Surgical technology is essential for improving equitable access to high-quality surgical care worldwide. As health systems face increasing demand and limited resources, many surgical procedures must be adapted for local contexts to ensure sustainability. Implementing surgical technology across diverse health systems requires tailored approaches to local contexts, addressing unmet needs and prioritising patient benefit.
Minimal access surgery has gained popularity over the past thirty years and has achieved high standards in Western countries. The need is greater in resource-limited settings; however, adoption there is slower and more challenging due to various barriers. Gasless laparoscopic surgery offers a cost-effective, minimally invasive option that can replace open surgery. This technique can serve as a transitional step from traditional open procedures to more advanced minimally invasive methods, but it requires thorough evaluation and assessment of related technologies.
This work on implementing and scaling up technology in global surgery presents gasless laparoscopy as an example of a cost-effective frugal surgical innovation. It draws on data from a systematic review and meta-analysis of 63 studies, assessments of training and proctorship over six months, registry outcome evaluations, learning-curve studies, and process evaluations of training interventions, following the Medical Research Council framework. Finally, it explores implementation and scale-up through mixed-methods qualitative research involving 25 stakeholders, guided by the diffusion of innovation theory and health technology assessment components.
This extensive evidence base concludes in a contextual framework for implementing technology in global surgery. This framework supports health care facilities and the community in adopting a comprehensive, systematic approach to evaluating, implementing, and scaling technology, while emphasising key elements of the diffusion of innovations. It also provides a comprehensive tool to help leaders, policymakers, and the international surgical community identify key factors for deploying and scaling technologies within surgical health systems. It encourages population-based strategies that drive behavioural change and strives to ensure high-quality, universal access to surgical care.
