The role of laparoscopic surgery in developing countries: A review

Tiffany E Chao, MD, MPH, Jessica Opuku-Anane, MD, Lars Hagander, MD, Rebecca Maine, MD, John G Meara, MD, DMD, MBA

Massachusetts General Hospital; Harvard Medical School Program in Global Surgery and Social Change, Children’s Hospital Boston, Lund University Faculty of Medicine, University of California San Francisco,

Objective: Surgical conditions are an acknowledged global health problem and laparoscopy may prove feasible and beneficial in the developing world. However, no aggregate data exists regarding the role of laparoscopy in low-and middle-income countries. This study was designed to describe the issues facing laparoscopic surgery in developing countries, to aggregate the solutions that have been described in the literature, and to summarize published outcomes reports.

Methods: A search was conducted using Medline, the African Index Medicus, and LILACS-BIREME, a database in partnership with the WHO. Articles were identified that report experiences with laparoscopy in low- and middle-income countries (LMICs).

Results: 71 articles were found describing laparoscopic surgery experiences in 23 LMICs. Lack of trained personnel and equipment are frequently cited as major challenges to the safety and efficacy of laparoscopic surgery, although some studies show that such resource constraints can be overcome. Creative measures have been undertaken to work around limitations in developing countries, including mechanical insufflation with room air, syringe suction, homemade endoloops, regular monopolar cautery, hand-assisted techniques, extracorporal knot tying, innovative uses of cheaper instruments, and the reuse of disposable trochars and graspers. While laparoscopy can confer the usual benefits of shortening hospital stay and reducing work absences, its use in developing countries can be especially useful as a diagnostic modality where imaging is limited, as well as reducing infection and hemorrhage, which are leading causes of morbidity. Training systems using lectures, workshops, lab-based trainers, animal models, and telemedicine are integral in teaching skills outside of the operating room.

Conclusion: Developing countries face challenges that require greater efforts in innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its availability, accessibility, acceptability, and quality. Surgeons, policy makers, and equipment manufacturers must work together to assess and overcome such limitations and share knowledge about implementation. Many current efforts to develop laparoscopic surgical training programs are worthy endeavors to advance surgical technology in developing countries.


Session: Poster Presentation

Program Number: P371

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