Gas Less Lift Laparoscopic Surgeries (GLLS): Our Initial Experience of 750 Surgeries in Remote Rural Areas in India

By Dr. Deepak David Chellappa and Dr. J. Gnanaraj | Published: Oct 2017 Volume: 6

BACKGROUND

Minimally invasive surgeries especially laparoscopic surgeries are difficult if not impossible in rural areas because of the high costs associated with the equipment and the difficulty in getting anesthesiologists with experience in managing pneumoperitoneum and its complications and the logistic nightmare of arranging gases for anesthesia and surgeries in rural areas and Government facilities. Most of the above problems are tackled by the GLLS [Gas Less Lift Laparoscopic Surgeries] as they are less expensive and could be performed under spinal anesthesia thus negating the need for gases.

[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()]

THE MATERIALS AND METHOD

The equipment consists of a portion that lifts the anterior abdominal wall and connects to the portion that is attached to the Operating Table. The special locking mechanisms help with quick positioning of the apparatus.

There is a mechanism to take the apparatus up or down as needed. The design of the apparatus is such that the exposure offered at the time of surgery is excellent and almost as good as traditional laparoscopic surgeries.

THE METHOD

The GLLS surgeries were performed by the visiting teams from Samiti for Environment, Education, Health and Social Action [SEESHA] at remote and rural hospitals in Tamil Nadu and Northeast India where the local surgeons wanted to learn the technique and collected patients for the monthly visits to their place.

Most of the surgeries were performed under spinal anesthesia at very remote and rural hospitals. The records were maintained by the visiting team in their Hospital Management software and the usual follow up was about a month later at most places.

FINDINGS

Table 1 gives the list of various surgical procedures that were carried out with the GLLS.

SILLS = Single Incision Lift Laparoscopic Surgery

The reason for very large number of surgeries for evaluation of infertility is that the primary surgeon at Mizoram is a gynecologist specializing in infertility care after special training at Bangalore for infertility. Earlier on many patients were not keen on either open or traditional laparoscopic diagnostic procedures for infertility. However with time, we began having more patients due to the patients opting for the diagnostic procedures which uses small single incisions at the umbilicus and the results of over 15% successful pregnancies.

The number of appendicectomies are also higher because many patients especially women came for elective surgeries after being referred from other places due to the cosmetic advantage of small single incision umbilical scars.

Ovarian cysts are one of the easier procedures to treat with the GLLS. Simple cysts are decompressed first and the vascular pedicle could be cut after using the vessel sealing equipment [both local made Ligasure and Harmonic shear] thus offering a quick and easy and cosmetic treatment for ovarian cysts.

The GLLS offers the most cosmetically attractive diagnostic laparoscopy. This is of special use in rural areas where diagnostic imaging equipment like CT scan, MRI and often even ultrasound examinations are not available. It is useful not just for diagnosis in acute abdomen but could be used for taking biopsies and for staging purposes in malignancies or assessing operability.

The GLLS is most useful for surgeries on the uterus. For surgeries like Myomectomies it is almost like open Myomectomies as the regular needle holders could be used for suturing and the uterine manipulator could be used to hold the uterus in a convenient position for suturing. Since a large scar of open surgery is not present more of Myomectomies were carried out with GLLS vs. open surgeries. GLLS, LAVH is another surgery that is convenient and easier with the GLLS method.

GLLS Cholecystectomies were not regularly carried out in Northeast India as the Gall Bladders there were adherent and difficult to remove due to repeated attacks and other factors. However, the surgeons at places like Maulana Azad Medical College and Midnapore Medical College could do it comfortably with the GLLS technique.

The advanced lower abdominal surgeries are possible and sometimes easier especially with thin patients when compared to regular laparoscopic surgeries. Suturing is easier with GLLS as compared to traditional laparoscopic surgeries.

DISCUSSION

GLLS is a technique that has the potential of demystifying laparoscopic surgeries and making them available in rural areas. The important reason for this is the ability to perform common laparoscopic surgeries under the easily available spinal anesthesia and do away with the logistics of providing bottled gases for both anesthesia and surgery.

The open surgical techniques could be used thus making learning easier and equipment more sturdy and user friendly. Patients are doing the procedures because they are less expensive, available near them and their minimally invasive.

Dr. Deepak David Chellappa and Dr. J. Gnanaraj, (2017), Gas Less Lift Laparoscopic Surgeries (GLLS): Our Initial Experience of 750 Surgeries in Remote Rural Areas in India, mdCurrent-India, Volume 6. Available online at: http://mdcurrent.in/surgery/gas-less-lift-laparoscopic-surgeries-glls-initial-experience-750-surgeries-remote-rural-areas-india/ This is a peer-reviewed article.

Dr. Deepak David Chellappa
gnanaraj Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

[/s2If]

Log in or register for free to continue reading
Register Now For Free Already Registered? Log In
This entry was posted in Primary Care, Primary Care Featured 2, Surgery and tagged , , . Volume: .

Post a Comment

You must be logged in to post a comment.