Barriers and facilitators to implementing laparoscopic surgery in low- and middle-income countries: a systematic...

Although laparoscopic surgery delivers substantial clinical benefits, its adoption across low- and middle-income countries (LMICs) remains inconsistent and incomplete. This systematic review aims to synthesise the barriers and facilitators of laparoscopic surgery adoption within LMICs healthcare systems using the Consolidated Framework for Implementation Research (CFIR).

A comprehensive systematic search was conducted in PubMed, MEDLINE, ScienceDirect, Embase, and Scopus to identify studies reporting barriers and facilitators to the adoption of laparoscopic surgery in LMICs, as defined by the World Bank classification. Data were extracted using standardised forms, and all implementation factors were mapped to CFIR domains. Additionally, a systematic thematic analysis was then conducted to refine and interpret the extracted data.

Across 18 studies, 417 factors were identified, including 222 barriers and 195 facilitators. Predominant barriers were high equipment costs (n = 24, 11%), structural limitations (n = 18, 8%), and limited training capacity (n = 27, 12%). Key facilitators included perceived clinical advantage (n = 26, 13%), institutional leadership engagement (n = 18, 9%), international collaboration (n = 13, 7%), and technical adaptability (n = 11, 6%). Inner-setting factors were most frequently represented (n = 114, 27%), reflecting institutional readiness as a critical determinant.

Implementation of minimally invasive surgery in LMICs is shaped by barriers including infrastructure and training limitations and facilitators such as leadership, collaboration, and adaptability-with inner-setting factors most frequent, indicating that strengthening institutional readiness is pivotal. Strategic deployment of international partnerships and locally tailored implementation pathways can accelerate equitable access to this essential surgical innovation.