Assessment of resource capacity and barriers to effective practice of laparoscopic surgery in training hospitals affiliated with the College of Surgeons of East, Central and Southern Africa (COSECSA)

Background:
The adoption and accessibility of laparoscopy have been serious issues in countries with limited resources,
and for varied reasons. This study assessed resource capacity and barriers to the efective practice of laparoscopic surgery
in training hospitals afliated with the College of Surgeons of East, Central and Southern Africa (COSECSA).

Methods:
A multi-country survey was conducted from January 2021 to October 2021 using a questionnaire distributed to
surgeons in COSECSA hospitals located in 16 diferent countries. Available resources and surgical volume were assessed,
and the barriers to routinely performing laparoscopy were determined.

Results:
Ninety-four surgeons working in 44 diferent hospitals from 16 countries participated in the survey. The majority
of respondents were general surgeons (n=75, 79.7%). Other specialties included urology (n=12, 12.8%) and pediatric
surgery (n=7, 7.4%). Senior surgeons accounted for 60.6% of participants, more than 40% had a managerial position and
approximately 20% were surgical trainees. Most respondents practiced in public hospitals (n=66, 70.2%). A median of
three surgeons per hospital performed laparoscopic surgery with, on average, two laparoscopic towers and two sets of laparoscopic instruments available. A median of 10 procedures was carried out per month. The cost of laparoscopic procedures
and laparoscopic consumables were reported as being covered by some health insurance payments in 76.9% and 48.4% of
cases, respectively. Cholecystectomy was the most commonly reported laparoscopic procedure performed. The fve top
barriers to performing laparoscopic surgery were: a lack of consumables, a limited quantity of equipment, a lack of skilled
surgeons, the high cost of laparoscopic procedures and complicated cases. In addition, having access to skilled anesthesiologists and anesthesia equipment, carbon dioxide, a consistent electric power supply and equipment maintenance were cited
as signifcant challenges.

Conclusion:
The practice of laparoscopy is currently limited in COSECSA countries due to a scarcity of skilled staf and
the lack of a funding plan to make laparoscopic services accessible. Therefore, policymakers and stakeholders should take
strategic measures to respond to this need.

Keywords Laparoscopic surgery · Global surgery · Sub-Saharan countries · Resources capacity · Barriers to laparoscopy.