Advancing laparoscopic surgery in Sudan and sub-Saharan Africa: a review of challenges, innovations, and policy pathways

Laparoscopic surgery offers clear benefits but remains scarce in Sudan and sub-Saharan Africa due to limited infrastructure, training, and policy support. A structured narrative approach (SANRA-guided; SWiM reporting) was used. We pre-specified eligibility criteria, searched seven databases and repositories (PubMed, Scopus, AJOL, African Index Medicus, HINARI, Google Scholar, organizational repositories) for 2018-30 June 2025, dual-screened records, and appraised included sources with JBI/AXIS/CASP/AACODS. Owing to heterogeneity, we used thematic Synthesis Without Meta-Analysis to examine the barriers, innovations, and policy pathways for expanding minimally invasive surgery (MIS) in the region. Key obstacles include equipment shortages, maintenance gaps, financing deficits, and gender inequities in training. While laparoscopy reduces relative surgical site infection (SSI) risk, absolute SSI rates remain driven by system deficits in sterility, antibiotics, and staffing. Emerging solutions - such as gasless laparoscopy, tele-mentoring, and simulation - are feasible but require financial planning and ethical safeguards for diaspora-led initiatives. Integrating MIS within National Surgical, Obstetric, and Anesthesia Plans (NSOAPs), ensuring 2%-5% annual maintenance funding, and expanding simulation-based training can enable equitable, sustainable scale-up. The review emphasizes practical implementation lessons rather than pooled statistical effects to inform regional policy and training reforms.