INTRODUCTION
Gasless laparoscopic surgery is an innovation with great potential. Although the innovation of laparoscopic or minimally invasive surgery almost as significant as that of discovery of anesthesia or antisepsis for surgery it has poor market penetration. The reason for this are the high costs, the logistics associated with provision of bottled gases and experiences anesthesiologists in rural areas. Gasless laparoscopic surgeries mitigates the problems associated with traditional laparoscopic surgeries and hence has a great potential.
THE POTENTIAL MARKET
Lancet commission on global surgery estimates that 5,000 surgeries are needed per 100,000 populations every year. Roughly about a fourth of this could be treated laparoscopically which is about 1,200 surgeries per 100,000 per year [1]. However, the actual number of surgeries that are carried out could be even less than 300 per 100,000 per year [2, 3]
It is estimated that only 7.5 million to 15 million laparoscopic surgeries are carried out annually whereas if all eligible surgeries are carried out laparoscopically it should be about 125 million [3,4]. As one would expect most of these surgeries would be in the well-developed Western World and Japan [66%].
THE LIMITATIONS OF GASLESS SURGERIES
Would gasless surgeries be possible for all the eligible 125 million every year? It has limitations. It is difficult in obese patients, almost impossible if the abdominal wall thickness is more than 2 inches and difficult if over 1.5 inches. It is very good for pelvic surgeries and would be difficult for complex upper abdominal surgeries. However in rural areas since the bulk of surgical procedures are in the lower abdomen it has great potential.
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