Troller R, Bawa J, Baker O, Ashcroft J. First experience in laparoscopic surgery in low and middle income countries: A systematic review. World J Gastrointest Surg 2024; 16(2): 546-553 [PMID: 38463379 DOI: 10.4240/wjgs.v16.i2.546]
Corresponding Author of This Article
Rebekka Troller, MD, Doctor, Surgeon, Department of Surgery, Medway Maritime Hospital, Windmill Rd, Gillingham ME7 5NY, Kent, United Kingdom. rebekka.troller@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2024; 16(2): 546-553 Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.546
First experience in laparoscopic surgery in low and middle income countries: A systematic review
Rebekka Troller, Jasmine Bawa, Olivia Baker, James Ashcroft
Rebekka Troller, Department of Surgery, Medway Maritime Hospital, Gillingham ME7 5NY, Kent, United Kingdom
Jasmine Bawa, Olivia Baker, James Ashcroft, Department of Surgery, University Hospital Cambridge, Cambridge CB2 0QQ, United Kingdom
Author contributions: Troller R contributed to identification and screening of papers, analysis, supervision of writing the abstract, completion of manuscript and revision; Bawa J contributed to study screening, data analysis, writing of abstract and part of manuscript; Baker O contributed to study screening, data analysis; Ashcroft J contributed to study screening, data analysis, writing part of manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rebekka Troller, MD, Doctor, Surgeon, Department of Surgery, Medway Maritime Hospital, Windmill Rd, Gillingham ME7 5NY, Kent, United Kingdom. rebekka.troller@gmail.com
Received: November 6, 2023 Peer-review started: November 6, 2023 First decision: December 6, 2023 Revised: January 2, 2024 Accepted: January 30, 2024 Article in press: January 30, 2024 Published online: February 27, 2024
Abstract
BACKGROUND
Laparoscopic surgery has reduced morbidity and mortality rates, shorter postoperative recovery periods and lower complication rates than open surgery. It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources. However, introducing laparoscopic surgery in low-and-middle-income countries (LMIC) can be expensive and requires resources, equipment, and trainers.
AIM
To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.
METHODS
MEDLINE, EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published between 1996 and 2022 with full text available in English. Exclusion criteria were studies considering only open surgery, ear, nose, and throat, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery.
RESULTS
Ten studies out of 3409 screened papers, from eight LMIC were eligible for inclusion in the final analysis, totaling 2497 patients. Most reported challenges were related to costs of equipment and training programmes, 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 a reduction in hospital stay, complications, and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors.
CONCLUSION
Despite financial and technical challenges, many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients. While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported, more support is critically required, in particular regarding training.
Core Tip: While laparoscopic surgery could have major positive effects on patients in low and middle income countries, this type of operation is not widely accessible in many parts of the world. The aim of this study was a systematic review of the literature on laparoscopic surgery in low in middle income countries in order to get a better understanding of first experiences made with minimal invasive surgical techniques and equipment. Out of over 3400 screened papers, 10 studies were selected and analised. We report on common challenges as well as on possible ways to overcome them.
