The expansion of minimally invasive gynecologic surgery into low- and middle-income countries remains an important milestone in improving women’s healthcare. A recent retrospective study conducted at Charak Memorial Hospital in Pokhara, Nepal, provides encouraging evidence that gynecologic laparoscopy can be performed safely and effectively even in resource-constrained environments when supported by structured training, careful patient selection, and ongoing clinical audit.

The study reviewed 159 women who were scheduled for gynecologic laparoscopic procedures between 2019 and 2023. Of these, 153 patients successfully completed surgery laparoscopically, yielding an impressive completion rate of 96.2%. Only six cases (3.8%) required conversion to open laparotomy. These findings compare favorably with conversion rates reported by many established centers during the early phases of laparoscopic program development and demonstrate that high-quality minimally invasive surgery can be achieved outside major tertiary institutions.

The most frequently performed operation in the series was ovarian cystectomy, reflecting the suitability of laparoscopy for the management of benign adnexal pathology. Total laparoscopic hysterectomy (TLH) represented the second most common procedure and constituted one of the more technically demanding interventions undertaken during the study period. Other procedures included diagnostic and therapeutic laparoscopic interventions for various gynecologic conditions.

An important outcome of the study was the relatively short postoperative recovery period. Most patients were discharged within two days of surgery, highlighting one of the principal advantages of minimally invasive surgery. Reduced hospital stay is particularly valuable in healthcare systems with limited bed availability and constrained resources. Earlier discharge not only lowers healthcare costs but also minimizes disruption to patients’ personal and professional lives while reducing the risk of hospital-acquired complications.

The overall complication rate was reported at 6.5%, with the majority classified as Clavien-Dindo Grade I or II complications. These minor complications typically required minimal intervention and were managed successfully without significant long-term consequences. More serious adverse events were uncommon but included one case of pelvic vein thrombosis and one intraoperative bladder injury. Both complications underscore the importance of vigilance, appropriate perioperative protocols, and timely recognition and management of complications.

Urinary tract injury remains one of the most significant concerns in advanced gynecologic laparoscopy, particularly during hysterectomy. The occurrence of a single bladder injury in this series is consistent with rates reported internationally and highlights the need for meticulous dissection, clear identification of anatomical landmarks, and ongoing surgical education. Similarly, the reported thrombotic event reinforces the importance of venous thromboembolism risk assessment and prophylaxis, even in minimally invasive procedures where overall mobility and recovery are generally enhanced.

The study also demonstrated that total laparoscopic hysterectomy required longer operative times and resulted in greater blood loss compared with less complex procedures. This observation is not unexpected and mirrors the experience of many centers worldwide. TLH is widely recognized as one of the more technically challenging gynecologic laparoscopic procedures, requiring advanced skills in pelvic anatomy, vascular control, intracorporeal suturing, and complication management. The findings emphasize that surgical teams introducing minimally invasive gynecology should adopt a stepwise progression in case complexity, allowing surgeons to build expertise through simpler procedures before advancing to hysterectomy and other major operations.

From a broader perspective, the Nepalese experience offers valuable lessons for healthcare systems seeking to expand laparoscopic services. Success depends not only on equipment availability but also on surgeon training, team coordination, standardized protocols, and continuous monitoring of outcomes. The study illustrates how even hospitals with limited resources can establish sustainable minimally invasive programs when performance indicators are regularly evaluated.

For laparoscopic surgeons, the most important message is that feasibility alone should not be the primary measure of success. Instead, programs should focus on maintaining low conversion rates, minimizing complications, documenting blood loss, monitoring operative times, and evaluating postoperative recovery. Continuous audit enables teams to identify trends, improve performance, and safely expand the range of procedures offered.

The authors also highlight the value of tracking specific quality indicators during service development. Conversion to laparotomy remains an essential benchmark, as it reflects both patient selection and intraoperative decision-making. Monitoring urinary tract injuries, thromboembolic complications, length of hospital stay, and procedure-specific outcomes provides a comprehensive assessment of program maturity and patient safety.

As minimally invasive surgery continues to expand globally, studies such as this demonstrate that high-quality gynecologic laparoscopy is achievable beyond large academic centers. The experience from Pokhara, Nepal, supports the growing body of evidence that structured implementation, progressive training, and rigorous outcome assessment can allow resource-limited institutions to deliver safe, effective, and patient-centered laparoscopic care. The findings serve as an encouraging model for hospitals throughout South Asia and other developing regions aiming to establish or strengthen their minimally invasive gynecologic surgery programs.

Reference: BMC Women's Health (2026). Gynecologic laparoscopic surgery outcomes from Charak Memorial Hospital, Pokhara, Nepal. Published by Springer Nature.