Customer Stories – Endoscopy Academy

Doctor Ronny Calderón is the Director and Head Instructor at the Endoscopy Academy in Costa Rica. Since 2012 the academy has taught laparoscopy to students from all over Latin America.

We talk to Ronny about his personal mission to introduce laparoscopy and virtual reality (VR) simulation to Costa Rica and Latin America.


Hi Ronny, can you give us a bit of background to what you do and the Endoscopy Academy?
In 2003, after I finished my post-graduate studies in obstetrics and gynaecology, I took a year off in Europe and Mexico to train in laparoscopy. At that time, in Costa Rica and most of Latin America, if you wanted to learn laparoscopy, you had to leave the country.

When I returned, I started the project I called the Endoscopy Academy, to teach the techniques of laparoscopy. I took out a loan, to buy the instruments, the cameras and the equipment, to improve the classroom and as well as the labs. It’s been a long road. It was hard for me as I was all my own, a personal project to bring laparoscopy techniques to Latin America.


VR simulation would have been in its infancy then. How did you get into that?
When I learned laparoscopy there was no visual simulation. But as young students, we played with Nintendo, so it was easy get into VR. I discovered VR simulation and LapSim when I attended a surgical congress and met Gisli (CEO of Surgical Science). We started to talk about simulation, and I just fell in love with it and instantly saw it as a valuable tool for training.


And when you started with simulation in your academy, were people sceptical of it as a training tool?
Yes, but only at the beginning. When we started, bosses didn’t even believe in laparoscopy, only open surgery. So that was the difficult part. But after a few years we had younger surgeons who believed in simulation. So, it was not hard trying to introduce it, surgeons and residents were impressed by the realism and the graphics.


And how did your first residents take to the LapSim simulator, did they have a lot of fun using it?
Yes, they did. They didn’t want to do anything else, they just jumped straight into the simulation. I was very impressed that they wanted to get so hands-on. They had a lot of very good comments about LapSim, they are always very into it. Not just young people, we had one trainee who was a 74-years-old and he was very impressed.

That’s great to hear. You don’t get many people of that age training on a simulator.
Yes, he was also really good, with the instruments and the simulator.


And what sort of training programmes do you run now?
We don’t believe in short training programs of two or three days, we want our training to give students the confidence at the end of the course to do the surgeries on their own. So we manage workshops of 11 to 12 days. We give them lectures, pelvic training and some training in the veterinary hospital with pigs. But a very important part of our workshops is to practice with the simulator, the LapSim.


“Having the confidence to multitask means residents can focus on the procedure and most importantly the patient.”

And how important is that? To have VR simulation in your program?
It’s very important and gives the students the most realistic training for the operating room. It gives them a lot of confidence and teaches them how to multitask. Students can switch instruments, irrigate, use the electricity. They learn to do many things at the same time, this is one of the hardest and most important skills in the learning curve. Having the confidence to multitask means residents can focus on the procedure and most importantly the patient.

Another advantage is that you can see how well you’re progressing, from they day you start to when you finish. You can see how you improve, with objective assessment and data. When you train with a surgeon, they are not necessarily doing anything wrong, but they can’t measure precisely the skills required for laparoscopy, the hand movements and instrument handling etc.

It also changes, not only the way of thinking, but the way of doing. We’ve always relied upon going into the OR to practice on patients. But you need to learn how to handle the instruments, how to handle the trocar, the various needles, and multitasking before seeing your first patient. We are totally against training on patients.

Did you find it easy to integrate VR simulation into your program?
Because of the essence of the workshops, we train small groups in relatively short periods of time. We had to focus on the most important and beneficial tasks of the LapSim, the basic skills modules. And then at the end of the course, we make them perform the most difficult tasks at the most difficult levels. That’s our main goal.

So, it was easy to integrate, we used it in the proper way, with the performance feedback, and I found no difficulties, the program works smoothly. It’s very user friendly, honestly.

We also had great support from Surgical Science. They helped me in every way they could. So I really feel very comfortable working with you.


Great. That is something we strive to do with our support team, help you along the whole journey with your simulator.
I wanted to address this because I do have another simulator from another company, no names! But it’s not the same as with Surgical Science, the support. There are good people behind the company. I want to congratulate you.

That’s nice to hear. I will let my colleagues know!


Going back to your course. Is this a well recognized institution in Latin America? Do your residents get a certificate at the end of the program.
Yes, we have very structured programs. We do tests and objectives, whatever the universities ask. We have a partnership with one of the universities here in Costa Rica, one of the best universities in Central America. We do workshops with their name and a seal of certification. We’ve been doing this for quite a long time abd since we started the program we’ve had hundreds of students from all over Latin America. It’s been very successful.

You said there was a small number of laparoscopic surgeries going on in Latin America. it must be hard to train for laparoscopy? So a good opportunity for learning with VR simulation?
I believe that maybe 5% of gynaecologists do laparoscopy. And this is mainly due to the lack of training programs during the residents’ program.

Universities are trying but it is quite hard because trainees do not have the opportunity to get into the surgeries. So most people interested in learning laparoscopy use a private practice such as ours in Costa Rica.


Is this changing with time?
It’s changing, but not as much as I would like, not everybody is into laparoscopy. Many of our colleagues are into the perinatology high-risk pregnancy, gynaecologic cancer. But we do have more and more people interested in laparoscopy. They will have short training program in universities, with no hands-on practice but it’s a start for the universities.


What are the reasons for not doing laparoscopy? It’s a different approach to the rest of the world. Is it cultural? The way it has always been done?
It’s very interesting because this is kind of a funny story. When I was in Switzerland, doing my laparoscopy training, I was working with a third-year resident, and he was very interested into coming to Costa Rica or any country Latin America to do a six-month practice.

I looked at the OR and all the new monitors, the laparoscopic equipment, and I asked myself, why would this guy want to go to Costa Rica? We don’t have anything over there. He told me that every year he only did three or five open surgeries, the rest were laparoscopy. And that gave me the idea! I would have to do something for my country and Latin America, change the way of thinking here. As I said, it was a personal project to get laparoscopy to Latin America.


So the main reason is lack of resources for laparoscopy equipment, monitors?
It was one of the main reasons 8 to 10 years ago. Now, hospitals in Costa Rica and other parts of Latin America have invested money into getting equipment. But now there is a need for training.


I thought I’d be trying to spread the word of VR simulation in Latin America but is sounds like we need to spread the word of laparoscopy too.
Yes but patients have good knowledge now, with the internet. hey go to the doctor and request laparoscopy, and this helps, encouraging colleagues to learn about laparoscopy. So now we have more and more people interested, looking for a place to learn and they come to the Endoscopy Academy.


Has it been a difficult year for you with Covid in terms of training?
Well, we were shut down in April, like everything in the world. By the middle of November, they reopened the airport and there were a couple of groups trying to come to the Academy, so we reopened the academy.

We had to make improvements, another room for the students, split the groups in two, one group in one room and the other half in the other room. Provide the residents with masks, and sanitizing products. So they would feel comfortable , knowing we are taking care of them, and we always ask every student to do a Covid-19 test.


And finally, how do you see the future of a VR simulation?
In other countries where they have on-site simulation in the hospitals. it was a very valuable tool during Covid-19, to keep surgeons warmed up so they could practice even when they were not into the operating room.

But I guess now, and in the future, there is no way you could take VR simulation out of any training in the world. It’s a really an important part of any surgical program.


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