Jonathan Jou. University of Illinois College of Medicine
Objective: Laparoscopic surgeries allow for shorter hospitalizations, earlier mobility, and decreased surgical site infections, advantages well-published in the literature and crucial in rural, agrarian communities. Surgeons practicing in low and middle-income countries (LMIC), where patients stand to benefit from these techniques the most, are often faced with difficult training decisions. Gaining exposure and mastery of current standards of surgical care, such as laparoscopy, requires a minimum six-month commitment away from areas in most need of medical care.
To address this issue, a low-cost, ready-to-assemble laparoscopic trainer was designed with readily available materials and shipped to a rural surgeon in Ethiopia as a pilot trial. This trainer is not intended to replace the laparoscopic surgery certification process. Instead, by increasing access to developing basic dexterity, it aims to decrease the learning curve and shorten the six-month training period. In conjunction with the widespread use of camera-equipped smartphones, ideally, anyone can assemble and begin training anywhere in the world. Ultimately, it attempts to demonstrate that surgical simulation need not be expensive; frugal solutions are often ones that can scale globally.
Description and Application: Triangulation of the surgical site, real-time haptic feedback, and 3D-to-2D video conversion were emphasized as essential design parameters. The dimensions of the unit and skills curriculum mimic the Fundamentals of Laparoscopic Surgery (FLS) training kit. The first prototype had a total assembly cost of $40 USD, created with universally available materials such as PVC piping, nuts, bolts, cheesecloth, and rubber pads. Financial analysis suggests that costs could be decreased to as low as $2 USD per kit.
This laparoscopic surgical simulation kit can be shipped in compact bundles assembled within minutes of unboxing without tools. Rubber pads increase reusability and can be combined with fruit flesh, such as mango or orange, to simulate undisrupted skin and muscle. This creates the opportunity to practice incision and trocar entry into the trainer abdomen. The cheesecloth, stretched taut by sutures, simulates the pneumoperitoneum required in standard laparoscopic procedures. The fine grade of the cloth also allows cavity visualization with any smartphone camera, projecting the contents of the trainer by placing the phone, camera down, on the cloth. The underlying theme and novelty is the adaptation of surgical simulation with materials and technology that would be appropriate for austere clinics around the world.
Conclusions and Future Directions: Currently, the prototype has been received by the surgeon in Ethiopia, who has been working through the FLS curriculum to develop comfort with laparoscopic movements. The need for standard-of-care surgical skills remains a burden to communities in LMICs who rely on labor-intensive livelihoods such as farming and animal husbandry. These communities stand to benefit most from laparoscopic operations, which simultaneously decrease the duration of hospital stay, mobility limitations, and surgical site infections in operations currently performed as open procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98724
Program Number: ETP761
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster