First experience in laparoscopic surgery in low and middle income countries: A systematic review

ARTICLE HIGHLIGHTS

Research background

Laparoscopic surgery has become routine practice in many places in the world and has numerous benefits when compared to open surgery, including: Reduced morbidity and mortality, length of hospital stay, blood loss, infection rate and postoperative pain. However, laparoscopic surgery is still not routine in many low- and middle income countries (LMIC) as introducing minimal invasive surgery can be expensive and requires resources. The economic deficit in low-and middle income countries can limit access to high-cost technology and its support and represents a great challenge to introduce laparoscopic surgery. In low-and middle income countries most surgeries are performed with an open approach, rather than a laparoscopically. Access to laparoscopic surgery in LMICs is difficult and thus much of the developing world cannot benefit from minimal invasive surgery. Introducing laparoscopic surgical services requires a range of specialist input necessitating that surgical teams are constituted from a broad multidisciplinary background.

Research motivation

This systematic review aims to assess the challenges in introducing laparoscopic surgery service in LMICs and to produce a consensus regarding commencing a high quality, replicable, and collaborative laparoscopic service.

Research objectives

The main objective was to assess the challenges in surgical services in Low- and middle-income countries. We could identify the main gaps and problems and analysed potential solutions. But also identified the need for future studies addressing certain questions and design.

Research methods

Systematic review of MEDLINE, EMBASE and Cochrane databases.

Research results

Ten studies have been included in this systematic review. They main challenges found were related to costs, training and equipment. Lack of training opportunities, faulty equipment or access to equipment and the associated costs. Some studies highlighted the benefits of introducing laparoscopic surgery, particularly the reduction in hospital stay, lower complications and lower morbidity and mortality.

Research conclusions

Identification of essential equipment needs and skill gaps, coupled with comprehensive training programs for both clinical staff and equipment engineers, are needed for a sustainable implementation. Reusable equipment, the use of remote technology, such as video-based training materials or remote video-assistance to train and mentor local teams, introduction of solar electricity or alternative power supplies should be considered. Further studies to assess cost-effectiveness of laparoscopic surgery and studies which also includes papers from less economically prosperous areas within developed countries might help to increase the validity of the review.

Research perspectives

Further studies to assess cost-effectiveness of laparoscopic surgery and studies which also includes papers from less economically prosperous areas within developed countries might help to increase the validity of the review.