# Increasing Accessibility of Laparoscopic Surgery in Low- and Middle-Income Countries

> **NIH NIH R21** · DUKE UNIVERSITY · 2022 · $183,065

## Abstract

Abstract
Laparoscopic surgery is the standard of care in high-income countries (HICs) for many cancer operations in
the chest and abdomen. Laparoscopic surgery avoids large incisions by using a tiny camera and fine
instruments manipulated through keyhole incisions, but it is generally unavailable in low- and middle-
incomes countries (LMICs) due to high cost of installment, lack of qualified maintenance personnel,
unreliable electricity and shortage of consumable items. Patients in LMICs would benefit from
laparoscopic surgery, as advantages include: decreased pain, improved recovery time, fewer wound infections,
and shorter hospital stays. Laparoscopic surgery would reduce recovery time, enabling patients to return to
home and work more quickly, thereby mitigating impoverishing health expenditure.
Laparoscopic technology can be developed that is low-cost, durable, and does not require a constant
supply of consumable items or electricity. This would enable laparoscopic surgery to be performed in rural
hospitals, where the majority of patients live. We describe a multi-disciplinary collaboration between surgeons
and engineers in the U.S. and Uganda to develop a laparoscopic system for use in LMICs. The laparoscopic
system will be designed for a cost of goods < $200. Rather than using the current design of fiber optic cables,
our prototype has been constructed with low-cost light emitting diodes (LEDs) and a color complementary
metal-oxide-semiconductor (CMOS) detector that has been moved to the front of the device. This allows for a
maintenance-free and low-cost laparoscope. Images can be displayed on a laptop computer, obviating the
need for expensive monitors and cables and preventing loss of function during power-outages. The
laparoscopic system also includes a prototype retractor for lift-laparoscopy, which obviates the need for a
constant power supply and medical-grade carbon dioxide availability.
In the proposed research, the current prototypes will be modified according to feedback from LMIC and HIC
surgeons. Safety parameters of the device will be tested in an in vivo porcine model. Clinical data on current
laparoscopic cases in Uganda will be collected to assess baseline rates of post-operative complications and
difficulties with laparoscopic equipment, which will inform the design of a future clinical study to test the
laparoscopic system in a clinical environment.

## Key facts

- **NIH application ID:** 10454790
- **Project number:** 5R21CA249696-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** TAMARA N FITZGERALD
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $183,065
- **Award type:** 5
- **Project period:** 2021-07-21 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10454790

## Citation

> US National Institutes of Health, RePORTER application 10454790, Increasing Accessibility of Laparoscopic Surgery in Low- and Middle-Income Countries (5R21CA249696-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10454790. Licensed CC0.

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