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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2013

01-11-2013

Barriers to the uptake of laparoscopic surgery in a lower-middle-income country

Authors: Ian Choy, Simon Kitto, Nii Adu-Aryee, Allan Okrainec

Published in: Surgical Endoscopy | Issue 11/2013

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Abstract

Background

Despite the significant improvements in surgical care in developed countries, the adoption of laparoscopy in lower-middle-income countries (LMICs) has been sporadic and minimal. Although the most quoted explanation for this has been an apparent lack of resources and training, recent studies have demonstrated that these constraints may not be the only significant barrier. The overall aim of this study was to analyze barriers to the adoption of laparoscopic surgery at a hospital in an LMIC.

Methods

Using an exploratory case study design, this investigation identified barriers to the adoption of laparoscopic surgery in an LMIC. More than 600 hours of participant observation as well as 13 in-depth interviews and document analyses were collected over a 12-week period.

Results

Three overarching barriers emerged from the data: (1) the organizational structure for funding laparoscopic procedures, (2) the hierarchical nature of the local surgical culture, and (3) the expertise and skills associated with a change in practice. The description of the first barrier shows how the ongoing funding structure, rather than upfront costs, of the laparoscopic program limited the number of laparoscopic cases. The description of the second barrier highlights the importance of understanding the local surgical culture in attempts to adopt new technology. The description of the third barrier emphasizes the fact that due to the generalist nature of surgical practice, surgeons were less willing to practice more technically complicated and time-consuming procedures.

Conclusion

This exploratory case study examining the barriers hindering the adoption of laparoscopy in an LMIC represents a novel approach to addressing issues that have plagued surgeons across LMICs for many years. These findings not only further understanding of how to improve the adoption of laparoscopy in LMICs but also challenge the economic-centric notions of the problems that affect the transfer of innovation across social, economic, and geographic boundaries.
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Metadata
Title
Barriers to the uptake of laparoscopic surgery in a lower-middle-income country
Authors
Ian Choy
Simon Kitto
Nii Adu-Aryee
Allan Okrainec
Publication date
01-11-2013
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-3019-z

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