Implementation and outcomes of laparoscopic surgery in a COSECSA-accredited teaching hospital in Kigali, Rwanda: Mixed-methods study

Abstract

Background: Laparoscopic surgery is increasingly adopted in low-resource settings, yet evidence describing its implementation and real-world practice remains limited. This study aimed to describe laparoscopic surgical practice, patient characteristics, and early outcomes at a tertiary teaching hospital in Kigali, Rwanda, while exploring contextual factors influencing service delivery.

Methods: A mixed-methods study was conducted at Kibagabaga Level II Teaching Hospital. The quantitative component included all consecutive patients undergoing laparoscopic surgery during the study period, with demographic, clinical, and procedural data extracted from routine hospital records. The qualitative component consisted of structured discussions with members of the multidisciplinary surgical team to explore workflow, implementation processes, and operational challenges. Quantitative data were analysed descriptively, and qualitative findings were synthesised narratively to provide contextual interpretation.

Results: Consecutive laparoscopic cases were captured, demonstrating the range of procedures performed and the characteristics of patients undergoing minimally invasive surgery in this setting. The analysis described operative indications, procedural distribution, and perioperative outcomes documented in routine clinical practice. Qualitative findings highlighted key organisational and resource-related factors influencing laparoscopic service delivery, including workflow, team coordination, and implementation challenges within the institutional context.

Conclusions: Laparoscopic surgery can be successfully delivered in a tertiary teaching hospital in Rwanda, with practice shaped by both clinical and organisational factors. Combining outcome data with contextual insights provides a more comprehensive understanding of surgical implementation in resource-limited settings and may inform future capacity-building efforts.