Evaluation of Surgeons' Perspectives and Perceived Readiness to Adopt Minimally Invasive Breast Surgery in a Low- and Middle-Income Setting.

Abstract

Minimally invasive breast surgery (MIBS), including endoscopic and robotic-assisted techniques, has demonstrated oncologic safety and favorable cosmetic outcomes in selected patients. However, adoption has been uneven globally, particularly in low- and middle-income countries (LMICs), where health-system constraints, training gaps, and resource limitations influence implementation. Understanding surgeons' perspectives and perceived readiness to adopt MIBS is critical for designing context-appropriate adoption pathways. We conducted a cross-sectional mixed-methods study among surgeons attending a national MIBS-focused breast surgery meeting in an LMIC. Participants completed an anonymized post-event survey. Outcomes were analyzed using the Kirkpatrick Levels 1-3 framework, assessing perceived relevance (reaction), self-reported understanding and confidence (learning), and intention to adopt or seek further training (behavior). Quantitative data were summarized descriptively, and qualitative responses underwent thematic content analysis. Seventy-seven of 114 eligible surgeons (67.5%) responded; Of which 81.8% were consultants. Prior hands-on MIBS experience was limited (19.5%). Post-meeting, 84.4% reported self-reported improvement in understanding of patient selection and 77.9% increased technical confidence. At the behavioral level, 59.7% expressed increased likelihood of considering MIBS, though an equal proportion preferred further structured training before independent practice. Key perceived barriers included lack of formal training pathways (89.6%), learning-curve concerns (85.7%), equipment costs (85.7%), and limited institutional support (59.7%). In this exploratory survey of selected cohort of surgeons attending a MIBS-focused academic symposium in an LMIC setting, respondents reported favorable perceptions of minimally invasive breast surgery, improved self-reported understanding, and interest in further structured training. However, these findings should be interpreted cautiously, as they reflect self-reported perceptions and intentions from an engaged group rather than objective evidence of technical readiness, clinical adoption, or broader system-level preparedness.