Abstract
Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.
Highlights
Five billion people worldwide lack access to safe, affordable surgical care.[1]
In comparison to open surgery, laparoscopy is associated with reduced infection rates,[5] which is problematic in low-income countries (LICs)[6] where rates are up to 25 times greater than in highincome countries (HICs).[5]
Abdominal laparoscopy was the focus of this review because acute abdominal conditions are a significant cause of premature mortality in many low- and-middle-income countries (LMICs).[12]
Summary
Five billion people worldwide lack access to safe, affordable surgical care.[1]. This problem is acute in low- and lower middle-income countries, where it applies to nine out of ten people.[1]. Laparoscopy helps to reduce postoperative pain[7] and shortens hospital stay,[8] which benefits LOW AND MIDDLE INCOME
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