Frugal Thinking in Global Surgery

As global surgery continues to evolve, the challenge is not only one of expanding services, but of rethinking how surgical care is designed and delivered. Many existing systems are built for high-resource environments and remain difficult to replicate across much of the world. Addressing this gap requires approaches that are not only effective, but also practical, adaptable, and sustainable.

Frugality in surgery represents one such shift. It is not about compromise, but about precision, delivering high-quality care through simpler, more efficient systems that reduce cost and align with the realities of low-resource settings. By stripping away non-essential elements while preserving clinical outcomes, frugal approaches offer a pathway to expand access without relying on complex infrastructure.

Minimally invasive surgery (MIS), traditionally associated with high-cost equipment and specialized environments, is increasingly being reimagined through this lens. Innovations such as portable imaging systems and gasless laparoscopic techniques demonstrate that advanced surgical care can be adapted for district and rural hospitals. These approaches reduce dependency on supply chains, enable procedures under regional anaesthesia, and bring care closer to patients who would otherwise face significant barriers.

Alongside this, training models are evolving. Decentralized education, simulation-based learning, and remote mentorship are enabling surgeons to develop and apply these techniques safely in diverse settings. In doing so, they support a more distributed and equitable model of surgical care, one that is not limited by geography or infrastructure.

While the articles in this issue span a range of topics, the underlying principle remains consistent: progress in global surgery depends on approaches that are grounded in context and designed for real-world application. In this sense, frugality extends beyond clinical innovation and reflects a broader way of thinking about systems, access, and equity.

This perspective is also reflected in the journal itself. By continuing to explore more accessible and sustainable models of publishing, the Journal of Global Surgery (ONE) seeks to align how knowledge is shared with the same principles that guide how care is delivered.

We invite readers to engage with this issue with that in mind. By prioritizing solutions that are practical, scalable, and inclusive, we move closer to a future where safe surgical care is accessible to all.