312 First Experience in Laparoscopic Surgery in Low- and Middle-Income Countries: A Systematic Review

Abstract

Abstract Aim This study aims to report the challenges and benefits of introducing laparoscopic surgery in low-and-middle-income countries (LMIC) as well as to identify solutions to these challenges for countries with limited finances and resources. Method MEDLINE, EMBASE and COCHRANE databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published after 1996 with full text available in English. Exclusion criteria were studies considering only open surgery, ENT, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery. Results Ten studies from eight LMIC were eligible for inclusion in the final analysis, totalling 2640 patients. Most reported challenges were related to costs, including affordability of equipment and training programmes, and equipment problems such as faulty equipment and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including reduced hospital stay, complications and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors. Conclusions Despite initial challenges, many studies described the benefits of introducing laparoscopic surgery. Centres proposed practical solutions to these challenges to ensure the sustainability of laparoscopic surgery in LMIC.