Establishing laparoscopic surgery in Timor-Leste: early outcomes and barriers to implementation

Timor-Leste has made very limited progress in implementing laparoscopic surgery. However, over the past year, laparoscopic cholecystectomy has been routinely performed in the country for the first time. This study aims to share operative outcomes and practical experience, as well as identify barriers to performing laparoscopic surgery in Timor-Leste. This single-center mixed-methods study included a retrospective analysis of laparoscopic cholecystectomy cases performed at the national hospital between January 1, 2024 and March 31, 2025. In addition, a cross-sectional survey using a closed-ended questionnaire was conducted among local doctors from the Department of Surgery in April 2025. A total of 48 laparoscopic cholecystectomies were performed, including 34 (70.8%) by a Chinese surgeon and 14 (29.2%) by a local surgeon. There were no statistically significant differences between the two groups in terms of operative time (90.6 ± 36.4 vs. 79.3 ± 27.0 min, P = 0.245), postoperative hospital stay (1.18 ± 0.46 vs. 1.14 ± 0.53 days, P = 0.827), or complication rates (8.8% vs. 7.1%, P = 0.669). 21 (response rate 100%) doctors participated in the survey. Regarding the perceived barriers to laparoscopic surgery in Timor-Leste, 19 (90.5%) respondents identified a lack of consumables or equipment, 17 (81.0%) cited a lack of skilled surgeons. We have taken the first steps to routinely perform laparoscopic cholecystectomy in Timor-Leste, laying a foundation for establishing a fully indigenous laparoscopic surgery team. The main barriers are the lack of medical infrastructure and skilled surgeons. Optimizing the use of limited resources and enhancing the skills of lead surgeons may be key factors during the initial phase.