Making Minimally Invasive Surgeries Available and Affordable: A Proposal Presented to Millennium Alliance by SEESHA

The Lancet Commission on Global Health estimates the need for surgical procedures at 5,000 per 100,000 population. In rural areas, the data from the Government and other surveys shows that only about 200 surgeries are carried out per 100,000 population.

Minimally Invasive Surgeries can help meet this need because they are possible by visiting teams and the quick turnover means that more surgeries are possible with less number of beds.

However the high costs, expensive equipment and the need for bottled gases for anesthesia and surgeries and the need for experienced anesthesiologists makes MIS almost impossible in rural areas at present.

The following three innovations hope to change the current scenario. They are as follows:

1. Making MIS possible under the easily available and less expensive Spinal Anesthesia.
2. Surgical camps to offer surgical care in remote areas and training for local surgeons through innovative Online – Onsite training programs
3. Specific courses and credentialing after standardizing and upgrading the rural surgical facilities

What is the impact of the work that SEESHA is doing so far?

SEESHA has been working at four locations this year and the table below gives the change during the last few years at these locations. These locations have a combined population of about 40,000 and the surgeries carried out at these locations increased from 235 in 2015-16 to 628. This could translate to 1,500 to 3,000 surgeries per 100,000 population.

The following slide gives more information on the two innovations that made these surgeries possible under spinal anesthesia.

The delivery model is also innovative.

It is a model that could be scaled up and repeated every where.

The following are the proposed action plans for the project.

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.