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

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

Reflections

John Boom

This Team in the News

Senior Spotlight: Reflections from the Class of 2022

Two Faculty Recognized for Exceptional Co-Leadership of Bass Connections Team

Cut Costs, Not Patients: The Promise of Laparoscopic Surgery in Global Health

Educational Innovation: Beyond Methods Into Experiences – Part 2: The GWHT Network

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–Biomedical Engineering–Ph.D. Student
  • Tamara Fitzgerald, School of Medicine-Surgery: Pediatric General Surgery
  • Jenna Mueller, University of Maryland
  • Ann Saterbak, Pratt School of Engineering-Biomedical Engineering

/graduate Team Members

  • Natalie Rozman, Electrical/Computer Engg-MS, Electrical/Computer Engg-PHD

/undergraduate Team Members

  • Vignesh Alagappan, Economics (BS)
  • Arushi Biswas, Biomedical Engineering (BSE), Global Health (AB2)
  • John Boom, Biomedical Engineering (BSE), Chemistry (AB2)
  • Yi Chen, Electrical & Computer Egr(BSE), Computer Science (BSE2)
  • Reed Chen, Biomedical Engineering (BSE)
  • Aarzu Gupta
  • Rebecca Hogewood, Biomedical Engineering (BSE)
  • Pierce Hollier, Neuroscience (BS)
  • Khue Huynh, Biomedical Engineering (BSE)
  • Aleksandra Koroza, Biomedical Engineering (BSE)
  • Tiffany Liu, Biology (BS)
  • Caroline Maloney, Biology (BS)
  • Jamila Otieno
  • Saajan Patel
  • Alan Tang
  • Ria Thimmaiahgari, Biomedical Engineering (BSE), Computer Science (BS2)
  • Matthew Wang, Biomedical Engineering (BSE)
  • Sophia Williams

/yfaculty/staff Team Members

  • Sarah Dunn Phillips, Margolis Center for Health Policy
  • Siddhesh Zadey, School of Medicine-Surgery

/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