Laparoscopic and basic surgical courses in Nepal

The Royal College of Surgeons of Edinburgh used to hold FRCS examinations in the 1990s and early 2000 in Kathmandu. Two Fellows of the College, Kamal Aryal and Jeremy Ward, have been conducting RCSEd-accredited laparoscopic surgery courses in Nepal since 2013 at Dhulikhel Hospital. These coursers have been part of a range of courses, including NOTSS and basic surgical skills courses, run in conjunction with Health Exchange Nepal (HExN) and the Nepalese Doctors’ Association (NDA-UK).

Last year, we conducted the 10th Lap Course, which was a special one due to the addition of wet laboratory facilities and use of an animal model. We ran it with faculty from the Davos laparoscopic course in Switzerland.

We wanted to take this course beyond Kathmandu to give other communities more opportunities and widen our reach. Since 2019, we have carried out four such two-day courses in Pokhara. In September 2022, the then RCSEd President, Mike Griffin, visited our Pokhara Course. Last year, we wanted to conduct a shortened one-day version of the course, with the objective of training surgeons at Karnali Academy of Health Sciences (KAHS) and the surrounding areas in laparoscopic surgery. We also included training in basic surgical skills in a parallel session because it was felt to be a necessary part of learning for senior medical students and resident doctors. Both of the courses were conducted on 22 November 2024. 

Hospital and region 

KAHS is located in Jumla, a beautiful and remote valley. Here one of the tributaries of the Karnali River flows in the hills of western Nepal at an altitude of 2,500 metres. Most of the communities in this region are socially and economically deprived. KAHS is the only teaching hospital in the province. A five-hour drive from here leads to the beautiful and unspoiled Rara Lake, the largest lake in Nepal, located at an altitude of 2,900 metres.

Courses conducted and feedback 

The two courses were run in parallel and the feedback on both was good (see the full feedback at https://www.rcsed.ac.uk/news-resources/publications/surgeons-news). 

Basic surgical skills course 

Twenty four participants took part – 20% were medical students and the remainder were at house officer and senior house officer grades. The stations included gloving and gowning, knot-tying, handling of instruments, suturing, bowel anastomosis, tendon repair and a laparoscopic station. 

Laparoscopic course 

Ten participants took part. We took five simulators with us, upon which they were able to practice various skills. This was a shortened version of the course we have been delivering in Nepal for the past decade. 

Way forward for collaboration 

On the evening of 22 November, the faculty had an informal dinner with the executive team of KAHS, including the Vice Chancellor Dr Mangal Rawal, the Dean and Medical Director.
The following potential areas of collaboration were discussed:

• Conducting further training courses and regular visits to the Institute.
• The logistics of a short-term visit (six weeks to three months) to the Institute by the UK faculty to help with the development of services. 
• Surgical research at high altitude.

We would like to thank all the faculty members, delegates and collaborators.