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Surgical Innovation

Improving Access to Laparoscopic Surgery in Low- and Middle-Income Countries

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JAMA Surgery

Published Online: July 20, 2022

Surgical Innovation

Article Information and Disclosures

Siddhesh Zadey, BSMS, MScGH^1,2;

Jenna Mueller, PhD³;

Tamara N. Fitzgerald, MD, PhD^1,4

Author Affiliations

¹Department of Surgery, Duke University School of Medicine, Durham, North Carolina
²Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
³Department of Bioengineering, University of Maryland, College Park
⁴Duke Global Health Institute, Durham, North Carolina

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There is a strong desire by surgeons and patients in low- and middle-income countries (LMICs) to access laparoscopic surgery. However, access is hindered by high installation costs, fragile equipment maintenance, lack of stable electricity, and limited consumable items such as medical-grade carbon dioxide. Using the human-centered design approach,¹ our multidisciplinary team of surgeons, engineers, and global health researchers has developed a low-cost laparoscope (KeyScope) and lift retractor (KeyLoop), collectively referred to as KeySuite, designed for the challenges and needs of LMICs.

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Article Information

Corresponding Author: Siddhesh Zadey, BSMS, MScGH, Department of Surgery, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710 (siddhesh.zadey@duke.edu).

Published Online: July 20, 2022. doi:10.1001/jamasurg.2022.2675

Conflict of Interest Disclosures: Dr Mueller reported grants from the National Institutes of Health during the conduct of the study and personal fees from Calla Health Foundation outside the submitted work. Dr Fitzgerald reported grants from National Institutes of Health, Duke/Duke-NUS Pilot Project Grant, and Bass Connections at Duke University during the conduct of the study. Drs Fitzgerald and Mueller have PCT patent applications for the KeyScope and KeyLoop. No other disclosures were reported.

Funding/Support: This project has been funded by Bass Connections at Duke University, Duke/Duke-NUS Collaboration Pilot Project, and the National Institutes of Health (grant R21 CA249696-01A1).

Role of the Funder/Sponsor: The funders had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.

References

Design Kit. The Field Guide to Human-Centered Design. Accessed June 10, 2022. https://www.designkit.org/resources/1

Mueller JL , Rozman N , Sunassee ED , et al. An accessible laparoscope for surgery in low- and middle- income countries. Ann Biomed Eng. 2021;49(7):1657-1669. doi:10.1007/s10439-020-02707-6 PubMed Google Scholar Crossref

Gupta A , Brown E , Davis JT , et al. KeyLoop: mechanical retraction of the abdominal wall for gasless laparoscopy. Surg Innov. 2022;29(1):88-97. doi:10.1177/15533506211031084 PubMed Google Scholar Crossref

Xenocor. Accessed March 5, 2022. https://xenocor.com/

Chao TE , Mandigo M , Opoku-Anane J , Maine R . Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc. 2016;30(1):1-10. doi:10.1007/s00464-015-4201-2 PubMed Google Scholar Crossref

Alganabi M , Biouss G , Pierro A . Surgical site infection after open and laparoscopic surgery in children: a systematic review and meta-analysis. Pediatr Surg Int. 2021;37(8):973-981. doi:10.1007/s00383-021-04911-4 PubMed Google Scholar Crossref

Farrow NE , Commander SJ , Reed CR , et al. Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study. Surg Endosc. 2021;35(12):6539-6548. doi:10.1007/s00464-020-08151-w PubMed Google Scholar Crossref

Mishra A , Bains L , Jesudin G , et al. Evaluation of gasless laparoscopy as a tool for minimal access surgery in low-to middle-income countries: a phase II noninferiority randomized controlled study. J Am Coll Surg. 2020;231(5):511-519. doi:10.1016/j.jamcollsurg.2020.07.783 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.