with a potential additional one-year option) in one or more of the following thrust areas outlined below to develop the simulation platform, develop the technologies, or demonstrate the impact of implementing these advances. Proposers should clearly relate work in these thrust areas to one or more of the program goals and objectives, but are not required to provide both platform technologies and end-to-end demonstrations. Synergies among performers will be facilitated by Wellcome Leap. The program will also assemble an expert group of professional organizations with the appropriate regulatory, certification, and oversight authority to work with performers throughout the program and enable the system demonstration(s).
Thrust Area 1: Create and deploy new models for surgical skills acquisition and quantification for MDs and non-MDs alike.
Thrust Area 2: Produce new patient recovery and/or deterioration detection systems that utilize patient-level inputs to assess patient condition and predict recovery or deterioration.
Thrust Area 3: Develop an end-to-end system demonstration of successful implementation of developments from Thrust Areas 1 and 2.
Wellcome Leap accepts project proposals from any legal entity, based in any legal jurisdiction, including academic, non-profit, for-profit, and regulatory/professional organizations. Applicants are encouraged to contact Wellcome Leap about joining its Health Breakthrough Network by executing its MARFA (or CORFA for commercial entities) agreement. Full execution of the Wellcome Leap MARFA is not required for application submission but is required for any award.