Low-cost Laparoscopic Surgery with Tele-mentoring (2018-2019)

Background

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.

Project Description

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.

Anticipated Outcomes

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

Student Opportunities

Students will have the opportunity to participate in designing a product that has the potential to change surgical care in Africa. Students  could potentially present this research project at national meetings or contribute to a peer-reviewed publication. Master’s students could use this opportunity to collect data toward a thesis project. A subset of students will have an opportunity to travel to Uganda, and learn first-hand how surgery is practiced in a low-income country.

The ideal team composition is 1-2 undergraduates, 1-2 medical students and 2 graduate students. Students with an interest in developing technology for global health applications and in global access to care are encouraged to apply. Disciplines that would be helpful include, but are not limited to, engineering, medicine, economics, business administration, law, public health or epidemiology.

Students will be evaluated by their level of participation in discussion sections and study design. They will all be expected to contribute to data analysis and preparation of a final report, and to prepare oral presentations on the progress of their work and well as a final presentation.

Timing

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

Crediting

Independent study credit available for fall and spring semesters; summer funding

Faculty/Staff Team Members

Tamara Fitzgerald, School of Medicine-Surgery: Pediatric General Surgery*
Jenna Mueller, Pratt School of Engineering-Biomedical Engineering*

Graduate Team Members

Christopher Lam, Biomedical Engineering-PHD

Community Team Members

John Sekabira, Mulago Hospital, Uganda

* denotes team leader

Status

Active, New