Global Utilization of Minimally Invasive Surgery: Practice and Challenges.

INTRODUCTION

Uptake of minimally invasive surgery (MIS) in low- and middle-income countries (LMICs) has been slow due to various barriers. This study examined the experiences of surgeons across multiple countries, highlighting the complications and challenges that arise with MIS.

METHODS

Forty-one surgeons from Japan, Singapore, Uganda, the United States, Cambodia, Vietnam, and Malaysia completed 12-question surveys detailing the challenges of their MIS cases. Data were collected from April 2021 to February 2023, and descriptive statistics were generated.

RESULTS

A total of 198 MIS cases were reported by 36 surgeons during the study period. In LMICs, patients tended to be older (P < 0.001), more likely to be female (P < 0.001), and have fewer comorbidities (P < 0.01) than in high-income countries (HICs). Antireflux procedures, appendectomies, and cholecystectomies were the most common MIS performed. Surgical assistants varied, with Japanese surgeons reporting the highest usage of experienced surgeons as assistants (n = 53, 56%). Minimal blood loss was perceived for 80% of cases in HICs (n = 99), whereas greater than minimal blood loss was perceived in LMICs (n = 41, 55%; P < 0.001). While most HIC surgeons found cases easy (n = 93, 75%) with no technical challenges, a higher percentage of LMIC surgeons considered converting to open procedures (n = 5, 7%) or had to convert (n = 6, 8%; P < 0.001). Thematic grouping identified four key barriers in LMICs: access to resources, maintenance of equipment, difficult intraoperative pathology, and surgical training availability.

CONCLUSIONS

This study highlights significant differences in the MIS experience between HICs and LMICs. Technical difficulties and intraoperative challenges were more frequent in LMICs, and all cases converted to open procedures originated from these regions. The identified barriers-access to resources, equipment maintenance, difficult intraoperative pathology, and surgical training-are critical areas that need targeted interventions.