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Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
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Global Utilization of Minimally Invasive Surgery: Practice and Challenges.

Olivia C McGinnis1, Anne S Wesonga2, Hizuru Amano3

  • 1Department of Surgery, Duke University School of Medicine, Durham, North Carolina.

The Journal of Surgical Research
|July 17, 2025
PubMed
Summary
This summary is machine-generated.

Minimally invasive surgery (MIS) faces significant barriers in low- and middle-income countries (LMICs), including resource access and training. These challenges lead to more technical difficulties and conversions to open procedures compared to high-income countries (HICs).

Keywords:
Clinical challengesCost-effective solutionsGlobal surgeryHealth care accessLaparoscopyMinimally invasive surgerySurgical outcomesSurgical training

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Area of Science:

  • Global Surgery
  • Surgical Innovation
  • Health Disparities

Background:

  • Minimally invasive surgery (MIS) adoption is hindered in low- and middle-income countries (LMICs) by various obstacles.
  • This study investigates surgeon experiences with MIS across diverse global settings.

Purpose of the Study:

  • To identify and analyze the challenges and complications encountered during MIS procedures in LMICs compared to high-income countries (HICs).
  • To pinpoint key barriers hindering MIS implementation and success in resource-limited settings.

Main Methods:

  • A survey of 41 surgeons from seven countries (Japan, Singapore, Uganda, USA, Cambodia, Vietnam, Malaysia) was conducted.
  • Data on 198 MIS cases were collected between April 2021 and February 2023, followed by descriptive statistical analysis.

Main Results:

  • LMIC patients undergoing MIS were older, more female, and had fewer comorbidities than HIC patients.
  • Greater blood loss and higher rates of conversion to open procedures were reported in LMICs.
  • Key barriers in LMICs included limited resource access, equipment maintenance issues, complex intraoperative pathology, and inadequate surgical training.

Conclusions:

  • Significant disparities exist in MIS experiences between HICs and LMICs.
  • Technical and intraoperative challenges are more prevalent in LMICs, with all open conversions originating from these regions.
  • Addressing resource access, equipment maintenance, pathology management, and surgical training is crucial for improving MIS in LMICs.