Frugal innovations for training surgeons in rural areas

Jesudian Gnanaraj, of Rural Surgery Innovations, shares how low resource innovations can be implemented in rural areas

Minimally Invasive Surgeries are relevant to rural areas because it is important for rural patients and their families to get back to productive work as quickly as possible and quick turnover would facilitate the efficient use of the meager facilities that are available in rural areas.

Laparoscopic Surgeries and Endoscopic Urological surgeries are thus ideal for rural areas. Unfortunately, these are very expensive and difficult to set up in rural areas in the current form. Moreover, training for these surgical procedures is also expensive and not easily available.

Frugal Innovations are important for bringing modern surgical techniques to rural areas, and this is exactly what Rural Surgery Innovations is doing. Rural Surgery Innovations was formed to help with rural surgery research and innovations for the Association of Rural Surgeons of India and international partners like the International Federation of Rural Surgeons and International Collaboration Innovations in Global Surgery.

The Innovations

The Gas Insufflation Less Laparoscopic Surgeries [GILLS] makes laparoscopic surgeries possible under the easily available and less expensive Spinal Anesthesia. A spiral ring is used to lift the abdominal wall in a dome shape like the way gas is used for creating space for surgery in conventional laparoscopy. The positioning of the operating room table is used to move the intestines away from the site of surgical procedures.

The set up necessary for conventional cystoscopy is expensive and hence out of reach for most non-urologists. The laptop cystoscope, instead, is a low-cost device that connects to the laptop computer and is capable of diagnostic cystoscopies and minor endourology procedures. This innovation was added to the WHO compendium of medical devices for resource-poor settings.

Training in modern surgical procedures is expensive and difficult for rural surgeons as they usually must travel to urban areas for such training. The Virtual Reality in Medicine and Surgery [VRiMS] videos offer the possibility of training from the rural areas using 360 videos with inlays of monitor feeds and teaching materials that give the trainee the opportunity to be virtually present in the best possible place in the operating room.

The Way Forward

The frugal innovations described above make minimally invasive surgical procedures possible in the rural areas at a much-reduced cost to the patients. Training is also possible without having to shift the trainees to expensive urban centers. Such training also makes sure that the surgical work in the rural areas does not suffer from the displacement of rural surgeons and prevents rural surgeons from settling down in the urban areas after training there.

Further research is required to develop remote controlled robotic arms that could help mentors from remote locations guide the trainees by holding the camera for laparoscopic surgeries or helping the remotely located surgeons by doing some helpful dissections from remote locations while supervising the surgeries.

Formal training programs can use VRiMS videos to help the trainees observe surgeries from rural areas during the training program. The faculty can travel to rural areas to teach the trainees basic surgical skills and, once they are proficient in them, guide them from remote locations.

About the author

Dr Jesudian Gnanaraj, is a urologist and laparoscopic surgeon who has been working in rural areas for over four decades performing a wide variety of surgeries and training for over 70 hospitals to start Minimally Invasive Surgeries. He has helped to develop Gas Insufflation Less Laparoscopic Surgeries that are possible under spinal anaethesia and developed training programmes for urology in rural areas by using low-cost laptop cystoscopes and using virtual reality in training programs