Disparities in access to and outcomes of minimally invasive surgery: a scoping review

Abstract Background Minimally invasive surgery (MIS) has been associated with improved clinical outcomes compared to open surgery for various procedures. However, disparities in access to MIS persist across race/ethnicity, sex, geography, and payor status. This scoping review aims to synthesize existing evidence on disparities in MIS use and outcomes and to highlight key gaps in the literature. Methods A comprehensive literature search was conducted in PubMed and Scopus from 1 January 2020, to 18 October 2024, for US peer-reviewed research on access to and outcomes of MIS in equity-seeking groups. Title/abstracts and full text were independently reviewed, with conflicts resolved by consensus. Information on study characteristics and both clinical and non-clinical outcomes were extracted. Factors associated with adverse clinical outcomes or a lower likelihood of access to MIS were grouped as themes and represented by surgical specialty using a bubble plot. A protocol for this review was pre-registered on Open Science Framework and updated through the course of the study. Results A total of 88 articles involving 11,647,821 patients were included in the review. The most frequently reported domain of disparity was race/ethnicity ( n = 62 papers), and the most frequently analyzed specialty was general surgery ( n = 41 papers). Overall, a decrease in likelihood of MIS was reported among patients who were Black, Hispanic or Native American, uninsured or on Medicaid, from lower socioeconomic status (SES), and those in rural locations. Adverse clinical outcomes of MIS, such as readmissions and complications, were associated with patients who were Black, female, of lower SES, and on Medicaid. Key gaps in the literature were noted in the investigation of disparities across geography (rurality/urbanicity), language and at the intersection of multiple domains of disparity. Conclusion Our review provides important considerations for understanding the inequities across patient groups in access to and outcomes of MIS. Graphical abstract