Instruments for Gasless Single-Incision Lift Laparoscopic Surgery: Making Laparoscopic Surgery Available to the Poor

The advent of laparoscopic surgery using small cameras in the late 1980s revolutionized general surgery, allowing operations to be viewed by more than just the operating surgeon. The new technology further improved with higher-quality miniature cameras, monitors, three-dimensional scopes, and increasing use of disposable equipment. An even further revolution came with the advent of robotic surgery developed by the US military and now widely practiced around the globe (1). Yet in 2014, the benefits of laparoscopic surgery are not available to 80% of the world’s population, many of which cannot afford the technology needed for even a standard laparoscopic cholecystectomy. Costs incurred by the need for general anesthesia, insufflation of CO2, and specialised instruments make traditional laparoscopic surgery too expensive in many poorer areas of the world. Even further beyond the reach of most patients is the cost of disposable instrumentation, let alone the multi-million dollar cost of a robot. As if the cost isn’t enough of a challenge, in many remote areas, one has to travel over 350 kilometers just to refill a carbon dioxide cylinder, and spare parts for equipment are virtually unobtainable.

In this context, we have developed a relatively inexpensive gasless laparoscopy that may be undertaken with spinal anesthesia and by using modified reusable open surgical instruments through flexible gel ports. This technique has allowed us to bring the benefits of laparoscopic surgery to rural areas, where conventional laparoscopy is neither feasible nor affordable. The benefits of minimally invasive surgery are particularly important in the lives of those in poor rural areas because the absence of any family member in these areas may be the difference between providing food or starving.

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