Barriers and Benefits – Laparoscopic surgery in Low to Middle Income Countries

Barriers and Benefits – Laparoscopic surgery in Low to Middle Income Countries

As discussed in a previous post, laparoscopic surgery has benefits not only regarding patient outcomes, but due to its association with shorter hospital stays and lower rates of post-operative complications, “has unlimited advantages in resource-limited settings” 1.

Low to middle income countries (LMIC) face challenges such as lack of skilled labour, limited resources, equipment and maintenance capacity as well as absence of safety procedure guidelines. These limit the access and application of laparoscopy and therefore opportunities to ensure optimal health outcomes and even the overall cost-effectiveness of hospital resources.

One study stated that laparoscopic surgery was associated with a more than 50% reduction in post-operative wound infection rates in LMIC. This may be due to the advantage of smaller incisions and subsequent contamination risks in a setting that may lack clean water, sanitation, and access to blood banks. Another paper indicated a 17% decrease in the duration of hospital stays without increasing total hospitalisation costs when laparoscopic colorectal surgery was performed.

As well as having fewer complications and faster recoveries, laparoscopic surgery has been evidenced to be especially advantageous for LMIC’s that have fewer hospital beds, higher rates of haemorrhage, rising rates of trauma, and single-income households. The ability to return to economic activity more swiftly has a meaningful impact for patients and their families.

There is a strong case to integrate laparoscopic surgery into LMIC surgical curricula despite its purported expensiveness, as “the cost-effectiveness… has been reported to be superior in numerous publications.” 2 There are many suggestions on how to adapt equipment and training to decrease such costs, including collaborative efforts, sourcing donated equipment and training of staff, the use of re-usable instruments, and most importantly – encouraging more local universities and teaching hospitals to advocate and include this essential service in their postgraduate teaching curriculums.

Persistent and standardized training of laparoscopic surgical skills will have many knock-on benefits for patients, hospitals, and the wider economy. A good learning curriculum will always include simulation combined with clinical practice and assessment.  Budget is an important consideration, and the market has a wide offering. Latest developments in Poland show the way in creating an important balance. For more information see