Diagnostic laparoscopies in rural areas: a different use for the cystoscope

Gnanaraj, Justin Paul

doi:10.1258/td.2010.090322

Cited by 5 publications

(4 citation statements)

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“…Where patients are particularly poor, clever workarounds help make care more affordable or free (eg, accepting payment-in-kind) or more reachable to patients who travel from far away (eg, scheduling clinics around public transportation times to allow for same-day diagnosis and treatment). Where supplies are limited or unavailable, inexpensive local alternatives are fashioned to fill the need gap (eg, sterilised mosquito net for hernia repair, 30–36 a cystoscope for diagnostic laparoscopy, 37–39 gasless laparoscopy 40 ). Given the broad variation in how governments and policymakers have approached these issues over the years, local clinicians steeped in these clinical environments have the best sense of what their patients are experiencing and how they can provide better care.…”

Section: Discussionmentioning

confidence: 99%

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings

et al. 2016

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Introduction5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges—the specific circumstances—faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges.MethodsFrom January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst.ResultsProviders described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient–provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges.DiscussionWhile some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences.

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Section: Discussionmentioning

confidence: 99%

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings

et al. 2016

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“…The need for diagnostic laparoscopic surgeries in rural areas brought many innovations. For example the use of Gas Insufflation Less Laparoscopic Surgeries (GILLS) [2] and the use of cystoscope for laparoscopy in rural areas [1] . This would still require the Laparoscopic camera and the light source.…”

Section: Discussionmentioning

confidence: 99%

“…The modern diagnostic facilities like CT scans and MRI are not available there. Survey of the operation registers of many rural hospitals (17 hospitals) belonging to an association of hospitals in North India revealed that Diagnostic laparotomies were a common surgical procedure in rural areas [1] . Despite the high costs and invasive nature Laparotomies were still carried out in rural areas because of the cost effectiveness and convenience.…”

Section: Introductionmentioning

confidence: 99%

Rigid video laparoscope: a low-cost alternative to traditional diagnostic laparoscopy and laparoscopic surgery

Jawale¹,

Gnanaraj²,

Agarwal³

2019

MIS

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“…3 Unfortunately, the cost of equipment for diagnostic laparoscopy is very high and out of reach of most rural healthcare facilities, especially those who do not perform laparoscopic surgical procedures. Although innovative methods such as using a cystoscope for diagnosis have been tried, 4 they are still expensive because of the high costs of the telescope.…”

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Low-cost laparoscopy for rural areas: the flexible video laparoscope

Jawale¹,

Gnanaraj

2018

Trop Doct

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Diagnostic laparoscopies are a very useful diagnostic tool especially in rural areas. However, the very high costs of the current diagnostic equipment make them unavailable to most of the rural centres. We describe a low-cost laparoscope that does away with the telescope and rod lens system and offers very good quality pictures for diagnostic laparoscopy at small fraction of the cost of current laparoscopic surgical instruments.

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Diagnostic laparoscopies in rural areas: a different use for the cystoscope

Cited by 5 publications

References 0 publications

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings

Rigid video laparoscope: a low-cost alternative to traditional diagnostic laparoscopy and laparoscopic surgery

Low-cost laparoscopy for rural areas: the flexible video laparoscope

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