Sustainable Implementation of Laparoscopy in Low-income Countries (2021-2022)

Background

Laparoscopic surgery is the standard of care for many surgical diseases in high-income countries but is unavailable in most low- and middle-income countries (LMICs) because of prohibitive costs. As a result, many patients undergo impoverishing health expenditure and lost wages recovering from surgery. 

Laparoscopic surgery renders smaller incisions and shorter stays in the hospital, minimizing postsurgical infections, pain and wound infections. Smaller incisions also prevent certain patients from experiencing stigmatization, which can occur with certain surgical conditions in some cultures. Patients in LMICs with appendicitis, gallbladder disease, intestinal problems, various cancers and reproductive problems would benefit from laparoscopic surgery.

Project Description

This is a continuing Bass Connections project that aims to increase access to laparoscopic surgery by developing a low-cost and reusable laparoscope suitable for use in low- and middle-income countries. In 2021-2022, the team will introduce an improved ReadySuite in a sustainable manner into sub-Saharan Africa. The ReadySuite is a comprehensive set of prototypes to enable laparoscopic surgery in LMICs. The current ReadySuite includes the following features:

  • ReadyView Laparoscope (a maintenance-free laparoscope)
  • ReadyMentoring (laptop used to display laparoscopic images; allows surgeons in different locations to interact audibly and visually during surgery, enabling information exchange and remote mentoring)
  • ReadyLift Retractor (laparoscopic retractor that eliminates need for carbon dioxide, pressure regulation and continuous electricity). 

Working with surgical and biomedical engineering colleagues in Uganda, team members will collaborate with international stakeholders, surgeons and engineers toward three aims:

  1. Ongoing innovation: The team will make improvements to the ReadyView Laparoscope.
  2. Development of manufacturing process instructions (MPI): Team members from Duke and Makerere University will develop an MPI that enables the laparoscopic technology to be constructed locally in sub-Saharan Africa. 
  3. Analysis of baseline laparoscopic data: The team will analyze data collected from laparoscopic surgeons in the U.S., Uganda, Singapore, Papua New Guinea and Myanmar about the types of laparoscopic cases they are performing and the problems that they have with current laparoscopes.

Learn more about this project team by viewing the team's video.

Anticipated Outputs

Refined ReadyLift and ReadyView prototypes; downloadable software package for ReadyView laparoscope; manufacturing process instructions; three peer-reviewed publications

Student Opportunities

Ideally, this project team will consist of 3 graduate students and 8 undergraduate students. Students from the fields of global health, engineering, health research, biostatistics and premedical studies are encouraged to apply. Students will have the opportunity to engage with 2-3 students from Makerere University in Uganda (MUK).

All students will participate in designing a product to transform surgical care in Africa and will have an opportunity to increase their experience and education in global health and develop practical engineering skills. Team members will have authorship on publications and research presented at national meetings.

Unique opportunities for graduate students include developing leadership skills in managing a subteam and writing a peer-reviewed journal article. Subteams will include:

  1. Innovation: 5 engineering students (1 Duke graduate student, 4 Duke undergraduate students) will continue with prototype improvement and testing
  2. Manufacturing: 2 Duke undergraduate students and 2-3 MKU Students will work in Shipping Container MakerSpaces at Duke and MKU to develop an MPI that will work in Uganda
  3. Clinical Analysis: 1 graduate student and 2 undergraduate students will be responsible for analyzing data in clinical database to design clinical trial and prepare IRB approval documentation

The whole team will meet weekly as an independent study. This interactive meeting will include teaching by project leaders, presentations by students on their progress, questions and feedback between team members and interpersonal connection. In the absence of COVID-19, the team will meet for team dinners. 

Selected students will have the opportunity to travel to Uganda. 

Erika Chelales will serve as project manager.

Timing

Summer 2021 – Summer 2022

  • Summer 2021 (optional): Continuing 2020-2021 project team members work toward 2021-2022 aims
  • Fall 2021: Incorporate 30-degree viewing technology, image quality and usability testing; create prototypes; complete first draft of MPI; analyze baseline data; prepare manuscript for publication
  • Spring 2022: Integrate 30-degree viewing into MPI; prepare manuscript; build prototypes and finalize MPI; write; design clinical trial from baseline data; submit IRB
  • Summer 2022 (optional): Fieldwork trip to Uganda; formalize manufacturing process; investigate industry partnerships

Crediting

Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Increasing Access to Laparoscopic Surgery in Low-income Countries (2020-2021).

 

Image: Team members with Dr. Ibingira and Dr. Ssekitoleko at Makerere, courtesy of 2018-2019 project team

Team members with Dr. Ibingira and Dr. Ssekitoleko at Makerere, courtesy of 2018-2019 project team.

Team Leaders

  • Erika Chelales, Pratt School of Engineering-Biomedical Engineering
  • Tamara Fitzgerald, School of Medicine-Surgery: Pediatric General Surgery
  • Jenna Mueller, University of Maryland
  • Ann Saterbak, Pratt School of Engineering-Biomedical Engineering

/yfaculty/staff Team Members

  • Sarah Dunn Phillips, Margolis Center for Health Policy

/zcommunity Team Members

  • Amos Loh, Duke-NUS, Singapore
  • Julius Mugaba, Makerere University
  • John Sekabira, Mulago Hospital, Uganda
  • Khushboo Shah, Kenan Institute for Ethics
  • Robert Ssekitoleko, Makerere University-Kampala