Keyhole device to reach more countries

Case study

A technology designed to support keyhole surgery in remote health clinics in India could be extended to other countries, thanks to funding from the Horizons Institute Crucible programme.

The technology was co-designed by Indian clinicians working with a team based in Leeds, led by engineer Dr Pete Culmer. It provides a means of mechanically lifting a patient’s abdomen to create the physical space needed to carry out keyhole surgery – also known as laparoscopy. In high-income countries like the UK, surgeons inflate the abdomen using carbon dioxide, but in many low-income countries the gas either isn’t available or supply is unreliable, which could put a patient at risk mid-operation.

To enable the benefits of laparoscopy – less pain, lower risk of infection and quicker recovery – to be available to patients in rural health clinics with limited resources, the Indian surgeons have pioneered the alternative mechanical technique. Pete and his team worked with them to create an improved device for the technique, making it straightforward to transport, sterilise and assemble, as well as easier to use during surgery. 

Following the device achieving full regulatory approval for use in clinic, it is now available commercially and being manufactured in India. To date, it has been used in 10 surgical settings on more than 20 patients. 

When Pete came to our International Crucible event on Health Systems for Health Security, he began to consider which other countries might benefit from the device. The event brought together early career researchers from the University of Leeds with researchers from Zimbabwe and Bangladesh to spark new ideas and collaborations.

Pete explains: “The Crucible helped me to take a really global view of the research, and not just focus on India where we’d worked up to that point. I also realised that you can’t just introduce a technology specifically designed for one healthcare system into another. There might be different regulations, different ways of carrying out operations, and different economic drivers, and any of these might require a slightly different design. I applied for the Crucible grant to help explore these questions.”

The funding allowed Pete to run a workshop at the Maulana Azad Medical College in Delhi, to showcase the equipment and how it works, and use this to begin discussions with surgeons in other countries. In India, Pete and his colleagues teamed up with the Association of Rural Surgeons in India, and he is now planning a similar workshop at the International Congress for Innovation in Global Surgery 2023, which will be held in Kenya. 

“We feel that countries in sub-Saharan Africa face similar healthcare challenges to regions of India, in terms of limited resources and very large geographical areas in which to provide healthcare,” he explains. “So that’s where we’re going to focus at first.”

The Crucible event and the University of Leeds NIHR Global Health Research Group made it possible for Pete to make contact with key people, such as leads of the College of Surgeons of East, Central and South Africa (COSECSA), which represents surgeons across Kenya, Uganda and South Africa. 

The NIHR Global Health Research Group worked alongside his team in India to help local surgical networks provide the training and mentorship in the new technique, which are crucial to enable long term adoption of the device. Having now seen the technique used in Kenya, Pete hopes to further expand this to other countries.

“It’s not as simple as just making a piece of equipment available, you also have to support people to use it,” says Pete. “Even for those surgeons who have done keyhole surgery before, there’s still a lot to learn to work without gas. For those who only have experience of open surgery, it’s a particularly big leap.”

Pete also hopes the workshop will open doors to new innovations: “We see the laparoscopic device as a starting point, but there may be other ways we can help address the needs of surgeons in these low resource settings.”