Laparoscopic surgery has transformed surgical care by reducing morbidity, shortening hospital stays, and improving recovery. However, its adoption in low- and middle-income countries remains limited.

This article assesses the current landscape, challenges, and enablers of laparoscopic surgery in LMICs and provides policy and research recommendations for sustainable expansion.

A narrative review was conducted across PubMed, Embase, Google Scholar, and institutional/grey literature sources for English-language records between January 2013 and March 2024. Search terms included (“laparoscopic surgery” OR “minimally invasive surgery” OR “MIS”) AND (“low- and middle-income” OR “LMIC” OR “developing country”) AND (“training” OR “cost” OR “barrier” OR “implementation”). Titles/abstracts and full texts were screened independently by two reviewers, with discrepancies resolved by consensus. A total of 78 articles met the inclusion criteria. Themes were synthesized using an iterative thematic analysis.

Key barriers identified were limited infrastructure, inadequate training programmes, high equipment costs, cultural resistance, and weak financing mechanisms. Emerging initiatives involving locally manufactured or refurbished laparoscopic equipment in regions including Nigeria and India may help mitigate cost barriers. Promising enablers included low-cost laparoscopic kits, mobile simulation platforms, and NGO-supported programmes. Evidence gaps remain in cost-effectiveness research, comparative evaluation of training models, and assessment of policy interventions.

Scaling up laparoscopic surgery in LMICs is an urgent priority. Targeted investments, supportive policies, and cultural engagement are essential to overcome barriers. Closing knowledge gaps and embedding laparoscopic techniques into national surgical plans can help reduce disparities and strengthen surgical systems in resource-limited settings.