When There is No Gas: Laparoscopic Surgery in Rural Areas

Laparoscopic surgery is now widely performed for treating many abdominal conditions. These surgeries use gases for abdominal insufflation and despite trials with other gases most commonly used gas is carbon dioxide [1]. Despite the many advantages the penetration of laparoscopic surgeries is only about 20% even in western countries except for few procedures like Laparoscopic Cholecystectomies. [2]

Of the 234 million surgeries conducted every year only 3.5% are conducted in rural areas [3] and these include a negligible number of laparoscopic surgeries. One of the most important reasons for this is the non-availability of bottled gases that are necessary both for general anesthesia and for surgery. High costs and steep learning curve are other reasons.

Despite the shortcomings there are few places that carry out laparoscopic surgeries with serious limitations on availability of gases. We describe some of the ways in which these were overcome to complete the surgeries.


This was the first method we used before getting the equipment for laparoscopic surgeries. We used the cystoscope for diagnostic laparoscopies and appendicectomies [4, 5]. We used the BP cuff or the pathfinder that we use with Ureterorenoscope to create the pneumoperitoneum using the cystoscope irrigation port. Later when we ran out of gas we could switch over to this method to continue the surgeries. However it was not a comfortable or reliable option.

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This entry was posted in Primary Care, Primary Care Featured 2, Surgery and tagged , , . Volume: .

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