Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies

Abstract

LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study

“…The introduction of any new technology in a resource-poor setting must also be done with care. Recommendations include ensuring the existence of sufficient financial support and organizational systems to address staff training, including biomedical engineering staff to undertake equipment maintenance, and to establish robust, affordable, and sustainable supply chains [10]. A successful implementation of laparoscopic surgery has already been demonstrated at scale in low-resource settings [30].…”

“…The role of laparoscopy in low-resource healthcare settings has been debated [10]. Those arguing against its use suggest that the required initial financial and training investment, together with the on-going costs of equipment upkeep and consumables, make it unviable when compared to relatively straightforward open surgery.…”

Disseminating technology in global surgery

“…Laparoscopic surgery is the preferred technique for many general surgical and gynaecological conditions owing to improved short‐term clinical outcomes. These benefits are even more pronounced in LMICs where access to follow‐up care is limited and there is a greater urgency to return to work to prevent spiralling poverty. Laparoscopy also provides a cost‐effective diagnostic tool where radiological facilities are limited, and may reduce negative laparotomy rates.…”

“…Although these are formidable challenges, laparoscopic surgery has been implemented successfully in low‐resource settings with complication rates similar to those in HICs. In a recent systematic review, Chao and colleagues described several adaptive strategies to enhance the adoption of laparoscopic surgery in LMICs. These included infrastructure and system innovations, such as soft drink companies providing carbon dioxide, sunlight as a light source, and low‐cost box trainers for surgical training.…”

Laparoscopic surgery for gynecologic cancer in low- and middle-income countries (LMICs): An area of need

“…The benefits of laparoscopy as compared with laparotomy have been well described. Laparoscopic surgery has been shown to decrease surgical blood loss, reduce rates of wound complications, decrease post-operative pain, and quicken recovery time (Chao et al, 2016). In the United States, laparoscopic surgery has been driven by patient demand, physician competition, and hospital administration.…”