Safe MIS in Rural Areas: An Experience with SEESHA

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

BACKGROUND

SEESHA is a charitable trust that organizes surgical camps in remote and rural areas of our country offering Minimally Invasive Surgeries to the poor and the marginalized [1, 2]. The first author had the privilege of joining some of the surgical camps in Northeast India. We describe some of the ideas that are used for making MIS safe in rural areas.

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  1. THE WHO SURGICAL SAFETY CHECK LIST AND PROTOCOLS: This helps with checking if all the available information is gathered before any surgical procedure [3]. Since the nursing staff keep changing pictures are available on how to set up the equipment that are necessary so that even if they do not know the names they can identify the necessary instruments.
  2. SURGERIES UNDER SPINAL ANESTHESIA: General anesthesia in addition to being more expensive is difficult because of unforeseen circumstances. For example one of the places ran out of nitrous oxide within 10 minutes and the place where refilling is available is about 300 kilometers away.
  3. GLLS [GAS LESS LIFT LAPAROSCOPIC SURGERIES]: This innovative equipment and technique allows common laparoscopic surgeries including surgeries like laparoscopic Cholecystectomies under spinal anesthesia [4, 5].
  4. ENDOSCOPIC RENAL SURGERIES WITH URS [URETERORENOSCOPE]: These make renal surgeries safe. Prior Double “J” [DJ] stenting makes the ureter dilate and allows the URS to the Kidneys. Mild inflammation allows the transitional epithelium to stick to the muscular layer preventing telescoping and since there is no incision in the Kidneys significant bleeding does not occur [6].
  5. THE OPEN TECHNIQUE OF ABDOMINAL TROCAR PLACEMENT: The small but significant injuries that are associated with trocar placement with traditional laparoscopic surgeries are not present [7].
  6. THE VAPORIZATION SURGERIES: The vaporization surgeries use a higher wattage and a smaller point of contact and thus vaporizing the tissues instead of cutting them during transurethral prostate surgeries [8]. The Uterine endometrium could be similarly vaporized.
  7. STUDIES AND SOFTWARE: The software that they use has facilities for sending SMS reminders for DJ stent removals and calling for repeat procedures. The unique Registration IDs help with quick referral to the patient’s records [9]. Several prospective studies are carried out improve the quality and safety of the surgical patients
  8. THE EQUIPMENT AND HUMAN RESOURCE SHARING: This makes more experienced persons available at the Operating rooms [10]

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.

References (click to show/hide)

  1. J. Gnanaraj, Lau Xe Xiang Jason, Hanah Khiangte. High quality surgical care at low cost: The Diagnostic camp model of Burrows Memorial Christian Hospital. Indian Journal of Surgery Vol. 69, No.6, December 2007 p 243-247
  2. Gnanaraj J. Diagnostic and surgical camps: Cost-effective way to address surgical needs of the poor and marginalized. mdCurrent-India Vo.3 January 2014
  3. Available from: http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf
  4. Available from: http://mdcurrent.in/primary-care/lift-laparoscopic-cholecystectomy-ideal-new-converts-laparoscopic-surgery/
  5. Michael Rhodes, Gnanaraj J. Laparoscopic surgery in low and middle income countries: gasless lift laparoscopic surgery. Surgical Endoscopy August 2015
  6. J Gnanaraj, Balaji Prasad Ellapan. Ureterorenoscopic removal renal stones: Cost effective patient friendly method in rural areas. Tropical Doctor April 2011, 41 page 102
  7. Available from: http://mdcurrent.in/courses/lift-laparoscopy-lesson-2/
  8. Gnanaraj J, Lionel Gnanaraj. Transurethral electrovaporisation of prostate. A boon to the rural surgeon. Aust N Z J Surg 2007 Aug; 77 (8) 708
  9. Available from: http://mdcurrent.in/technology-2/nabh-pre-accreditation-entry-level-standards-using-software-help/
  10. Available from: http://mdcurrent.in/practice-management/meeting-surgical-needs-rural-areas-supply-chain-concept/

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