Trends in the Adoption of Minimally Invasive Surgery in a Resource-Limited Setting: An Eight-Year Retrospective Analysis from a Tertiary Care Hospital in Pakistan

Abstract

Introduction: Minimally invasive surgery (MIS) has gained global recognition for its superior outcomes, including reduced postoperative pain, shorter recovery times, and improved cosmetic results compared to open surgery. However, its adoption in resource-limited settings remains a challenge due to high equipment costs, limited training opportunities, and patient perceptions. This study aimed to evaluate the trends in the adoption of MIS versus open surgery over eight years in a public sector hospital in Pakistan.

Methods: A retrospective review was conducted of all elective abdominothoracic surgeries performed from January 1, 2015, to December 1, 2022, at the Department of General Surgery, a tertiary care hospital in Rawalpindi, Pakistan. Data were extracted from electronic surgical records, including the number and type of surgeries performed. Cases were categorised as open or minimally invasive, and annual trends were analysed. Conversion rates from MIS to open surgery were recorded. Statistical significance of trends was assessed using the chi-square test, with a p-value < 0.05 considered significant.

Results: A total of 4,119 elective surgeries were included, averaging 514 cases annually. In 2015, 79.5% of procedures were open surgery, with only 20.4% performed via MIS. By 2022, the trend had reversed, with 42.6% open surgeries and 57.3% MIS, a statistically significant change (p < 0.001). Conversion from MIS to open occurred in 17 cases.

Conclusion: The study highlights a significant shift toward MIS in a public hospital setting, demonstrating its feasibility in resource-limited environments. Continued efforts to reduce costs and enhance training are essential to sustain this trend and align with global surgical standards.