Virtual-Reality Laparoscopic Simulation in Togo and Financial Barriers to Scale-Up

Background: Virtual reality (VR) is a key tool of modern surgical education, yet minimally invasive surgery training remains scarce in sub-Saharan Africa. We describe the first experience of VR laparoscopic simulation in a developing sub-Saharan country and assess the feasibility of such training in Togo and the financial barriers to its dissemination. Methods: This was a cross-sectional, questionnaire-based survey of surgeons and trainees enrolled in two VR laparoscopic simulation workshops held in March and September 2022 at the skills-transfer centre of the Biasa Clinic in Lomé, using the Virtamed LaparoS anatomical-model simulator. Seven standardized tasks were used, and participants rated each task and the course design on Likert scales. The primary endpoint was feasibility, defined as successful completion of two workshops with locally trained faculty by the end of 2022. Data were analyzed with Epi Info 7.2. Results: A total of 15 of 18 enrolled practitioners responded (participation rate 83.3%). The mean age was 34.2 ± 5.2 years, with a male-to-female ratio of 2:1; one-third were foreign nationals and two-thirds were gynecologists. Residents and surgeons in training accounted for 53.3% of participants, and 53.3% had never performed laparoscopic surgery. The overall impression was good for 73.3%. Circular cutting was the most difficult task. All participants considered that simulation could improve their practice, and 93.3% endorsed mandatory integration in residency curricula. Four participants (26.7%) considered the course expensive, and the main reported limitations were lack of funding, scarcity of laparoscopic towers, and absence of locally engineered solutions. Conclusion: VR laparoscopic simulation is feasible, well accepted, and locally sustainable in Togo and is seen by trainees as an essential component of surgical education. Its scale-up is chiefly constrained by the high cost of equipment and training, which calls for public investment, partnerships, and the development of affordable, locally adapted simulation tools.