Global Utilization of Minimally Invasive Surgery: Practice and Challenges

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.