Rigid video laparoscope: a low-cost alternative to traditional diagnostic laparoscopy and laparoscopic surgery

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Rigid video laparoscope: a low-cost alternative to traditional diagnostic laparoscopy and laparoscopic surgery


INTRODUCTION
Diagnosis of abdominal conditions is always a challenge in rural areas. The modern diagnostic facilities like CT scans and MRI are not available there. Survey of the operation registers of many rural hospitals (17 hospitals) belonging to an association of hospitals in North India revealed that Diagnostic laparotomies were a common surgical procedure in rural areas [1] . Despite the high costs and invasive nature Laparotomies were still carried out in rural areas because of the cost effectiveness and convenience. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) have given a long list of indications for Diagnostic laparoscopy that are applicable in Urban areas too [2] .
The problem in rural areas is the high costs involved in the set up for Diagnostic Laparoscopies. Traditionally it would involve almost all the equipment required for laparoscopic surgeries and most of the rural surgical facilities cannot afford such high costs especially if they are doing only diagnostic laparoscopies. We offer an alternative low-cost method for carrying out Diagnostic Laparoscopies. The second author has used this innovation for diagnostic laparoscopies in rural areas. This innovation, a unique rigid video laparoscope is the first device of its kind described in the literature of laparoscopy. A patent is filed for it at Mumbai office.

MATERIALS AND METHODS
The first author has used these laparoscopes in his hospital from last 5 years for laparoscopy in children and adults in about 356 cases and got away completely with the conventional equipment. It has been used for laparoscopic surgeries such as appendicectomy, orchidopexies [Supplementary Video 1-2], herniotomies [Supplementary Video 3], pyloromyotomy, Intussusception reduction and in diagnostic laparoscopies.
Diagnostic Laparoscopies are carried out using our innovative equipment that has the video camera and LED lights in the tip of the instrument. It is connected to the Laptop computer through a USB hub and is powered by the Laptop computer. It makes the rod lens system and the light source redundant. Since there is no image loss by the rod lenses, the image quality is phenomenal [ Figure 1].
These scopes are available in 5, 8-and 10-mm sizes. The camera is fitted at the tip of a seamless joint free stainless-steel tube with 5 mm, 8 mm and 10 mm diameter [ Figure 2]. The wires of the camera are connected to male USB connector which is fitted outside the holder of the scope. The holder of the scope is made up of heat resistant polymer called Delrin (Polyacetal). Polyacetal or polyformaldehyde, is an engineering thermoplastic used in precision parts requiring high stiffness, low friction, and excellent dimensional stability. The focal length is from 2 to 20 cm and the white balance, shutter, iris, colors are automatically set by the camera.

DISCUSSION
The need for diagnostic laparoscopic surgeries in rural areas brought many innovations. For example the use of Gas Insufflation Less Laparoscopic Surgeries (GILLS) [2] and the use of cystoscope for laparoscopy in rural areas [1] . This would still require the Laparoscopic camera and the light source. The rigid Laparoscope is a three in one device replacing the telescope, light source and camera combining them into a single lowcost device.
The advent of Laparoscopy has widened the need for Diagnostic laparoscopies especially in gynecological practice like confirming the diagnosis of acute pelvic inflammatory disease; in the evaluation of malignancies and abdominal-pelvic trauma; and the surgical treatment of pelvic pain [2] .
Since the laparoscope has a video camera in the front, the image is converted into electronic signal and there is no image loss as in the case of rod lenses of conventional optical laparoscopes.

CONCLUSION
The rigid video laparoscope device is safe, compact of good quality and is likely to revolutionize diagnostic and operative laparoscopy in India and other third world countries.