Optimizing the management of laparoscopic equipment in low-resource settings: a SAGES White Paper

The availability of well-maintained, functional equipment is a major limiting factor for laparoscopic surgery. As the practice of laparoscopy expands into low-resource settings (LRS), there is limited guidance on how laparoscopic equipment should be tailored to local environments to ensure appropriate maintenance, sustainability, and cost reduction. This White Paper, developed by the SAGES Global Affairs Committee, examines the challenges and opportunities associated with introducing laparoscopic equipment into LRS. It highlights the innovative strategies employed by surgeons to train and perform minimally invasive procedures effectively while ensuring the continued functionality of essential equipment. Key stakeholders engaged in the global surgery field began by identifying and prioritizing the most pressing challenges and considerations related to the adaptation of laparoscopic surgery in LRS. This initial framework served as the basis for engaging additional experienced practitioners who have worked extensively in LRS. Their insights, grounded in firsthand knowledge and practical experience, were synthesized into a comprehensive report that provides both strategic guidance and actionable recommendations for advancing minimally invasive surgery in LRS. This paper outlines key adaptations that make laparoscopic surgery more accessible and sustainable in LRS. Simulation-based training, using low-cost or homemade trainers, helps overcome limited access to commercial equipment and improve technical skills and equipment familiarity. Various innovative programs have successfully integrated telesimulation, local materials, and structured curricula to build capacity. Procurement strategies emphasizing reusables, durable tools, local sourcing, and thoughtful donations can ensure reliability and affordability. Sustainability efforts include proper sterilization, maintenance, and equipment care using low-cost, locally adapted methods. Alternatives to CO₂ insufflation, such as gasless laparoscopy or air insufflation, offer cost-effective solutions but may compromise outcomes; further research is needed. Intraoperative patient safety can be addressed through creative positioning solutions and low-cost ergonomic practices to prevent staff injury. Overall, these locally driven innovations demonstrate how LRS surgeons are leading practical, cost-effective approaches that not only improve access and quality but also offer valuable lessons for high-resource settings. Laparoscopic surgery will continue to grow in LRS worldwide. Strategies for the sustainability of laparoscopic equipment are essential to address the resource constraints faced by surgeons. These adaptations also offer high-income countries valuable opportunities to learn effective methods for sustainability and cost reduction through reverse innovation.