McGinnis Olivia C, Wesonga Anne S, Amano Hizuru, Loh Amos, Biswas Arushi, Hollier Pierce, Ssekitoleko Robert T, Mueller Jenna L, Fitzgerald Tamara N
Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
Mulago Hospital, Kampala, Uganda.
J Surg Res. 2025 Jul 16;313:198-209. doi: 10.1016/j.jss.2025.06.024.
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.
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.
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.
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.
由于各种障碍，低收入和中等收入国家（LMICs）对微创手术（MIS）的采用一直很缓慢。本研究调查了多个国家外科医生的经验，强调了MIS中出现的并发症和挑战。
来自日本、新加坡、乌干达、美国、柬埔寨、越南和马来西亚的41名外科医生完成了一份包含12个问题的调查问卷，详细说明了他们MIS病例的挑战。数据收集于2021年4月至2023年2月，并进行了描述性统计。
在研究期间，36名外科医生共报告了198例MIS病例。与高收入国家（HICs）相比，LMICs的患者往往年龄更大（P<0.001）、女性比例更高（P<0.001）且合并症更少（P<0.01）。抗反流手术、阑尾切除术和胆囊切除术是最常见的MIS手术。手术助手各不相同，日本外科医生报告经验丰富的外科医生作为助手的使用率最高（n = 53，56%）。HICs中80%的病例（n = 99）出血量极少，而LMICs中出血量大于极少的情况（n = 41，55%；P<0.001）。虽然大多数HIC外科医生认为病例简单（n = 93，75%）且无技术挑战，但LMIC外科医生中考虑转为开放手术的比例更高（n = 5，7%）或不得不转为开放手术（n = 6，8%；P<0.001）。主题分组确定了LMICs中的四个关键障碍：资源获取、设备维护、术中病理困难和手术培训可用性。
本研究突出了HICs和LMICs在MIS经验方面的显著差异。技术困难和术中挑战在LMICs中更为频繁，所有转为开放手术的病例均来自这些地区。确定的障碍——资源获取、设备维护、术中病理困难和手术培训——是需要有针对性干预的关键领域。
