ReviewSurgical endoscopy2026
Barriers and facilitators to implementing laparoscopic surgery in low- and middle-income countries: a systematic review using the consolidated framework for implementation research.
Review in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough 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).
methodsA 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.
resultsAcross 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.
conclusionsImplementation 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.
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Registered trials
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