A University of Michigan-led team carried out the analysis of data from 1.6 million hospital stays for four common operations: gall bladder removal, colon surgery, hernia repair and appendectomy [1]. Their conclusion was small rural hospitals may be safer, less expensive for common operations. Even in countries like USA there are less surgeons and rural areas and when it comes to the volume part of the volume/outcome equation, overall number of cases is rarely an issue for rural surgeons [2]. Apart from some peer review process and quality control there is hardly any research that is specific to rural areas [3, 4].
There is a great need for innovations to reduce the cost of surgical treatment and improve the safety of surgical treatment in rural areas [5]. Usually with advances in surgical research and treatment methods the costs go up significantly. For example, in a study in India the cost of hernia treatment went up almost 5 times as various methods of treatment were introduced [6]. It is common knowledge that laparoscopic surgeries were more expensive than open surgeries and further advances like Single Incision Laparoscopic Surgeries and Robotic surgeries made them even more expensive. A study of cost per minute of Operating Room time in USA showed that over a decade the costs doubled and for laparoscopic surgeries increased tenfold in some instances. [7]
Hence the need of the hour is Rural Surgery Specific Research that aims at reducing the costs of surgical treatment while improving the quality of the treatment. The Association of Rural Surgeons of India promoted the use of Prolene mosquito net instead of the commercial Prolene mesh used for hernia repair and this greatly reduced the cost of hernia surgery [8, 9] and operation hernia an International Organization started using it in African countries.
The Gas Insufflation Less Laparoscopic Surgeries [GILLS] made laparoscopic surgeries possible in remote and rural areas as there was no need for expensive equipment, there was no logistic nightmare related to providing gases for surgery and anaesthesia and laparoscopic surgeries were possible under the easily available and low cost Spinal Anaesthesia [10].
The Association of Rural Surgeons of India along with the help from NIHR – GHRG project of University of Leeds [11] developed a training program in GILLS certified by the Martin Luther Christian University at Shillong. So well over 1,000 GILLS surgeries have been performed in rural and remote areas and some Medical Colleges are involved in teaching the techniques.
The development of the Laptop Cystoscope helped the rural doctors to carry out diagnostic Cystoscopies and small procedures like “DJ stenting” in rural and remote areas with small investment for the Laptop Cystoscope.
Without the Laptop Cystoscope the investment required for such procedures would be twentyfold and hence only trained Urologists could afford it.
THE RURAL SURGERY RESEARCH AND TRAINING CENTRE
The Association of Rural Surgeons of India [12] and the International Federation of Rural Surgeons [13] started the Rural Surgery Research Training Centre [RS-RTC] at Shanthi Bhavan Medical Center at Biru for the following:
Evaluate, supervise, publish, and help in Rural Surgery research
Develop relevant courses for the rural surgeons and get them accredited by relevant Universities
Conduct rural surgery relevant research programs
Conduct the rural surgery relevant training programs
The RS – RTC is accredited to the Martin Luther Christian University at Shillong. [14]
THE LAPTOP CYSTOSCOPE AND RENAL STONE MANAGEMENT IN RURAL AREAS STUDY
VACUUM THERAPY STUDY FOR DIABETIC ULCERS
SURGICAL SITE INFECTION STUDY
WOUND HEALING STUDY USING VARIOUS LOCALLY AVAILABLE DRESSINGS LIKE HONEY, SUGAR, ETC.,
FUTURE PLANS
Invite proposals from rural surgeons for research
Liaise with funding agencies for application of funds
Monitor, evaluate and help with publications of rural surgery research
Organize Hackathons
Organized evaluation and greater support for the Antia Finseth award of ARSI
Have more research Hubs [or Spokes] at various places
Have a separate Department of Rural Surgery Research and Training at MLCU
Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is an urologist and laparoscopic surgeon trained at CMC Vellore. He is the Past President and Project Lead for the Project GILLS of the Association of Rural Surgeons of India, the Secretary of the International Federation of Rural Surgeons and board member of the G 4 Alliance. He is also an Adjunct Professor at Karunya University. He has over 400 publications in national and international Journals related to rural surgery and has won many innovations award like the EHA innovation award, Antia Finseth award, the Lockheed Martin award, the Millennium Alliance award, etc., He has few patents and the low cost equipment is listed in the WHO compendium of medical equipment for resource poor setting. He has helped many hospitals start Minimally Invasive Surgeries. The popular innovations that have made MIS possible in rural areas are the Gas Insufflation Less Laparoscopic Surgeries and the Laptop cystoscope.
References (click to show/hide)
University of Michigan Health System. "Surgery surprise: Small rural hospitals may be safer, less expensive for common operations: Critical access hospital study suggests local care works well for straightforward surgical cases in uncomplicated patients." ScienceDaily. ScienceDaily, 17 May 2016.
Sticca RP, Mullin BC, Harris JD, Hosford CC. Surgical specialty procedures in rural surgery practices: Implications for rural surgery training. Am J Surg. 2012;204(6):1007-1013.
Allen J.W. DeSimone K. Valid peer review for surgeons working in small hospital. Am J Surg. 2002; 184: 16-18
Linda S. Chan, Manal Elabiad, Ling Zheng, Brittany Wagman, Garren Low, Roger Chang, Nicholas Testa and Stephanie L. Hall, A Medical Staff Peer Review System in a Public Teaching Hospital—An Internal Quality Improvement Tool, Journal for Healthcare Quality, 36, 1, (37-44), (2012).
Chatterjee S, Laxminarayan R. 2013. “Costs of Surgical Procedures in Indian Hospitals.” BMJ Open 3 (6)
Childers CP, Maggard-Gibbons M. Understanding Costs of Care in the Operating Room. JAMA Surg. 2018;153(4): e176233. doi:10.1001/jamasurg.2017.6233
Stephenson BM, Kingsnorth AN. Inguinal hernioplasty using mosquito net mesh in low income countries an alternative of cost-effective prosthesis. Christmas 2011; Surgery: BMJ 2011; 18:1237-47.
Tongaonkar RR, Reddy BV, Mehta VK, Singh NS, Shivade S. Preliminary multicentric trial of cheap indigenous mosquito-net cloth for tension-free hernia repair. Indian J Surg 2003; 65:89-95
indicates a Peer-Reviewed Article
Rural Surgery Research and Training Center – Shanthi Bhavan Medical Center, Biru, Jharkhand
A University of Michigan-led team carried out the analysis of data from 1.6 million hospital stays for four common operations: gall bladder removal, colon surgery, hernia repair and appendectomy [1]. Their conclusion was small rural hospitals may be safer, less expensive for common operations. Even in countries like USA there are less surgeons and rural areas and when it comes to the volume part of the volume/outcome equation, overall number of cases is rarely an issue for rural surgeons [2]. Apart from some peer review process and quality control there is hardly any research that is specific to rural areas [3, 4].
There is a great need for innovations to reduce the cost of surgical treatment and improve the safety of surgical treatment in rural areas [5]. Usually with advances in surgical research and treatment methods the costs go up significantly. For example, in a study in India the cost of hernia treatment went up almost 5 times as various methods of treatment were introduced [6]. It is common knowledge that laparoscopic surgeries were more expensive than open surgeries and further advances like Single Incision Laparoscopic Surgeries and Robotic surgeries made them even more expensive. A study of cost per minute of Operating Room time in USA showed that over a decade the costs doubled and for laparoscopic surgeries increased tenfold in some instances. [7]
Hence the need of the hour is Rural Surgery Specific Research that aims at reducing the costs of surgical treatment while improving the quality of the treatment. The Association of Rural Surgeons of India promoted the use of Prolene mosquito net instead of the commercial Prolene mesh used for hernia repair and this greatly reduced the cost of hernia surgery [8, 9] and operation hernia an International Organization started using it in African countries.
The Gas Insufflation Less Laparoscopic Surgeries [GILLS] made laparoscopic surgeries possible in remote and rural areas as there was no need for expensive equipment, there was no logistic nightmare related to providing gases for surgery and anaesthesia and laparoscopic surgeries were possible under the easily available and low cost Spinal Anaesthesia [10].
The Association of Rural Surgeons of India along with the help from NIHR – GHRG project of University of Leeds [11] developed a training program in GILLS certified by the Martin Luther Christian University at Shillong. So well over 1,000 GILLS surgeries have been performed in rural and remote areas and some Medical Colleges are involved in teaching the techniques.
The development of the Laptop Cystoscope helped the rural doctors to carry out diagnostic Cystoscopies and small procedures like “DJ stenting” in rural and remote areas with small investment for the Laptop Cystoscope.
Without the Laptop Cystoscope the investment required for such procedures would be twentyfold and hence only trained Urologists could afford it.
THE RURAL SURGERY RESEARCH AND TRAINING CENTRE
The Association of Rural Surgeons of India [12] and the International Federation of Rural Surgeons [13] started the Rural Surgery Research Training Centre [RS-RTC] at Shanthi Bhavan Medical Center at Biru for the following:
The RS – RTC is accredited to the Martin Luther Christian University at Shillong. [14]
THE COLLABORATING ORGANIZATIONS
THE INITIAL PROJECTS
FUTURE PLANS
References (click to show/hide)
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