INTRODUCTION: Minimally invasive gynecologic surgery (MIGS) reduces perioperative complications, shortens hospital stays, and improves patient recovery compared to laparotomy. However, its application in low- and middle-income countries (LMICs) remains limited, contributing to disparities in surgical outcomes. While barriers such as limited training and infrastructure are key factors, adoption of MIGS in LMICs depends on patient knowledge of MIGS and acceptance. Understanding patient perspectives is essential to determine the value and feasibility of MIGS adoption. OBJECTIVE: To assess patient knowledge, attitudes, and concerns regarding MIGS at Korle Bu Teaching Hospital in Accra, Ghana. METHODS: We conducted a qualitative study at Korle Bu Teaching Hospital, the largest referral teaching hospital in Ghana. Eligible participants were those 18 years of age or older; speaking Twi, Ga, or English; and those who had undergone surgery performed by a gynecologist at Korle Bu Teaching Hospital for benign indications from January to June 2025. Exclusion criteria were pregnant patients, those with stage ≥3 endometriosis, uterine size ≥20 weeks, ovarian cysts ≥20 cm, FIGO grade >3 myomectomy, and prolapse repair aside from hysterectomy. Patients with these conditions were excluded as surgeries for these conditions typically require additional surgical training for the clinician. After informed consent, we conducted semi-structured interviews with eligible patients postoperatively. Informed by the Theoretical Framework of Acceptability, interviews explored patients’ awareness of MIGS, concerns, and perceptions regarding surgical options. Recruitment continued until saturation given limited surgical access. Interviews were audio-recorded, translated, and back-translated from Twi or Ga to English, where applicable, then transcribed verbatim, and imported into Dedoose. Individually, two research team members read each transcript to identify codes, then developed a codebook with a third research member. Two research team members coded each transcript, with coding differences discussed with a third researcher to ensure intercoder reliability. We thematically analyzed codes using Thematic Networks to understand patient knowledge, concerns, and attitudes regarding MIGS. RESULTS: Twenty-four patients participated in our study. Participants expressed positive perceptions of MIGS, specifically appreciation of faster recovery and earlier return to work compared to open surgery. Negative perceptions included concerns regarding postoperative pain and surgical complications. Regarding surgical decision making, fear and anxiety were prominent emotions, with 42 coded references, alongside an equal number highlighting reliance on family and/or social circles’ advice. Overall, participants indicated that if financial burden were not a factor, they would preferentially select MIGS over laparotomy. CONCLUSIONS: Participants expressed interest in minimally invasive gynecologic surgery, with financial burden being the highest barrier. These findings emphasize the importance of implementing patient-centered communication and directly addressing patient concerns during counseling and MIGS procedures. Additionally, evaluating insurance options and hospital resources to alleviate financial concerns is important. Recognizing patients as essential stakeholders in MIGS can encourage communication between surgeons and patients, enhancing both surgeon readiness and patient acceptance. Ultimately, this can improve equity in the access to and outcomes of gynecologic surgery.
Das et al. (Fri,) studied this question.