Factors Hindering and Supporting the Adoption of Laparoscopic Surgery in Low- and Middle-Income Countries: A Systematic Review Guided by the Consolidated Framework for Implementation Research

By
Ali Yasen Mohamedahmed
Mohammed A. Adam
Seddig Adam Jebril Saleh
Malaz A. E. Dafallah
Omar Elfaroug Salim
Kayla Bagg
Johnelize Louw
Tiffany E. Chao
Kathryn Chu
October 13, 2026

Surgical Endoscopy

Overview

This systematic review examines factors that hinder or support implementation of laparoscopic surgery in low- and middle-income countries (LMICs), organizing the evidence using the Consolidated Framework for Implementation Research (CFIR). The supplied article material describes the review rationale and methods but does not provide its study-selection results or synthesized barriers and facilitators.

Background

An estimated 5 billion people worldwide lack access to safe, affordable surgical and anaesthesia care, and the source estimates that 321.5 million additional procedures are needed annually, with deficits concentrated in LMICs. Minimally invasive surgery is associated in the source with faster recovery, less postoperative pain, shorter hospitalisation, lower surgical-site infection rates, and quicker return to usual activities than open surgery. Despite its routine incorporation into practice in high-income countries, laparoscopic surgery has had sporadic and marginal adoption in LMICs. The review applies CFIR, which groups implementation determinants into innovation characteristics, outer setting, inner setting, characteristics of individuals, and process.

Data Highlights

Measure or method	Source-reported detail
Unmet access to surgical and anaesthesia care	Approximately 5 billion people worldwide
Additional procedures estimated to be required annually	321.5 million
Recovery time associated with minimally invasive surgery	20–30% faster than open surgery, as reported in the context
Review approach	Systematic review following 2020 PRISMA guidelines; prospectively registered under PROSPERO CRD42024593992
Search sources and period	PubMed, MEDLINE, ScienceDirect, Embase, Scopus, and Google Scholar; eligible publications from 1996 to 2024
Language restriction	English-language articles only

Key Findings

The review’s prespecified objective was to identify and synthesize barriers and facilitators affecting laparoscopic surgery implementation in LMICs.
The authors used CFIR to organize implementation determinants across innovation characteristics, outer setting, inner setting, characteristics of individuals, and process.
Searches covered five bibliographic databases and Google Scholar, with reference-list screening for potentially eligible publications from 1996 through 2024.
Eligible populations included patients, healthcare institutions, surgical teams, and healthcare professionals involved in laparoscopic surgery provision or implementation in LMICs.
The source describes implementation challenges as extending beyond resources and including costs, personnel shortages, inadequate infrastructure, cultural resistance, and insufficient support.
Wilkinson et al. (2021), as cited in the source, identified seven principal challenges: funding, equipment, trainers, stakeholder dynamics, curricula, departmental structure, and trainee opportunities.

Clinical Implications

The source frames CFIR-based synthesis as a way to organize multilevel implementation factors for healthcare leaders, policymakers, and researchers working to broaden access to laparoscopic surgery in resource-limited settings. The supplied material does not report the review’s detailed results or provide specific clinical recommendations.

Conclusion

The review addresses an important implementation question by applying CFIR to laparoscopic surgery in LMICs. The provided source text establishes its rationale and methods but does not include the synthesized review findings.