Background and objectives: Endoscopic surgery may have added benefits in low-resource countries including improved recovery time, lower post-operative infection rates and decreased blood loss. These techniques are being used by gynecologists worldwide, but the extent is largely unknown. The aim of this review is to evaluate the laparoscopic gynecologic surgical capacity in low-resource countries and identify economic indicators that are associated with advanced skill.Methods: An online literature search was conducted; search terms included gynecologic, laparoscopy, minimally invasive, and low-resource countries. Of 336 abstracts identified, 100 articles were chosen in English and Spanish during between 1998-2015. Types of procedures, indications, and complication rates were grouped and compared according to World Bank Income Groups of Developing Nations: Low Income Country (LIC), Low-Middle Income Country (LMIC), or Upper-Middle Income Country (UMIC). Each country was categorized into Categories of complexity based on the highest level of skill required for reported procedures. The level of complexity was compared to World Bank Healthcare Development Indicators to identify correlates of advanced laparoscopic capacity.Results: 14% of LIC report performing MIG procedures; twice as many LMIC and UMIC countries report such proficiency. LICs primarily perform diagnostic laparoscopies or adnexal surgery, with infertility being the most common indication. UMICs perform a variety of laparoscopic surgeries for benign and oncologic indications.
Conclusions:Minimally invasive surgery is widely adopted around the world. Advanced laparoscopic surgical procedures are increasingly performed in upper middle-income countries.