Surgical Endoscopy

, Volume 27, Issue 11, pp 4009–4015 | Cite as

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

  • Ian Choy
  • Simon Kitto
  • Nii Adu-Aryee
  • Allan Okrainec



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.


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.


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.


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.


Exploratory case study Laparoscopic surgery Lower-middle-income countries Qualitative Training 


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ian Choy
    • 1
    • 3
    • 4
  • Simon Kitto
    • 1
    • 3
    • 5
    • 6
  • Nii Adu-Aryee
    • 7
  • Allan Okrainec
    • 1
    • 2
    • 4
  1. 1.Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Division of General SurgeryToronto Western Hospital, University Health NetworkTorontoCanada
  3. 3.Wilson CentreUniversity of Toronto, University Health NetworkTorontoCanada
  4. 4.Temerty/Chang International Centre for Telesimulation and Innovation in Medical EducationTorontoCanada
  5. 5.Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  6. 6.Office of Continuing Education and Professional Development, Faculty of MedicineUniversity of TorontoTorontoCanada
  7. 7.Department of SurgeryKorle-Bu Teaching Hospital, Ghana University of Ghana Medical SchoolAccraGhana

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