Frugal innovations in surgical technology in rural India

Surgeons and engineers at the NIHR Global Health Research Group in Surgical Technologies at the University of Leeds have been working with partners in India to develop innovative surgical technology, tools and training for routine operations to be safely and successfully conducted in rural hospitals, where surgeons cannot access high-tech facilities, specialist equipment and general anaesthetic routinely used in high-income settings like the UK.

A transcript of this video is available 

The group has developed an innovative device to lift the abdominal cavity and create an operating space, instead of using expensive carbon dioxide gas which is often difficult to obtain in rural areas. The technique also significantly reduces the number of disposable surgical instruments required for routine surgery and therefore limits waste. 

Dr Peter Culmer - Associate Professor in Healthcare Technologies, School of Mechanical Engineering at University of Leeds and Surgical Technologies Research Group Lead, said: 

“Many people around the world can’t access the most basic surgical care. Gasless laparoscopic surgery aims to address this need and bring surgical care to those rural communities. 

“At the heart of this work has been a close collaboration between a variety of disciplines from across the world. We brought together surgeons and manufacturing partners in India with designers and engineers in the UK.” 

This ‘frugal’ innovation has been successfully evaluated and rolled out across northeast India through training provided by local health providers and surgical societies. Policy take-up depends on convincing national and state ministries and public insurance funds that investment in frugal technology is justified. Health economics analysis undertaken as part of the project shows that it is cost-effective. 

Dr Jesudianj Gnanara, NIHR Global Health Research Group in Surgical Technologies India Lead said: 

“This project is unique in that it takes laparoscopic surgery to rural and remote areas where it is not normally possible. In rural areas, getting anaesthetists is very difficult, and if we have anaesthetists the problem is that it is a logistical nightmare to get the necessary gases. The device enables us to perform surgery under the more easily available and less expensive spinal anesthesia."

Functional, effective technology is one part of the process of improving access to surgery. An important further aspect of this work is to undertake robust research to demonstrate that health facilities are able to provide keyhole surgery, and patients are willing and able to access these services. 

Work within the project demonstrated that access to current essential surgery in northeast India, such as  caesarean section, is determined partly by the availability of services but also other factors such as distance, terrain and cost.

Assessments have been undertaken of the facilities at which keyhole surgery will  be offered to understand how systems need to be strengthened to deliver these services. The results suggest that in addition to the technology, strengthening access to anaesthetics, reliable blood supply and 24/7 access to a surgeon is vital if services are to be strengthened.