Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2017; 9(1): 13-18
Published online Jan 27, 2017. doi: 10.4240/wjgs.v9.i1.13
Practice, training and safety of laparoscopic surgery in low and middle-income countries
Maryam Alfa-Wali, Samuel Osaghae
Maryam Alfa-Wali, Epsom and St Helier University Hospitals, Wrythe Lane SM5 1AA, United Kingdom
Samuel Osaghae, University of Benin Teaching Hospital, Benin City, Nigeria
Author contributions: Alfa-Wali M contributed to concept and design of review article, and performed and analysed data; Alfa-Wali M and Osaghae S contributed to literature review, writing and reviewing of the manuscript.
Conflict-of-interest statement: No conflicts of interest to declare.
Open-Access: 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:
Correspondence to: Dr. Maryam Alfa-Wali, Epsom and St Helier University Hospital, Wrythe Lane SM5 1AA, United Kingdom.
Telephone: +44-208-2962000 Fax: +44-137-2735048
Received: March 31, 2016
Peer-review started: April 6, 2016
First decision: June 6, 2016
Revised: October 19, 2016
Accepted: November 1, 2016
Article in press: November 3, 2016
Published online: January 27, 2017

Surgical management of diseases is recognised as a major unmet need in low and middle-income countries (LMICs). Laparoscopic surgery has been present since the 1980s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with high-income countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.

Keywords: Laparoscopic surgery, Global surgery, Low and middle-income countries, Laparoscopic training, Patient safety, Laparoscopy, Minimally invasive surgery

Core tip: The rate of laparoscopic surgery in low and middle-income countries (LMICs) is gradually increasing. In this review we highlight the practice of laparoscopic surgery in LMICs from diagnostic procedures to complex resections. Training in laparoscopic surgery is inherently variable in LMICs, however innovative teaching methods with inexpensive materials have been developed. Safety data on laparoscopic surgery in LMICs is minimal and more research needs to be done. It is essential to establish safe practices that must be contextualized to serve the population in various LMICs.