The Availability and Utilization of Minimally Invasive Techniques (MITs), in Neurosurgery in Pakistan
DOI:
https://doi.org/10.36552/pjns.v29i2.1025Keywords:
Neurological Surgery, Traditional, MITs, Factors Influencing Adoption, Private and Public HospitalsAbstract
Background: Minimally invasive techniques (MITs) have transformed the landscape of neurological surgery, offering a paradigm shift to patient safety, recovery speed, and surgical precision. Objectives: This article explores the availability and utilization of these techniques, highlighting their benefits, advancements, and regional variations in practice. The primary goal of this study is to facilitate the adoption of advanced Minimally Invasive Techniques (MITs) in neurosurgery at hospitals in Faisalabad. Methodology: A complete methodology, keeping the said purpose in mind, is designed to bring a pragmatic shift of advanced minimally invasive techniques in neurosurgery to the healthcare system of Faisalabad for improved patient care and surgical outcomes. A total of two District Headquarters Hospitals, DHQs, and two private hospitals are selected in Faisalabad. The sample of N=100 neurosurgeons, technicians, support staff and hospital administrators selected randomly. Results: The study revealed significant differences in the adoption and attitudes towards minimally invasive techniques (MITs) across public and private hospitals, with private hospitals showing higher adoption of advanced surgical methods. Factors such as equipment costs, training programs, and institutional support were key barriers influencing MIT utilization. The statistically significant differences in factors influencing MIT adoption underscore the need for targeted.- Conclusion: The study highlights that while both public and private hospitals show positive attitudes toward the adoption of MITs, various barriers such as high equipment costs, insufficient training, and lack of institutional support hinder widespread adoption. Public hospitals are more reliant on traditional surgeries, whereas private hospitals are leading the adoption of advanced surgical techniques.
References
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hospitals in Faisalabad over 3 months, from June 2024 to August 2024, with a one-year follow-up period.
Sample & Sampling Strategy:
Neurosurgeons, technicians, support staff, and hospital administrators were selected from the DHQ Allied hospital, DHQ Civile hospital, Fatimah Hospital & Medical College and Faisal Hospital Faisalabad. Approximately 100 participants were selected randomly for surveys, with around 30 individuals selected for in-depth interviews.
Inclusion Criteria:
Ø Neurosurgeons, assistant surgeons, and other members of the surgical team (such as anesthesiologists and operating room nurses) directly involved in neurosurgical procedures at the selected hospitals.
Ø Neurosurgeons and surgical team members with a minimum of 3 years of experience in neurosurgery.
Ø Hospital administrators and decision-makers involved in planning and allocating resources for surgical services, including those responsible for acquiring medical technologies and equipment.
Exclusion Criteria:
Ø Neurosurgeons or surgical team members working on a temporary, part-time, or visiting basis who do not have ongoing involvement with the hospital’s neurosurgery department.
Ø Neurosurgeons, surgical staff, or hospital administrators with less than 3 years of professional experience in their respective roles related to neurosurgery or healthcare resource management.
Ø Individuals who express reluctance or refusal to participate in the study’s surveys, interviews, or discussions regarding the adoption of MITs.
Data Collection:
Develop a structured questionnaire focusing on current practices, attitudes towards MITs, perceived barriers to adoption, and knowledge of AI applications in neurosurgery. Distribute surveys electronically or via paper forms to all participating hospitals. Conduct semi-structured interviews with key stakeholders (neurosurgeons, surgical teams) to gain insights into their experiences with open procedures versus MITs.
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Data Analysis:
Use statistical software R to analyze survey data. Employ descriptive statistics to summarize participant demographics and responses; inferential statistics chi-square tests were comparing attitudes towards MITs across different hospitals.
Ethical Considerations:
Approval from an institutional review board (IRB) was obtained prior to study commencement. Informed consent was secured from all participants involved in interviews or observational studies. Data confidentiality and participant anonymity was maintained throughout the research process.
Results:
Study Participants Demographic Characteristics
At selected hospital researchers found the study participants there were 20(20%) neurosurgeons, technicians 30(30%), support staff 30 (30%) and hospital administrators were 20(20%). among the years of experience 3-5 years were 13(13%), 6-10 years in majority 47(47%) and > 10 years 40(40%). Furthermore, demographic was hospital type there were 50(50%) public and private 50(50%) in (table 1). There were equal numbers of neurosurgeons (10 each) in both public and private hospitals, indicating a balanced representation of surgical expertise across hospital types. The count for technicians is also equal in both hospital types (15 each), totaling 30. Similar to technicians, support staff were evenly distributed across public and private hospitals, with 15 individuals in each category. Again, there is an equal distribution of hospital administrators (10 each) in both types of hospitals. Only 1 neurosurgeon has between 3-5 years of experience, indicating that this group is relatively small. The majority (13 out of 20) fall into the 6-10 years category, suggesting a significant number of mid-career professionals. There were 6 neurosurgeons with more than ten years of experience, indicating a presence of seasoned professionals in this field. A total of 8 technicians has between 3-5 years of experience. There were also 13 technicians in the mid-experience range. The group includes 9 technicians with over ten years of experience. There were 4 support staff members with relatively less experience. The largest group (15 out of 30) falls within this range. There were also a notable number (11 out of 30) with over ten years of experience. No administrators fall into this category, indicating that new entrants to administration may be less common in this field. There were only 6 administrators with moderate experience. A significant number (14 out of 20) have more than ten years of experience, suggesting that many administrators were seasoned professionals who likely bring valuable insights to hospital management.
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Table 1: Demographic Characteristics of study Participants.
Demographic
Frequency/Percentage
Profession
Neurosurgeons
(20.0%)
Technicians
(30.0%)
Support Staff
(30.0%)
Hospital Administrators
(20.0%)
Years of Experience
-5 Years
(13.0%)
-10 Years
(47.0%)
> 10 Years
(40.0%)
Hospital Type
Public
(50.0%)
Private
(50.0%)
Further analysis reveals a clear distinction in surgical practices between public and private hospitals regarding traditional surgeries and minimally invasive techniques. Public hospitals performed a total of 40 traditional surgeries, while private hospitals conducted 31. This indicates that public hospitals are more reliant on traditional surgical methods compared to private hospitals. In contrast, private hospitals have a higher number of MITs performed (19) compared to public hospitals (10). This suggests that private hospitals may be more progressive in adopting advanced surgical techniques, possibly due to better access to resources, training, and technology. The calculated ?² value is 3.934. The P value obtained is 0.03. The statistically significant results from the Chi-square test underscore the need for further investigation into factors influencing these differences, such as resource availability, staff training, and institutional policies. Promoting the adoption of MITs in public hospitals may enhance patient care and align surgical practices with contemporary standards in neurosurgery.
Table 2: Hospital type wise compression of traditional surgeries versus MITs.
Hospital Type
Traditional Surgeries
MITs
Total
Public
Private
Total
?2 3.934a P Value 0.03*
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Likewise, analysis reveals significant differences in attitudes towards minimally invasive techniques (MITs) based on hospital type, profession, and years of experience (Table 3). A total of 43 participants expressed a positive attitude towards MITs, while 7 were neutral or undecided. The high number of positive responses indicates a favorable perception of MITs among staff in public hospitals. In private hospitals, 42 participants reported positive attitudes, with 8 being neutral or undecided. The attitudes are similarly favorable but slightly lower than those in public hospitals. The Chi-square statistic for hospital type is 0.078, with a P value of 0.005, indicating a statistically significant difference in attitudes between public and private hospitals regarding MITs. Moreover, Attitudes by Profession; Among neurosurgeons, there were 18 positive responses and only 2 neutral or undecided. This indicates strong support for MITs within this professional group. Both technicians and support staff showed similar positive attitudes (24 each) with relatively few neutral responses (6 each). Hospital administrators had a total of 19 positive responses and only 1 neutral response, indicating strong support as well. The Chi-square statistic for profession is 3.137, with a P value of 0.001, indicating a highly significant difference in attitudes based on profession. Attitudes by Years of Experience; Participants with this level of experience showed only 9 positive attitudes against 4 neutral, indicating some hesitance or uncertainty about MITs. This group had the highest positive responses (43) compared to only 4 neutral, showing strong support for MITs among mid-level experienced professionals. Those with over ten years of experience also demonstrated significant support with 33 positive responses, but had more neutral responses (7) compared to the previous group. The Chi-
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square statistic for years of experience is 4.284, with a P value of 0.003, indicating that years of experience significantly influence attitudes toward MITs.
Table 3: Some compression of attitudes towards MITs.
Hospital Type
Positive
Neutral/Undecided
Total
?2
P Value
Public
.078a
.005
Private
Total
Profession
Neurosurgeons
137a
.001*
Technicians
Support Staff
Hospital Administrators
Total
Years of Experience
-5 Years
284a
.003
-10
> 10 Years
At the end data presents a crosstabulation of factors influencing the adoption and utilization of minimally invasive techniques (MITs) in neurosurgery across different hospital types, along with Chi-square test results for statistical significance in (Table 4). The perceived adoption of MITs 1st high equipment costs; In public hospitals, 37 participants cited high equipment costs as a barrier to adopting MITs, while 28 in private hospitals did the same. The Chi-square statistic is 3.713 with a P value of 0.000, indicating a significant difference in perceptions regarding equipment costs as a barrier between public and private hospitals. 2nd is lack of funding; The lack of funding is noted by 8 public and 12 private participants, suggesting that funding issues are perceived as more problematic in private settings. 3rd is maintenance costs; only 5 public participants and 10 private participants expressed concerns about maintenance costs, indicating that this is a lesser issue compared to equipment costs.
Technological factors adoption of MITs 1st Lack of Equipment; Both public (29) and private (28) hospitals report similar concerns regarding the lack of equipment. The Chi-square statistic is 0.041, with a P value of 0.005, indicating that this factor significantly influences MIT adoption. 2nd Outdated Infrastructure; A similar number of participants from both hospital types reported outdated infrastructure (21 public vs. 22 private), suggesting that infrastructure issues are prevalent across both settings.
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Training and Expertise Factors adoption of MITs 1st Insufficient Training Programs; Public hospitals reported 30 instances of insufficient training programs compared to 25 in private hospitals. The Chi-square statistic is 1.295, with a P value of 0.006, suggesting that training programs are viewed as inadequate in both settings but may be more pressing in public hospitals. Resistance to Change & Long Learning Curve; The responses indicate moderate resistance to change and long learning curves, with no significant differences between hospital types.
Regulatory and Institutional Factors adoption of MITs; lack of institutional support; Public hospitals reported a higher concern about institutional support (23%) compared to private hospitals (28%). The Chi-square statistic is 1.000, with a P value of 0.002, indicating significant differences in perceptions regarding institutional support. Regulatory Hurdles; Public hospitals had more participants citing regulatory hurdles (27%) than private hospitals (22%), indicating that regulatory issues may be more pronounced in public settings. Facilitators for Adoption of MITs; A majority from both hospital types indicated positive facilitators for MIT adoption, with public hospitals showing stronger support (37% yes vs. 30% no) compared to private hospitals. The Chi-square statistic is significant at 2.216, with a P value of 0.004, suggesting that facilitators play an important role in MIT adoption.
Technological Availability and Support; Both hospital types reported similar access to cutting-edge technology, but public hospitals had slightly higher positive responses (32%) compared to private ones (30%). The Chi-square statistic is significant at 1.70, with a P value of 0.005, indicating that access to technology is an important factor influencing MIT adoption.
Training and Education; Public hospitals reported strong hands-on training opportunities (31%) compared to private hospitals (32%), with significant statistical backing (P Value = .000) indicating the importance of training in adopting MITs. Patient demand for the introduction of MITs: public hospitals had quite good demand from patients concerning safety (41%) while private hospitals also demonstrated considerable interest-37. Chi-square: significant differences in patient demand factors affecting the introduction of MITs concern safety, recovery speed, and surgical precision.
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Table 4: Factors influencing the adoption and utilization of MITs
Factors
?2
P Value
Perceived Adoption
High Equipment Costs
Lack of Funding
Maintenance Costs
Public
713a
.000
Private
Technological Factors
Lack of Equipment
Outdated Infrastructure
Public
.041a
.005
Private
Training and Expertise Factors
Insufficient Training Programs
Resistance to Change
Long Learning Curve
Public
295a
.006
Private
Regulatory and Institutional Factors
Lack of Institutional Support
Regulatory Hurdles
Public
000a
.002
Private
Facilitators for MIT Adoption
Yes
No
Public
216a
.004
Private
Technological Availability and Support
Access to Cutting-Edge Technology
Supplier Partnerships
Public
70a
.005
Private
Training and Education
Hands-On Training Opportunities
International Exposure
Public
33a
.000
Private
Institutional and Financial Support
Hospital Leadership Support
Government or Private Funding
Public
.443a
.003
Private
Patient Demand
Patient Awareness
Competitive Advantage
Public
.932a
.000
Private
MITs introduce
Patient safety
Recovery speed
Surgical precision
Public
849a
.005
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Private
Discussion:
This present study was elaborate on the current situation of minimally invasive techniques in neurological surgery in Pakistan, compare their efficacy with conventional surgical techniques, analyze attitudes toward MITs in public and private healthcare settings, and finally investigate those factors that influence the adoption and utilization of these advanced surgical techniques. The discussion now synthesizes findings from recent research into the importance of MITs for improving surgical outcomes and overcoming various challenges faced by neurosurgeons in Pakistan.
Because of the associated benefits-which include reduced surgical trauma, shorter recovery times, and lower complication rates-minimally invasive surgery has gained a lot of prominence lately in neurosurgery compared to traditional open surgeries.16 The need for research and training in subspecialties like spine and neurovascular surgery has also been in greater emphasis by the Pakistan Society of Neurosurgeons, particularly for minimally invasive approaches.11 More significantly, the global market of minimally invasive neurosurgery devices has also marked increasing records of growth, implying a tendency in the direction of these techniques through technological development and by the demands of patients for less invasive techniques.17 Statements from the Board indicate that such MITs are typically characterized by small wounds, minimal loss of blood, and faster recovery compared to craniotomies and other similar conventional procedures.18 For instance, it has been ascertained that the number of patients who have gone through endoscopic surgeries experiences far lesser post-operative pain and stays in the hospital for fewer days. The introduction of MITs brings immense value to the patients in countries like Pakistan where open surgeries are more common due to historic reasons and because surgeons are more confident with those.19 It was also demonstrated by the systematic review conducted by Dundar, Yurtsever20 that machine learning algorithms had the potential to optimize surgical planning in the case of brain tumors, thereby supporting the efficacy of MITs in enhancing precision throughout procedures. Neurosurgeons diagnose conditions and plan minimally invasive approaches with the use of enhanced imaging technologies such as MRI and CT scans.
The attitudes towards MITs among healthcare professionals are crucial for their adoption. In this study, a significant difference was observed between public and private hospitals regarding perceptions of MITs. Public hospital staff exhibited greater concerns about high
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equipment costs and lack of funding compared to their private counterparts (Table 4). This aligns with findings from previous studies indicating that financial constraints significantly hinder the adoption of advanced surgical techniques in resource-limited settings.17,11 Moreover, training and expertise play a pivotal role in shaping attitudes towards MITs. A lack of sufficient training programs was identified as a barrier in both public and private sectors. The need for comprehensive training initiatives that equip neurosurgeons with the necessary skills to perform MITs cannot be overstated.20 Resistance to change among established practitioners further complicates this transition. Therefore, targeted educational programs that emphasize the benefits and applications of MITs are essential for fostering a positive attitude among healthcare professionals.
Several factors influence the adoption and utilization of MITs in Pakistan. Access to cutting-edge technology is paramount. Public hospitals often face challenges related to outdated infrastructure and lack of equipment (Table 4). This disparity highlights the need for investment in modern surgical technologies to facilitate the transition to minimally invasive techniques. Institutional support is critical for implementing new surgical techniques. Public hospitals reported higher concerns regarding institutional support compared to private hospitals (Table 4). Regulatory hurdles can also impede progress; thus, advocacy for policy changes that promote innovation in surgical practices is vital. Increasing patient awareness regarding the benefits of MITs can drive their adoption. As patients become more informed about their treatment options, they are likely to prefer less invasive procedures that promise quicker recovery times and fewer complications (Board, 2023). Collaboration between neurosurgeons, neurologists, and other medical professionals can enhance research efforts aimed at improving MIT applications. As noted by Prof. Shahid Ayub from the Pakistan Society of Neurosurgeons, interdisciplinary collaboration can lead to innovative breakthroughs in treatment methodologies.
Conclusion:
The current landscape of minimally invasive techniques in neurological surgery in Pakistan reflects both opportunities and challenges. While there is a growing recognition of the benefits associated with MITs such as improved patient outcomes and reduced recovery times barriers such as high costs, inadequate training programs, and institutional resistance remain significant hurdles. To facilitate the successful adoption of these techniques across both public and private healthcare settings, it is imperative to address these challenges through targeted training initiatives, investment in technology, regulatory support, and
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increased collaboration among healthcare professionals. By fostering a culture that embraces innovation in surgical practices, Pakistan can enhance its neurosurgical capabilities and ultimately improve patient care outcomes.
References:
Hamam H. Revolutionizing Neurosurgery and Neurology: The transformative impact of artificial intelligence in healthcare. Computing and Artificial Intelligence. 2024;2(1). DOI: https://doi.org/10.59400/cai.v2i1.416
Schroeder HW, Sgouros S. Neuroendoscopy: history, endoscopes, and instrumentation. Child's Nervous System. 2023;39(10):2729-35. DOI: https://doi.org/10.1007/s00381-023-06090-0
Evanson J. Radiology of the Pituitary. Endotext [Internet]. 2023.
Kalani M, Anjankar A. Revolutionizing Neurology: The Role of Artificial Intelligence in Advancing Diagnosis and Treatment. Cureus. 2024;16(6). DOI: https://doi.org/10.7759/cureus.61706
Cè M, Irmici G, Foschini C, Danesini GM, Falsitta LV, Serio ML, et al. Artificial intelligence in brain tumor imaging: a step toward personalized medicine. Current Oncology. 2023;30(3):2673-701. DOI: https://doi.org/10.3390/curroncol30030203
Rowbottom H, Šmigoc T, Ravnik J, Flis V. Robot-assisted deep brain stimulation. Acta Medico-Biotechnica. 2024;17(1):11-7. DOI: https://doi.org/10.18690/actabiomed.263
Liu X, Liu F, Jin L, Wu J. Evolution of Neurosurgical Robots: Historical Progress and Future Direction. World Neurosurgery. 2024. DOI: https://doi.org/10.1016/j.wneu.2024.08.008
Sorger JM. How to objectively evaluate the impact of image-guided surgery technologies. European Journal of Nuclear Medicine and Molecular Imaging. 2024;51(10):2869-77. DOI: https://doi.org//10.1007/s00259-023-06504-w
Winter F, Krueger MT, Delev D, Theys T, Van Roost DM, Fountas K, et al. Current state of the art of traditional and minimal invasive epilepsy surgery approaches. Brain and Spine. 2024;4:102755. DOI: https://doi.org/10.3969/j.issn.1672?6731.2024.07.007
Khan T, Wahjoepramono E, Wahjoepramono P, Andrews R. Private healthcare initiatives in developing countries–building sustainable neurosurgery in Indonesia and Pakistan. Brain and Spine. 2023;3:101729. DOI: https://doi.org/10.1016/j.bas.2023.101729
Javed S, Asif MA, Yaqoob E, Mushahid Z, Arshad MM, Farooq M, Chaurasia B. Neurosurgical landscape in Pakistan: Past, present and future perspectives. Journal of Clinical Neuroscience. 2024;120:115-9. DOI: https://doi.org/10.1016/j.jocn.2024.01.005
Wireko AA, Ahluwalia A, Ali SH, Shah MH, Aderinto N, Banerjee S, et al. Insights into craniosynostosis management in low-and middle-income countries: A narrative review of outcomes, shortcomings and paediatric neurosurgery capacity. SAGE Open Medicine. 2024;12:20503121241226891. DOI: https://doi.org/10.1177/20503121241226891
Ahmad H. Knowledge, Implementation, And Perception of Enhanced Recovery After Surgery Amongst Surgeons in Pakistan. 2024. DOI: https://doi.org/cv43p3884
/ 15
Mushtaq N, Qureshi BM, Javed G, Sheikh NA, Bakhshi SK, Laghari AA, et al. Capacity building for pediatric neuro-oncology in Pakistan-a project by my child matters program of Foundation S. Frontiers in Oncology. 2024;14:1325167. DOI: https://doi.org/10.3389/fonc.2024.1325167
Mehmood Z, Khan SU, Khan B, Shah SM, Khan A, Ali H, et al. Management of Ischemic Stroke in a Tertiary Care Hospital in Khyber Pakhtunkhwa: Existing Status and Prospective Opportunities. Cureus. 2024;16(6). DOI: https://doi.org/10.7759/cureus.63094
Suraj E, Vignesh V, Soumith S. Endoscopic Neurosurgery in the 21st Century: A Comprehensive Review of Challenges and Prospects. Asian Journal of Research and Reports in Neurology. 2024;7(1):34-41. DOI: https://doi.org/10.1016/j.wneu.2022.07.036
Mualem W, Durrani S, Lakomkin N, Van Gompel J, Quiñones-Hinojosa A, Bydon M. Utilizing data from wearable technologies in the era of telemedicine to assess patient function and outcomes in neurosurgery: systematic review and time-trend analysis of the literature. World neurosurgery. 2022;166:90-119. DOI: https://doi.org//4121/1/Ethiraj712024AJORRIN112958
Board CIT. Industry Insights. 2023.
Qazi SH, Meerza SSA, Groen RS, Dogar SA, Mirani M, Jamali MK, et al. Assessment of pediatric surgical needs, health-seeking behaviors, and health systems in a rural district of Pakistan. PLOS Global Public Health. 2022;2(12):e0000810. DOI: https://doi.org//16460/6/21-25.pdf
Dundar TT, Yurtsever I, Pehlivanoglu MK, Yildiz U, Eker A, Demir MA, et al. Machine learning-based surgical planning for neurosurgery: artificial intelligent approaches to the cranium. Frontiers in Surgery. 2022;9:863633. DOI: https://doi.org/10.1371/journal.pgph.0000810
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Copyright (c) 2025 Saud Ahmed, Muhammad Naeem Ur Rehman, Hafiz Muhammad Junaid, Hassaan Sharif, Muhammad Adeel Rauf, Kashif JavedThe work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
