A novel low cost minimally invasive surgical system allows for the translation of modern pediatric surgical technology to low- and middle-income nations

There is a critical need for pediatric surgical humanitarian care. The role of minimally invasive surgery (MIS) in these environments with its reduction in pain and wound care, operative time, length of hospitalization, and morbidity is logical. However, the costs, logistics and feasibility of MIS in Low- and Middle-Income Countries (LMIC) can be challenging. Our goal was to develop a new low cost rapidly deployable minimally invasive surgical system (RDMIS) for use during remote pediatric general surgical (GPS) missions in LMIC. RDMIS system components consist of a universal serial bus (USB) interfaced laparoscopic camera, portable computer and a battery powered wireless portable laparoscopic light source. The surgeon transports the RDMIS in a single standard carry-on luggage. Utilizing prepositioning logistics from prior World Pediatric GPS missions, a standard MIS tower system (sMIS) was maintained on site. The RDMIS was utilized to carry out procedural components of laparoscopic appendicostomy and laparoscopic cholecystectomy. Both sMIS and RDMIS were interchanged during the cases to allow for subjective comparison of surgical exposure and visualization. The RDMIS system allowed for safe and effective visualization and dissection of surgical structures. All children recovered uneventfully and were discharged the following day and have had no complications. The RDMIS system costs were significantly less than those of sMIS. RDMIS appears to be a safe, inexpensive option that will allow for the translation of modern MIS technology during GPS in remote locations. Further studies validating the RDMIS are indicated, however, the lower costs, ease of transport and potential benefit to children in the LMIC may be significant.