Laparoscopic surgery is the gold standard treatment for many conditions but limited access to expensive equipment limits its adoption globally [1]. It has been reported that there are 143 million additional surgical procedure needed annually [2] and 18 million of these could be amenable to a laparoscopic approach. Despite such huge demand, its adoption is limited due to non-affordability of simulator in both developing countries and developed countries.
LAP-PACK is a low-cost simulator for training in laparoscopic surgery. It is designed as a collapsible, portable flat pack trainer with following features:
- Ultra-low cost, sturdy, light-weight corrugated plastic builds its structure. The rationale behind using it was to simulate the roughness of human abdominal organs, which was supported by clinical surgeons in the GHRG-ST team.
- Endoscopic camera with integrated light for illuminating the operative field. This camera is compatible with tablet, phone and computer screens. It could be manually adjusted to change the depth of view and zoom into the surgical task.
- Elastic wall for simulating abdomen and laparoscopic ports where trainees could create ports as per their comfort of training.
Lap-Pack has been designed in order to address the barriers in laparoscopic training like, (i) limited access to expensive specialist commercial equipment, (ii) time-intensive training requiring a skilled mentor, and (iii) monitoring the adequacy of acquired skills.
Lap-Pack is useful for trainees as a home-based or hospital based training equipment which has been used to provide training to 7 North-East India rural surgeons in Kolkata (March 2019), 35 trainees in Maulana Azad Medical College, Delhi (July 2019), 15 trainees in St. James Hospital, Leeds (August 2019) and 25 trainees in rural Karnataka, India (November 2019). All these studies were conducted under GHRG-ST using TARGET training protocol [4].
Having produced from locally available materials, the Lap-Pack has several features which enhances its usability and provides flexibility of use in limited resource setting. After successful training session in 2019, Lap-Pack has been requested for being available as a personal training equipment from a large number medical trainees in India and Africa since January 2020.
References:
[1] Chao, T. E., Mandigo, M., Opoku-Anane, J. & Maine, R. Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg. Endosc. Other Interv. Tech. 30, 1–10 (2016).
[2] Meara, J. G. et al. The Lancet Commissions Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. www.thelancet.com 386, 569 (2015).