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An Accessible Laparoscope for Surgery in Low- and Middle- Income Countries

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Abstract

Laparoscopic surgery is the standard of care in high-income countries for many procedures in the chest and abdomen. It avoids large incisions by using a tiny camera and fine instruments manipulated through keyhole incisions, but it is generally unavailable in low- and middle-income countries (LMICs) due to the high cost of installment, lack of qualified maintenance personnel, unreliable electricity, and shortage of consumable items. Patients in LMICs would benefit from laparoscopic surgery, as advantages include decreased pain, improved recovery time, fewer wound infections, and shorter hospital stays. To address this need, we developed an accessible laparoscopic system, called the ReadyView laparoscope for use in LMICs. The device includes an integrated camera and LED light source that can be displayed on any monitor. The ReadyView laparoscope was evaluated with standard optical imaging targets to determine its performance against a state-of-the-art commercial laparoscope. The ReadyView laparoscope has a comparable resolving power, lens distortion, field of view, depth of field, and color reproduction accuracy to a commercially available endoscope, particularly at shorter, commonly-used working distances (3-5 cm). Additionally, the ReadyView has a cooler temperature profile, decreasing the risk for tissue injury and operating room fires. The ReadyView features a waterproof design, enabling sterilization by submersion, as commonly performed in LMICs. A custom desktop software was developed to view the video on a laptop computer with a frame rate greater than 30 frames per second and to white balance the image, which is critical for clinical use. The ReadyView laparoscope is capable of providing the image quality and overall performance needed for laparoscopic surgery. This portable low-cost system is well suited to increase access to laparoscopic surgery in LMICs.

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References

  1. Aoki, H., H. Yamashita, T. Mori, T. Fukuyo, and T. Chiba. Ultrahigh sensitivity endoscopic camera using a new CMOS image sensor: providing with clear images under low illumination in addition to fluorescent images. Surg. Endosc. 28:3240–3248, 2014.

    Article  Google Scholar 

  2. Baiu, I., and B. C. Visser. Minimally invasive small bowel cancer surgery. Surg. Oncol. Clin. N. Am. 28:273–283, 2019.

    Article  Google Scholar 

  3. Bhangu, A., et al. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect. Dis. 18:516–525, 2018.

    Article  Google Scholar 

  4. Bharathi, R. S., V. Sharma, A. Chakladar, and P. Kumari. Performing laparoscopic cholecystectomy using diagnostic laparoscope: our Adaptations. Med. J. Armed Forces India 67:64–66, 2011.

    Article  CAS  Google Scholar 

  5. Brooks, D. C. Current Review of Minimally Invasive Surgery. New York: Springer, pp. 54–56, 1998.

    Book  Google Scholar 

  6. Cappell, M. S. Injury to endoscopic personnel from tripping over exposed cords, wires, and tubing in the endoscopy suite: a preventable cause of potentially severe workplace injury. Dig. Dis. Sci. 55:947–951, 2010.

    Article  Google Scholar 

  7. Cassaro, S. Delayed manifestations of laparoscopic bowel injury. Am. Surg. 81:478–482, 2015.

    Article  Google Scholar 

  8. Committee, N. T. S. Report and Reports of Panel No. 11, 11-A, 12-19, with Some supplementary references cited in the Reports, and the Petition for adoption of transmission standards for color television before the Federal Communications Commission. (1953).

  9. Cotton, P. B. Advanced Digestive Endoscopy: Practice and Safety. Hoboken: Blackwell, 2009.

    Google Scholar 

  10. Drake, T. M., et al. Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study. Surg. Endosc. 32:3450–3466, 2018.

    Article  Google Scholar 

  11. Duchemann, B., and L. Zelek. Cancer treatment. Surgery, radiotherapy, medical treatments (chemotherapy, targeted therapies, immunotherapy). Multidisciplinary therapeutic decision and patient information. Rev. Prat. 67:e499–e509, 2017.

    PubMed  Google Scholar 

  12. Farquharson, D. V., P. Jaramillo, and C. Samaras. Sustainability implications of electricity outages in sub-Saharan Africa. Nat. Sustain. 1:589–597, 2018.

    Article  Google Scholar 

  13. Fleischer, J. C., J. C. Diehl, L. S. G. L. Wauben, and J. Dankelman. The effect of chemical cleaning on mechanical properties of Tthree-dimensional printed polylactic acid. J. Med. Device. 14:1–9, 2020.

    Article  Google Scholar 

  14. Fogg, D. Cleaning endoscopes; advance medication preparation; reusing irrigation setups; procedure masks; fire safety; reusing blades. AORN J. 78:839–844, 2003.

    Article  Google Scholar 

  15. Gheza, F., F. O. Oginni, S. Crivellaro, M. A. Masrur, and A. O. Adisa. Affordable laparoscopic camera system (ALCS) designed for low- and middle-income countries: a feasibility study. World J. Surg. 42:3501–3507, 2018.

    Article  Google Scholar 

  16. Groen, R. S., V. M. Sriram, T. B. Kamara, A. L. Kushner, and L. Blok. Individual and community perceptions of surgical care in sierra leone. Trop. Med. Int. Heal. 19:107–116, 2014.

    Article  Google Scholar 

  17. Higgins, R. M., M. J. Frelich, M. E. Bosler, and J. C. Gould. Cost analysis of robotic versus laparoscopic general surgery procedures. Surg. Endosc. 31:185–192, 2017.

    Article  Google Scholar 

  18. Hugo, W. B. A brief history of heat and chemical preservation and disinfection. J. Appl. Bacteriol. 71:9–18, 1991.

    Article  CAS  Google Scholar 

  19. International Electrotechnical Commission. Medical electrical equipment-Part 1: General requirements for basic safety and essential performance. (2012).

  20. Janhofer, D. E., C. Lakhiani, and D. H. Song. Addressing surgeon fatigue: current understanding and strategies for mitigation. Plast. Reconstr. Surg. 144:693e–699e, 2019.

    Article  CAS  Google Scholar 

  21. Jawale, S., and G. Jesudian. Low-cost laparoscopy for rural areas: the flexible video laparoscope. Trop. Doct. 49:68–70, 2019.

    Article  Google Scholar 

  22. Storz, K. Innovative by Technology. (2018).

  23. Koren, N. The Imatest program: comparing cameras with different amounts of sharpening. In Digital Photography II (eds. Sampat, N., DiCarlo, J. M. & Martin, R. A.) 6069, 60690L (SPIE, 2006).

  24. Lam, C. T., et al. Design of a novel low cost point of care tampon (POCkeT) colposcope for use in resource limited settings. PLoS ONE 10:1–22, 2015.

    CAS  Google Scholar 

  25. Lam, C. T., et al. An integrated strategy for improving contrast, durability, and portability of a Pocket Colposcope for cervical cancer screening and diagnosis. PLoS ONE 13:1–20, 2018.

    Google Scholar 

  26. Li, W., M. Soto-Thompson, and U. Gustafsson. A new image calibration system in digital colposcopy. Opt. Express 14:12887, 2006.

    Article  Google Scholar 

  27. Lombardo, S., et al. Cost and outcomes of open versus laparoscopic cholecystectomy in Mongolia. J. Surg. Res. 229:186–191, 2018.

    Article  Google Scholar 

  28. Meyer, M.-P., and P. Read. Restoration of Motion Picture Film - Paul Read. Oxford: Mark-Paul Meyer. Butterworth Heinemann, 2000.

    Google Scholar 

  29. Murray, A., et al. Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews. Health Technol. Assess. 2006(10):1–144, 2006.

    Google Scholar 

  30. Muzira, A., et al. The socioeconomic impact of a pediatric ostomy in Uganda: a pilot study. Pediatr. Surg. Int. 34:457–466, 2018.

    Article  Google Scholar 

  31. O’Hara, N. N., K. R. Patel, A. Caldwell, S. Shone, and E. A. Bryce. Sterile reprocessing of surgical instruments in low- and middle-income countries: a multicenter pilot study. Am. J. Infect. Control 43:1197–1200, 2015.

    Article  Google Scholar 

  32. Oosting, R. M., L. S. G. L. Wauben, R. S. Groen, and J. Dankelman. Equipment for essential surgical care in 9 countries across Africa: availability, barriers and need for novel design. Health Technol. (Berl) 9:269–275, 2019.

    Article  Google Scholar 

  33. Ramsay, C., et al. Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol. Assess. 16:1–313, 2012.

    Article  CAS  Google Scholar 

  34. Roumm, A. R., L. Pizzi, N. I. Goldfarb, and H. Cohn. Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures. Surg. Innov. 12:261–287, 2005.

    Article  Google Scholar 

  35. Schwartz, M., C. J. Jeng, and L. T. Chuang. Laparoscopic surgery for gynecologic cancer in low- and middle-income countries (LMICs): an area of need. Gynecol. Oncol. Reports 20:100–102, 2017.

    Article  Google Scholar 

  36. Sood, H. S., M. Arya, H. Maple, P. Grange, and A. Haq. Robotic telemanipulating surgical systems for laparoscopy: the story so far in the UK. Expert Rev. Med. Devices 7:745–752, 2010.

    Article  Google Scholar 

  37. Trouiller, P., et al. Drug development for neglected diseases: a deficient market and a public-health policy failure. Lancet 359:2188–2194, 2002.

    Article  Google Scholar 

  38. Wang, Q., Desai, V. N., Ngo, Y. Z., Cheng, W.-C. & Pfefer, J. Towards standardized assessment of endoscope optical performance: geometric distortion. 2013 Int. Conf. Opt. Instruments Technol. Opt. Syst. Mod. Optoelectron. Instruments 9042, 904205 (2013).

  39. Yavuz, Y., J. G. Skogås, M. G. Güllüoglu, T. Lango, and R. Marvik. Are cold light sources really cold? Surg. Laparosc. Endosc. Percutaneous Tech. 16:370–376, 2006.

    Article  Google Scholar 

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Acknowledgements

This work was supported by a Bass Connections grant at Duke University and a Duke/Duke-NUS pilot project grant. JLM and NM work with the Calla Health Foundation.

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Authors and Affiliations

  1. Clark School of Engineering, University of Maryland, College Park, MA, USA

    Jenna L. Mueller

  2. Pratt School of Engineering, Duke University, Durham, NC, USA

    Natalie Rozman, Enakshi D. Sunassee, Aryaman Gupta, Cayla Schuval, Arushi Biswas, Shreyas Kulkarni & Nimmi Ramanujam

  3. Trinity School of Arts and Sciences, Duke University, Durham, NC, USA

    Bailey Knight & Meredith Brown

  4. Duke Global Health Institute, Durham, NC, USA

    Nimmi Ramanujam & Tamara N. Fitzgerald

  5. School of Medicine, Duke University, Durham, NC, USA

    Tamara N. Fitzgerald

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  1. Jenna L. Mueller
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  2. Natalie Rozman
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  3. Enakshi D. Sunassee
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  4. Aryaman Gupta
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Contributions

NR and JLM performed device development and testing, and drafting of the manuscript. EDS, CS, AB, BK, AG, SK, and MB all assisted in device development and testing. JLM, NR, and TNF created the project, obtained project funding and drafted the manuscript.

Corresponding author

Correspondence to Tamara N. Fitzgerald.

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Disclosures

JLM, AG and TNF have a patents pending related to this work. NR, EDS, CS, AB, BK, SK, and MB have nothing to disclose.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Mueller, J.L., Rozman, N., Sunassee, E.D. et al. An Accessible Laparoscope for Surgery in Low- and Middle- Income Countries. Ann Biomed Eng 49, 1657–1669 (2021). https://doi.org/10.1007/s10439-020-02707-6

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  • DOI: https://doi.org/10.1007/s10439-020-02707-6

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