Factors Influencing the Adoption of Minimally Invasive Surgery

Abstract

Background: Cost is a major concern for delivery of minimally invasive surgical technologies due to the nature of resources required. It is unclear whether factors extrinsic to technology availability impact on this uptake. Objectives: To establish the influence of institutional, patient and surgeon-related factors in the adoption of minimally invasive surgical technologies. Methods: Eighty surgeons in tier 4 hospitals in Nairobi were subjected to questionnaires and key informant interviews between January and May 2015. The respondents were required to cite one surgical procedure for which they had the option of either open or minimally invasive surgical approach (MIS). Of the factors presented, they were required to grade them from 1 for least recurring to 5 for most recurring. Results: The response rate was 100%. A total of 9 surgical interventions emerged from the respondents. The most common impediment to MIS was unavailability of the required equipment and non-functional equipment (mean score, 2.61). The most common patient related factors that led to an open approach were patient presentation, obesity, co-morbidities and age (mean score 2.87). The most common surgeon related factor was lack of confidence in the MIS approach (mean score, 2.55). Conclusions: Absence of enabling functional equipment or device at the time of surgery is the most significant institutional factor that impedes the adoption of MIS. Intraoperative complications and the surgeon’s comfort emerged as the most significant patient and surgeon factors respectively.

Keywords: Minimally Invasive Surgical Approaches, Health System Pillars, Service Delivery.