Integration of an Abdominal Wall Lift Device and Imaging System

Abstract

Background: Laparoscopic surgery has improved patient outcomes and reduced healthcare costs in high-income countries but faces implementation barriers in low -and middle-income countries due to reliance on carbon dioxide insufflation, expensive equipment, and specialized personnel. Gas Insufflation-Less Laparoscopic Surgery (GILLS) provides an alternative by lifting the abdominal wall without carbon dioxide; however, expensive laparoscopes and assisting staff to operate those remain necessary. Hence, the need for a device that substitutes for the gas insufflation and laparoscope was identified.

Methods: This thesis aimed to integrate an abdominal wall lift (AWL) device and imaging system to enhance GILLS and Single-Incision Laparoscopic Surgery (SILS). Using a context-driven approach, the design focused on surgeon visibility, patient safety, cost-effectiveness, and user-friendliness. The device was developed using inexpensive, readily available components and conventional production techniques. The validation included seven verification tests and an expert user evaluation.

Results: The lifting device consists of a stainless steel tubular hook with LED lighting and a $5$ MP camera module. It can be inserted in the abdomen through a small incision, lifts the abdominal wall, and creates a clear view inside the abdominopelvic cavity. An aluminum prototype had sufficient structural strength, was cost-effective, lightweight, and compatible with existing AWL systems, but it generated excessive heat, was not waterproof, and lacked a functional imaging system. Evaluation by a GILLS expert highlighted design strengths while emphasizing three areas for improvement: the frame's shape, the imaging system, and the sealing technique.

Conclusion: This study illustrated the potential of integrating an abdominal wall lift device and imaging system despite the substantial constraints of the current tubular design. The cost-effective alternative eliminates the reliance on carbon dioxide gas, expensive laparoscopes, general anesthesia, and untrained assisting staff. Therefore, development should continue to improve access to laparoscopic surgery worldwide.