Troller Rebekka, Bawa Jasmine, Baker Olivia, Ashcroft James
Department of Surgery, Medway Maritime Hospital, Gillingham ME7 5NY, Kent, United Kingdom.
Department of Surgery, University Hospital Cambridge, Cambridge CB2 0QQ, United Kingdom.
World J Gastrointest Surg. 2024 Feb 27;16(2):546-553. doi: 10.4240/wjgs.v16.i2.546.
Laparoscopic surgery has reduced morbidity and mortality rates, shorter postoperative recovery periods and lower complication rates than open surgery. It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources. However, introducing laparoscopic surgery in low-and-middle-income countries (LMIC) can be expensive and requires resources, equipment, and trainers.
To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.
MEDLINE, EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published between 1996 and 2022 with full text available in English. Exclusion criteria were studies considering only open surgery, ear, nose, and throat, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery.
Ten studies out of 3409 screened papers, from eight LMIC were eligible for inclusion in the final analysis, totaling 2497 patients. Most reported challenges were related to costs of equipment and training programmes, equipment problems such as faulty equipment, and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including a reduction in hospital stay, complications, and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors.
Despite financial and technical challenges, many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients. While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported, more support is critically required, in particular regarding training.
与开放手术相比，腹腔镜手术降低了发病率和死亡率，缩短了术后恢复期，并发症发生率更低。这在高收入国家已是常规做法，在资源有限的国家也越来越普遍。然而，在中低收入国家（LMIC）引入腹腔镜手术可能成本高昂，且需要资源、设备和培训人员。
报告在中低收入国家引入腹腔镜手术的挑战和益处，并为财政和资源有限的国家确定应对这些挑战的解决方案。
检索MEDLINE、EMBASE和Cochrane数据库，查找报告在中低收入国家首次开展腹腔镜手术经验的研究。纳入的研究发表于1996年至2022年之间，全文为英文。排除标准为仅考虑开放手术、耳鼻喉、内窥镜检查、关节镜检查、宫腔镜检查、膀胱镜检查、移植或减肥手术的研究。
在3409篇筛选论文中，来自8个中低收入国家的10项研究符合纳入最终分析的条件，共计2497例患者。报告的大多数挑战与设备和培训项目成本、设备问题（如设备故障）以及手术器械的获取有关。与培训相关的挑战包括依赖外国培训人员以及缺乏本地培训的外科医生和手术室工作人员。引入腹腔镜手术的益处包括经济和临床方面，包括缩短住院时间、减少并发症以及降低发病率/死亡率。腹腔镜手术的引入也为初级医生提供了培训机会。
尽管存在财政和技术挑战，但许多研究强调在中低收入国家引入腹腔镜手术的总体益处，如缩短住院时间以及为患者降低相关成本。虽然中低收入国家的许多临床中心已针对报告的挑战提出了实际解决方案，但仍迫切需要更多支持，特别是在培训方面。
