A Context-specific Design of an Electrosurgical Unit and Monopolar Handheld to Enhance Global Access to Surgical Care: a Design Approach Based On Contextual Factors

Objective To comply to the large global need for surgery, surgical equipment that fits the challenging environment in low- and middle-income countries (LMICs) should be designed. The aim of this study is to present a context-specific design of an electrosurgical unit (ESU) and a monopolar handheld to improve global access to surgery. Scope Extensive fieldwork (by means of surveys, interviews, observations and collection of maintenance records) was done by authors RO, KO and LH to present a detailed description of electrosurgery in clinical practice in LMICs. These findings were translated into design requirements. Feedback from users working in Kenya on the first demonstrator designs was obtained, after which the designs were adapted into conceptual prototypes. These were further evaluated by surveying respondents who attended the annual meeting of the College Of Surgeons of East, Central and Southern Africa (COSECSA) in Kigali, Rwanda in December 2018. Results Conceptual prototypes were developed for a) an affordable ESU that is compact and battery powered and b) a robust reusable monopolar handheld, that can be cleaned in the autoclave and by chemicals (e.g., glutaraldehyde solution). The conceptual prototypes were positively received by the 51 respondents of the survey. Conclusion The findings from the field work and the feedback from users during the design phase has led to a clear understanding of the specific needs and potential solutions. The presented conceptual prototypes need to be further developed into functional prototypes, which could be implemented in Kenya and other settings for further evaluation.