# Robotic and Laparoscopic Inguinal Hernia Repair in Africa: Current Adoption, Challenges, and Future Horizons

## TL;DR

Laparoscopic and robotic hernia repair are underused in Africa due to cost, training, and resource challenges, but progress is possible with investment and training.

## Contribution

This paper reviews the current state and challenges of robotic and laparoscopic hernia repair adoption in Africa.

## Key findings

- Only 3.3% of hernia repairs in sub-Saharan Africa use laparoscopic techniques.
- Robotic hernia repair has not yet been reported in Africa.
- Training, cost, and resource allocation are major barriers to adoption.

## Abstract

Inguinal hernia repair is one of the most common surgical procedures performed globally. Laparoscopic inguinal hernia repair (LIHR) is recognized globally to be effective and safe, with advantages over open surgery, but its implementation across the African continent has been slow, with only 12 countries reporting implementation, and only 3.3% of inguinal hernia repairs in sub-Saharan Africa performed using laparoscopic techniques. Robotic surgery, although still emerging within the continent, with around 20 robots primarily used in urology across South Africa, Egypt, Morocco, Angola, and Tunisia, no reports of robotic inguinal hernia repair currently exist. Progress, however, is being observed with the growing interest from surgical societies, private-sector robotic expansion, and humanitarian missions introducing mesh-based and limited laparoscopic procedures. Limitations include the low global utilization of minimally invasive surgery (MIS) for hernia repair despite guideline recommendations. This has been attributed to training challenges, steep learning curve, and limited evidence of benefit for bilateral and recurrent hernias. African-specific challenges include costs, inadequate training opportunities, surgeon preference, ongoing debates regarding its necessity in low-resource settings, lack of institutional support, and resource prioritization for other MIS procedures such as cholecystectomy and prostatectomy. Despite ongoing challenges, investments in research, training and cost-effective equipment, increased availability of mesh, and integration of humanitarian hernia missions into national training systems, can enhance adoption and contribute to better surgical outcomes for patients. This narrative review presents the present state of robotic and laparoscopic inguinal hernia repair in Africa, as well as the current challenges, and recommendations to improve adoption.