The Gas Insufflation Less Laparoscopic Surgeries (GILLS): Update

The Gas Insufflation Less Laparoscopic Surgeries [GILLS] are a great boon to the Rural Surgeons for many reasons. It is possible under the easily available Spinal Anesthesia. It is relatively easier to learn. It is less expensive and offers advanced procedures like Single Incision Laparoscopic Surgeries to the poor and the marginalized. In addition to all these it is safe.
The Association of Rural Surgeons [ARSI] recognized these benefits to rural surgeons and has taken the following steps to promote GILLS.

  1. The ARSI gave the prestigious Antia Finseth award
  2. The ARSI formed the Project GILLS to promote GILLS with the headquarters at Dimapur in Nagaland


The GILLS equipment is an apparatus to lift the anterior abdominal wall similar to the way the pneumoperitoneum would lift it. It was modified from the AbdoLift designed by Dr. Daniel Kruschinski in Germany. It has been made easier to fix to any type of table and could be fixed very quickly and starting the surgeries take less time than a conventional laparoscopic surgeries that require placement of at least three ports. Details of how to fix the apparatus and use it is available in the following You Tube video:


The SEESHA [Samiti for Education Environment Health and Social Action] team [a charitable Trust in South India] has performed about 950 surgeries in the last few years by GILLS in very remote and rural areas. The Appendix 1 gives the list of the procedures.

The General Surgery department at Maulana Azad Medical College is doing a controlled trial on GILLS Cholecystectomies and have performed about 50 such surgeries. The Medical College, Kolkata and other mission and rural hospitals at Aizawl, Dimapur, Sitilingi, Tukrajhar, Bhaulkpong, Churachandpur, etc., have been doing this procedure.

A wide variety of surgeries are possible. However it is more popular for lower abdominal surgeries.


Recently the World Health Organization included the GILLS in the compendium of health care technology for low resource setting.

It is found on page 75 of the publication. Other International organizations like the GE Health care and Millennium Alliance recognized and awarded the method of Making MIS available and affordable to the poor and the marginalized.


The Project GILLS is a new initiative of ARSI that was approved during the Governing Council meeting this year. The Goal of the project is to popularize Minimally Invasive Surgeries in rural areas especially the GILLS. The activities planned include the following:

  1. GLLS Workshops
  2. Diagnostic camps
  3. Surgical camps
  4. Research projects
  5. Fellowships and scholarships
  6. Training programs for rural surgeons
  7. Training program for OR staff

It now has an office at Dimapur and managed by Mr. Keso [ ]. The project helps with Equipment and Human resource sharing and so far about 5 rural surgical facilities in Northeast India are participating in it.


The GILLS is endorsed by the Harvard University through its PGSSC program and funded the GILLS study at the Maulana Azad Medical College at Delhi. The University of Leeds through its NIHR - GHRG project is helping with the promotion of GILLS in Northeast India especially in Arunachal Pradesh and also is helping with making the Medical College, Kolkata as the training center for GILLS. The Karunya University or the West Bengal University of Health Sciences Is considering providing the certification for the GILLS training program.



You can get involved with Project GILLS in any of the following ways:

  1. You can learn and start GILLS at your place
  2. You can invite Project GILLS to organize training programs at your place
  3. You could join to help at any of the Project GILLS Diagnostic or Surgical camps
  4. You can contribute in cash, Kind or in form of Human Resource to the Project GILLS


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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