Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

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.

Lessons learned during the COVID-19 pandemic using virtual basic laparoscopic training in Santa Cruz de la Sierra, Bolivia: effects on confidence, knowledge, and skill

“…The many advantages of laparoscopy make it the standard-of-care technique for many surgical procedures in HIC, yet use of laparoscopy in LMICs such as Bolivia remains limited due to barriers including lack of training opportunities [ 6 , 7 ]. Despite the added challenges imposed by the COVID-19 pandemic, a team of Bolivian and U.S.-based surgeons sought to address this issue by creating a virtual basic laparoscopic surgery course teaching both didactic content and box trainer skills to Bolivian surgeons with minimal prior laparoscopic experience.…”

“…The lack of human capacity is largely due to limited minimally invasive training opportunities. Surgeons and trainees rely on infrequent workshops or observation in the operating room, as designated laparoscopic fellowships are lacking [ 6 , 7 ].…”

Audit of laparoscopic surgery for colon cancer in Morocco: A report of the results of a prospective multicentre cohort study

“…Additionally, in Morocco, insurance reimbursement is the same for open and laparoscopic colectomies, which does not help to cover the high initial cost of implementing laparoscopic procedures. Another challenge is equipment maintenance, which is especially challenging due to the lack of funding and mishandling of the equipment [ 24 ]. Training is also a significant obstacle for performing advanced laparoscopic procedures.…”

Future of Surgery: Technology Enhanced Surgical Training: Report of the FOS:TEST Commission

“…Other contributing factors include the lack of funding in weak health systems, infrastructure, hierarchy, and the absence of structured surgical training and accreditation programmes for rural surgeons. 331 Training programmes need to recognise the cultural context and empower trainees, resulting in high quality, in-country opportunities facilitating trainee retention, 4 and skill development relevant to the setting and population need.…”