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Building Surgical Capacity in Resource-Limited Settings Through Innovative Laparoscopy Training: A Systematic Review
Ali Yasen Mohamedahmed1,2, Shafquat Zaman3,4, Safeya Mohammed5
1Centre for Global Surgery, Stellenbosch University, Stellenbosch, South Africa.
Background:
Laparoscopic surgery offers substantial benefits compared to open surgery, yet access to structured laparoscopic training remains limited in low- and middle-income countries (LMICs). This systematic review aimed to synthesize evidence on training interventions, methods, and outcomes of laparoscopic education programs in LMICs.
Methods:
A systematic search of PubMed, Embase, Scopus, and Web of Science was performed from 1990 to September 2025, including studies that reported laparoscopic training programs conducted in LMICs as defined by the World Bank classification. Data were extracted on study setting, training method, participant characteristics, and outcomes. Due to heterogeneity of study designs and interventions, a narrative synthesis was conducted.
Results:
Nineteen studies were included, spanning Africa, Latin America, Asia, and the Caribbean. Training methods were diverse, encompassing low-cost simulators, telesimulation and telementoring, structured curricula, international collaborations, and virtual or remote learning. Participant groups ranged from small cohorts of residents and rural surgeons to large-scale programs training thousands of practitioners. Reported outcomes consistently demonstrated improved technical skills, increased knowledge and confidence, high participant satisfaction, and evidence of feasibility and cost-effectiveness. Longitudinal implementation studies in Ghana and Ethiopia highlighted progressive adoption of laparoscopy with increasing independence of local surgeons. Barriers identified included limited access to equipment, lack of simulation laboratories, and insufficient integration into formal curricula.
Conclusions:
Laparoscopic training in LMICs is feasible, effective, and increasingly diverse in delivery models. Innovative low-cost simulators, telesimulation, and structured curricula have proven particularly successful in overcoming resource constraints. Expansion of sustainable context-appropriate training programs is essential to strengthen surgical capacity in LMICs.
