Gasless Laparoscopic Surgeries Making MIS Affordable and Available: The Medicall Innovations Awards Presentation


Medicall is an international Hospital needs expo that is conducted annually to display a variety of new and innovative medical products and equipment. This year it was held at Chennai. The exhibition had over 700 stalls from all over the World displaying their equipment and devices. They arrange an annual innovation award for which there are many applications. This was the 16th Expo and the sixth year they were inviting the innovations and there were more than 250 innovations. The eminent juries choose few of the top innovations for final presentations at the Expo. The Gasless laparoscopic surgical equipment was chosen for final presentation at Chennai on July 22, 2016.

The following are some of the excerpts from the presentation.


0716-791 pic 1All over the World the trend in surgery is towards minimally invasive surgeries. Transparency Medical Research estimates that the current 10.5% reach is expected to double by 2019. However the very high costs, the steep learning curve, expensive equipment and most importantly the need for general anesthesia and gases has made minimally invasive surgeries like laparoscopic surgeries out of reach for the poor and the rural patients and the rural health care facilities.


0716-791 pic 2Fortunately there is a solution to the above problems. It is the gasless laparoscopic surgeries that are possible under spinal anesthesia, with the traditional open surgical instruments. Spinal anesthesia is less expensive and possible at many operating rooms where general anesthesia is not available. The uses of traditional surgical instruments make learning easier.

The logistical nightmare of providing bottled gases in remote areas is also not available.


The impact of the innovation could be great as it opens up many rural surgical facilities for minimally invasive surgeries. The possibility of discharge of the patient in a few days makes surgeries possible in camp setting thus getting more rural patients operated in remote areas. The low-cost and sturdy nature of the equipment makes the surgeries affordable.


There are many unique features in the design of the equipment. The locking mechanisms are simple, easy to use and quick. One has to just hold the correct position and use two click locks to fix the apparatus. The ball and socket joint offers a wide range of movement and thus position options. The hand instruments have special design for single incision surgeries. The special connector gives the capability of fixing to any type of operating tables. The training program has a unique on-site training opportunity that is relevant and makes the doctors very happy.


The following Table gives the comparison and the advantages of gasless laparoscopic surgeries.

0716-791 table 1


The potential market is very large as the estimates show that less than 2.6% of the operating rooms at present have laparoscopic surgical facilities. The actual figure might be much lower as data from the rural areas are not easily available. The surgeons in rural areas are the main beneficiaries of this technique. It is a great value addition to their surgical repertoire.


Several workshops with live surgery demonstrations have been arranged including workshops in two government medical colleges. Several papers about the equipment and surgical procedures were published in national and international journals and have been presented at various national and international conferences.

The innovation received the Antia–Finseth innovation award given by the Association of Rural Surgeons of India and was short listed among the top innovations from India by the Millennium Alliance.

0716-791 table 2

About 600 gasless surgeries were carried out by the SEESHA team and surgeons at five centers are performing these surgeries on their own. After several trials with a variety of prototypes the final commercial one for production was chosen.

0716-791 table 3


Several groups and organizations have come forward to work together to take the Minimally Invasive Surgeries forward. Significant among them are the following:

  1. WHO (World Health Organization)
  2. The Lancet commission on Global health the Indian section
  3. The International Federation of Rural Surgeons
  4. The Association of Rural Surgeons of India
  5. The Christian Medical Association of India
  6. The Association of Rural Practitioners of Nigeria
  7. The Global Association of Physicians of Indian Origin
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.
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