Low-cost Laparoscopic Surgery with Tele-mentoring (2018-2019)
For much of the 20th century, surgeons advanced the techniques of traditional open surgery. In the 1980s, the field of surgery advanced further with the development of laparoscopy. This technology allowed surgeons to make two to four small incisions and operate with an intra-abdominal camera and instruments. Benefits of laparoscopic surgery compared to open surgery include decreases in pain, recovery time, intra-abdominal scar tissue, wound infections, abdominal scar size, wound breakdown and length of hospital stay. It is routinely performed in high-income countries.
However, laparoscopic surgery is expensive and demands a great amount of infrastructure to maintain the equipment. These costs are prohibitive to low- and middle-income countries, and therefore most surgeries in these countries are performed with the traditional, open approach.
This Bass Connections project’s goal is to develop a low-cost, reusable laparoscope appropriate for use in a low-income country. Its design will allow images to be transferred over the internet, enabling surgeons in high- and low-income countries to interact in real-time during surgical cases, thus allowing for remote mentoring or “tele-mentoring”.
The laparoscope should cost less than $1,000 (in comparison to the current $216,000), be reusable, amenable to sterilization and not require maintenance. It will connect to a standard laptop computer or tablet by a USB cable, such that the surgical team can view this screen while performing surgery. The laptop or tablet, which has an integrated battery, will provide the required source of power for the laparoscope; this will prevent loss of function during power-outages that are common in sub-Saharan African hospitals. The components of the laparoscope will be designed to fit into standard trocar ports currently used in laparoscopic surgery with a maximal outer diameter of 5 mm.
The laptop or tablet used to display the laparoscopic images will be connected to the internet through wi-fi or cellular GSM signals. Numerous mobile phone companies exist in Africa, and it is affordable to purchase cellular modem devices made for laptop computers. Methods and workflows that enable intra-operative images to be transferred securely over the internet will be developed. This will protect patient privacy and allow surgeons to interact audibly and visually during a surgical case, enabling information exchange and remote mentoring.
The project is divided into four components: laparoscopic design and safety; considerations in global surgery; low-cost laparoscope design and testing; and implementation of tele-mentoring.
Prototype for low-cost laparoscope, leading to industry support for production and delivery in low- and middle-income countries; potential to be included on peer-reviewed publications
Fall 2018 – Summer 2019
- Fall 2018: Project meetings held once per week: discussion of relevant journal articles, previous work in this area and team-based learning. Meetings will transition to project development as the year progresses: needs assessment, design specifications, engineering design matrix (concept selection), ergonomic nonfunctional mockup assessment by Duke and Uganda surgeons. Rapid prototyping of two designs: one-third of team working on laparoscope casing and final assembly, one-third of team working on optoelectronic design (circuits design), one-third of team working on graphical user interface software development including telemedicine
- Spring 2019: Continued work on rapid prototyping
- Summer 2019: Implementation of tele-mentoring: a subset of the team will travel to Uganda
Team Outcomes to Date
Low-Cost Laparoscopic Surgery with Tele-Mentoring (poster by Selena J. An, Erin Brown, Aryaman Gupta, Bailey Knight, Shreyas Kulkarni, Junyu Liang, Claire North, Apoorva Ramamurthy, Natalie Rozman, Chris Lam, Jenna Mueller, Tamara Fitzgerald, presented at Bass Connections Showcase, Duke University, April 17, 2019)
Novel Technique for Gas-Independent Laparoscopic Procedures in LMICs (poster by Aryaman Gupta, Erin Brown, Apoorva Ramamurthy, Selena An, Bailey Knight, Natalie Rozman, Claire North, Shreyas Kulkarni, Junyu Liang, Chris Lam, Jenna Mueller, Tamara Fitzgerald, presented at Bass Connections Showcase, Duke University, April 17, 2019)
This Team in the News
See related team, Sustainable Laparoscopic Surgery for Low-Income Countries: FDA Approval and Business Model for Access (2019-2020).
- Tamara Fitzgerald, School of Medicine-Surgery: Pediatric General Surgery
- Jenna Mueller, Pratt School of Engineering-Biomedical Engineering
/graduate Team Members
Jingjing An, Medicine MD Fourth Year
Christopher Lam, Global Health - MS, Biomedical Engineering-PHD
Apoorva Ramamurthy, Biomedical Engineering-MS
Natalie Rozman, Electrical/Computer Engg-PHD
/undergraduate Team Members
Erin Brown, Biomedical Engineering (BSE)
Aryaman Gupta, Biomedical Engineering (BSE)
Bailey Knight, Biology (BS), Global Health (AB2)
Shreyas Kulkarni, Computer Science (BS)
Junyu Liang, Electrical & Computer Egr(BSE), Computer Science (BSE2)
Claire North, Electrical & Computer Egr(BSE)
/zcommunity Team Members
Julius Mugaba, Makerere University in Kampala
John Sekabira, Mulago Hospital, Uganda
Julia Ssekabunga, Department of Neurosurgery, Mulago Hospital, Uganda