A Surgical Lift System Enabling Gasless Laparoscopy In Low-resource Healthcare Facilities

In most rural facilities, open surgery (Laparotomy) is still the first-line approach to abdominal surgery treatment for abdominal surgeries which naturally involves a big cut, more bleeding, pain, longer recovery time, higher chances of infection, and on the whole, more suffering for the patient. Laparoscopy (Keyhole surgery), the alternative, is particularly advantageous in such facilities where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage and infection, and single-income households – all of which contribute to surgical morbidity and mortality. However, a functional laparoscopy program requires significant investment and trained personnel, as a result, remains unavailable for the majority of the world’s population in LMICs.

Where laparoscopy is available, the predominant way to gain access is the insufflation of the abdominal cavity with CO2 gas. Although laparoscopy poses more benefits than open surgery, the use of CO2 in laparoscopy has challenges in reducing access to laparoscopy in low-resource areas, such as rural hospitals where only one surgeon per 2.5 million people is available. Some drawbacks include:
• Minimal/no availability of bottled gas
• Necessitates general anesthesia
• Sustainability concerns due to the use of CO2 and single-use instruments
• Expensive acquisition and maintenance of equipment
• Clinical contraindications: cardiac and respiratory complications

Because of these limitations, the World Health Organisation (WHO) has included gasless laparoscopy as an essential element of the WHO Compendium of Innovative Health Technologies.

These drawbacks present an opportunity to develop a low-resource gasless alternative to insufflation. We have developed a relatively inexpensive retractor that may be undertaken with spinal anesthesia and using modified reusable open surgical instruments through flexible gel ports.

Retractor for Abdominal Insufflation-less Surgery (RAIS) was developed by a collaborative multidisciplinary team of surgeons and engineers in the UK (University of Leeds) and India as an alternative to the existing CO2 use for abdominal visualization during laparoscopy. RAIS has been closely designed and evaluated with surgical experts working in low-resource areas. Our device works by mechanically lifting the abdominal wall, creating a space in the abdominal cavity to conduct laparoscopic surgery without compromising visualization. This device is clinically proven to be advantageous in the surgical room in several ways.

Removes the need for general anesthesia: Gasless laparoscopy with RAIS can be performed under spinal anesthesia, removing the need for catheter insertion, no post-operative confusion/cognitive dysfunction, and better patient comfort.

No CO2 required: Environmentally sustainable as there is no carbon emission and reduced surgical waste

Feasibility: Inexpensive, reusable, easy maintenance, intuitive assembly, and can be mounted on any surgical bed. RAIS is sterilized in the autoclave.

Approximately 980 abdominal procedures have been successfully conducted using RAIS by surgeons in India, Kenya & Uganda. With 8 publications and FDA approval in India, RAIS is clinically and commercially proven to be scalable with impact.