Surgeons have collaborated with engineers and designers to develop a technology that enables abdominal laparoscopic surgery in low-resource, rural areas globally.
Comprising members from India, Africa, and the University of Leeds in the UK, the team is also training surgeons in India and sub-Saharan Africa on its use.
Surgeries like laparoscopic cholecystectomy and appendicectomy are still out of reach for nine out of ten people worldwide, especially in low- and middle-income countries (LMICs).
Key benefits of laparoscopy include reduced pain, no need for general anaesthesia, lower risk of infection, and quicker recovery. This is particularly significant in LMICs, where a prolonged recovery can lead to unaffordable time off work.
However, the technique often has its limitations due to its technical complexity, higher costs, and logistical difficulties.
One significant limitation is carbon dioxide insufflation, which is vital for creating operative space during laparoscopy. Many rural areas struggle to access a reliable CO₂ supply, making surgery more hazardous.
It also requires general anaesthesia and ongoing monitoring during the operation by skilled staff, resources often not available in remote clinics.
Overcoming these challenges, the team developed a device that mechanically lifts the abdominal wall, making it possible to perform laparoscopic procedures without relying on CO₂. This approach enables the use of spinal or epidural anaesthesia, further simplifying the process and reducing costs.
The technology – RAIS (RetrActor for Insufflation-less Surgery) – is designed specifically for deployment in low-resource environments. But innovation alone isn’t enough. Surgical competency requires more than brief introductions to a new technique, the team believes.
Anurag Mishra, a surgeon at Maulana Azad Medical College in Delhi and a member of the development team, explained: ‘You can’t become a competent surgeon in a five-hour workshop. It’s inevitable that you’ll continue to face challenges and problems as you put a new technique into practice. Training can’t be just a one-off – it needs to include ongoing support and mentoring. We provide this through video calls and WhatsApp messaging groups, to create a network through which surgeons can share their experiences, which is critical for embedding a new approach.’
Following its success in India, the RAIS system was trialled in Kenya and Uganda, with support from the University of Leeds.
Professor Pete Culmer, from the School of Mechanical Engineering, has been involved from the outset. He and Dr Mishra are founding members of the Innovation in Global Surgery initiative, which aims to address rural surgical challenges through multidisciplinary innovation.
He explained: ‘We wanted to be sure there was a pull for the technology, not just us as a team trying to push it. There was huge enthusiasm amongst the surgeons, who saw it as a potential solution to the inequalities in sub-Saharan Africa, where healthcare is even more polarised than in India. In Nairobi, for example, keyhole surgery is only available to private patients, and it’s not available at all outside the city.’
The initiative, initially supported by the University of Leeds NIHR Global Health Research Group, has since received additional funding from the Global Challenges Research Fund. Training is now underway in Uganda and Kenya, with plans to expand to Tanzania and Ethiopia.
Indian surgeons with first-hand experience in remote settings are leading the African training programmes.
The initiative employs a train-the-trainer model, empowering local surgeons to disseminate knowledge within their communities.
Dr Mishra said: ‘We’re using the same model as we used in India, where providing the equipment and initial training is just the start. We are creating a network of surgeons in Uganda who can share their own unique challenges. And we’re not assuming that the same systems that work in India can simply be transferred wholesale to Africa. It’s possible that things need to change, to create ways of working that are unique to a country or region.’
