Increasing Accessibility of Laparoscopic Surgery in Low- and Middle-Income Countries

摘要 腹腔镜手术是高收入国家（HIC）许多癌症手术的标准护理， 胸部和腹部腹腔镜手术通过使用微型摄像机和精细的 通过锁孔切口操作的器械，但通常在低和中- 低收入国家由于安装费用高，缺乏合格的维修人员， 电力供应不稳定，消耗品短缺。LMIC患者将受益于 腹腔镜手术的优点包括：减少疼痛，改善恢复时间，减少伤口感染， 缩短住院时间腹腔镜手术将减少恢复时间，使患者能够返回 更快地回家和工作，从而减少浪费的医疗支出。 腹腔镜技术可以开发低成本，耐用，不需要常数 消耗品或电力的供应。这将使腹腔镜手术能够在农村地区进行， 医院，大多数病人居住的地方。我们描述了外科医生之间的多学科合作 以及美国和乌干达的工程师们开发一种用于中低收入国家的腹腔镜系统。腹腔镜 该系统将设计用于货物成本<200美元。不是使用当前的光纤电缆设计， 我们的原型是用低成本的发光二极管（LED）和一个颜色互补的 金属氧化物半导体（CMOS）检测器，其已被移动到设备的前面。这允许 免维护低成本腹腔镜。图像可以显示在笔记本电脑上， 需要昂贵的监视器和电缆，并防止停电时功能丧失。的 腹腔镜系统还包括用于提升腹腔镜检查的原型牵开器，其避免了对 稳定的电力供应和医用级二氧化碳的可用性。 在拟议的研究中，现有的原型将根据LMIC和HIC的反馈进行修改 外科医生将在体内猪模型中测试器械的安全性参数。当前的临床数据 将收集乌干达的腹腔镜病例，以评估术后并发症的基线发生率， 腹腔镜设备的困难，这将为未来的临床研究设计提供信息，以测试 腹腔镜系统在临床环境中的应用。

Abstract Laparoscopic surgery is the standard of care in high-income countries (HICs) for many cancer operations in the chest and abdomen. Laparoscopic surgery avoids large incisions by using a tiny camera and fine instruments manipulated through keyhole incisions, but it is generally unavailable in low- and middle- incomes countries (LMICs) due to high cost of installment, lack of qualified maintenance personnel, unreliable electricity and shortage of consumable items. Patients in LMICs would benefit from laparoscopic surgery, as advantages include: decreased pain, improved recovery time, fewer wound infections, and shorter hospital stays. Laparoscopic surgery would reduce recovery time, enabling patients to return to home and work more quickly, thereby mitigating impoverishing health expenditure. Laparoscopic technology can be developed that is low-cost, durable, and does not require a constant supply of consumable items or electricity. This would enable laparoscopic surgery to be performed in rural hospitals, where the majority of patients live. We describe a multi-disciplinary collaboration between surgeons and engineers in the U.S. and Uganda to develop a laparoscopic system for use in LMICs. The laparoscopic system will be designed for a cost of goods < $200. Rather than using the current design of fiber optic cables, our prototype has been constructed with low-cost light emitting diodes (LEDs) and a color complementary metal-oxide-semiconductor (CMOS) detector that has been moved to the front of the device. This allows for a maintenance-free and low-cost laparoscope. Images can be displayed on a laptop computer, obviating the need for expensive monitors and cables and preventing loss of function during power-outages. The laparoscopic system also includes a prototype retractor for lift-laparoscopy, which obviates the need for a constant power supply and medical-grade carbon dioxide availability. In the proposed research, the current prototypes will be modified according to feedback from LMIC and HIC surgeons. Safety parameters of the device will be tested in an in vivo porcine model. Clinical data on current laparoscopic cases in Uganda will be collected to assess baseline rates of post-operative complications and difficulties with laparoscopic equipment, which will inform the design of a future clinical study to test the laparoscopic system in a clinical environment.