A novel approach to improve global health and health care delivery: low cost mobile-based laparoscopy

Vivian de Ruijter vruijter@stanford.edu
Brian Huynh brihuynh@stanford.edu
Kay Hung kayhung@stanford.edu
Catherine Wong catwong@stanford.edu
Brian Bradley bmwenze0@stanford.edu
Alison Keiper akeiper@stanford.edu
Ankit Goyal Ankit Goyal
Iretiayo Akinola iakinola@stanford.edu
James Wall jkwall@stanford.edu
James Lau jnlau@stanford.edu


Introduction: In the last two decades there has been a major shift toward more minimally invasive laparoscopic surgeries (MIS). MIS has proven benefits for patients over traditional open surgery, such as less postoperative pain, shorter hospital stay and faster recovery time. However, the costs and infrastructure requirements of MIS remain high and limit the availability of best practice to those who can afford it or have access to its facilities. Currently, laparoscopic surgery requires a dedicated operating room that houses costly equipment such as laparoscopic cameras, video-processors, monitors, and cables. Attaching a mobile phone directly to the laparoscope eliminates the need for costly equipment and facilities, and downsizes the apparatus to fit into the palm of a hand. We present the preliminary results of a mobile-based laparoscopic imaging system, which connects a laparoscope to a widely available smartphone using a novel low-cost 3D printed coupling device. 

MethodsThis study compared, subjectively and objectively, two imaging systems: 1) traditional high definition camera connected to a 30° 10mm laparoscope and xenon light source (all Stryker®, San Jose, CA); 2) an iPhone 5S (iPhone 5S, Apple Inc., Cupertino, CA) connected to a 30° 10mm laparoscope and a xenon light source via a custom-made 3D printed coupling device.  First, 9 laparoscopic experts viewed 2 laparoscopic videos recorded in a human cadaver with the two systems. The experts were blinded as to the type of imaging system and were asked to rate using a 5-point Likert-Scale: 1) the overall quality of each video (1-Very poor, 5-Excellent) and 2) how useful the systems would be for basic, moderate and advanced laparoscopic procedures, as well as for education or research applications (1-Not useful, 5-Very useful). In the second phase, the performance of the imaging systems was compared between device specific characteristics.

Results There was no significant difference in expert opinion on overall quality of the image between both systems (3.89 versus 3.89). Experts expressed that the mobile-based laparoscopic imaging system would be more useful for basic and moderately difficult laparoscopic procedures, and for education and research purposes compared to the traditional system (p<0.01). The mobile-based laparoscopic imaging system provided better performance results in camera resolution (1080p vs. 780p) and weight (238g vs. 669g). The overall costs for the iPhone and the 3D printed endoscopic coupling device was $114.66.

Conclusion: In this study, the authors demonstrated a novel way to revolutionize surgical care through a compact, low-cost, and widely accessible mobile laparoscopic imaging device. The apparatus not only affords surgeons and surgical trainees an inexpensive tool to learn and hone their laparoscopic skills in order to improve clinical outcomes and patient safety, but it also has the potential to provide high quality laparoscopic services to patients who previously lacked the opportunity. To conclude, mobile-based laparoscopy has the potential to revolutionize the way surgical care is delivered, providing patients with state-of-the-art care, particularly in resource-limited and underserved areas. Further studies are ongoing to improve the fidelity of the system and test the device in underserved areas.

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