Design opportunities in paediatric laparoscopy: insights from a national qualitative study with surgeons

Paediatric laparoscopic surgery (PLS) presents complex human-centred challenges that extend beyond clinical technique, yet the experiential knowledge of surgeons – the primary users of these systems – remains under-represented in design research. This study adopts a design-led qualitative approach to characterize surgeons’ real-world challenges and translate them into actionable directions for future device and system innovation. Fifty-one paediatric surgeons across India participated in semi-structured interviews. Thematic analysis was used to identify patterns in qualitative responses, while quantitative measures evaluated the descriptive insights. Despite experience and training, 88% of participants reported significant difficulties performing PLS. Key challenges included anatomical variations (94%), ergonomic strain (94%), limitations of current instruments (76%), task-specific complexity (43%) and inadequate training opportunities (19.6%). Additional issues related to surgical optics, infrastructure and cost were also identified. Synthesizing these insights through a human-centred design and experience-based co-design lens, actionable design opportunities in miniaturized instrumentation, improved surgical interfaces, spatial ergonomics and simulation-based training were identified. By reframing PLS challenges as user-centred design problems, this study provides a foundational design brief and a structured pathway for engineers, designers and clinicians to co-create next-generation surgical tools and systems tailored to the unique constraints of paediatric minimally invasive surgery.