Poster Y5 - Engineering a low-cost 30° laparoscope to enable laparoscopy in low- and middle-income countries

Introduction: Laparoscopic surgery is commonly used for abdominal and chest cavity surgeries. The laparoscope includes a small camera and light source coupled to a fiber optic probe that ends at either a 0° or 30° angle. Many surgeons prefer a 30° angle, which improves visualization of challenging anatomy. The laparoscope and thin surgical instruments are inserted into the abdomen via keyhole incisions, eliminating the need for large incisions [1]. Laparoscopic surgery is the standard of care in high-income countries (HICs); however, laparoscopic setups can cost >$136,000 USD, which is a barrier to their use in low- and middle-income countries (LMICs) [2]. Further, laparoscopic equipment requires expensive maintenance contracts, which poses issues in LMICs, due to a lack of biomedical technicians [3]. To address this unmet need, we are developing the KeyScope laparoscope, a reusable, low-cost, durable laparoscope specifically designed for LMICs. The KeyScope includes light-emitting diodes (LEDs) and a color complementary metal-oxide-semiconductor (CMOS) detector at the tip of the device's scope and is powered through a USB connection to a laptop. In previous work, we demonstrated that our 0° KeyScope performed similarly to a standard-of-care (SOC) laparoscope despite being a fraction of the cost (cost of goods = $1,000 USD). However, to provide adequate exposure for complex surgeries, developing a 30° KeyScope is necessary, which is the focus of the work presented here.

Materials and

Methods: We are developing a prototype of our 30° KeyScope with two additional key components. First, the camera at the tip is angled 30° (work in progress). Second, a tilt sensor has been incorporated into the printed circuit board in the handle of the device. Since our camera is placed at the tip of the laparoscope, if a surgeon rotates the laparoscope without a tilt sensor, the image will also rotate, making the horizon incorrect. Our custom software uses information from the tilt sensor to rotate the image, so it appears upright to the user (Fig. 1). We will next evaluate the success of our autorotation platform through a compass-based target. The compass will be imaged, and the tilt sensor will be turned on. The north location on the compass should be located at the 12 o’clock position in the presented image. Deviation from the 12- o’clock position will be quantified as rotation offset

Results, Conclusions, and Discussions: We have demonstrated the feasibility of the autorotation system in Fig 1. The surgeon can rotate the scope clockwise or counterclockwise, and the image remains upright. The final video is presented to the surgeon in a circular view to remove any distracting rotating edges. The implementation of the tilt sensor provides proof-of-concept for its eventual implementation in the final 30° KeyScope. In future work, we will assess the 30° KeyScope image quality using standard optical imaging targets (previously described [4]) and through the compass-based target. Success criteria for image quality will be established through SOC laparoscope parameters [4]. We will also evaluate the 30° KeyScope in vivo performance through surgeon use in porcine models.

Acknowledgements (Optional): Acknowledgements: This study was funded by the NIH (R21CA249696, U01CA269190).

References: 1. Garry R et al, Best Pract Res Clin Obstet Gynaecol. 2006. 2. Higgins RM et al, Surg Endosc. 2017. 3. Oosting RM et al, BJS Open. 2020. 4. Mueller et al, Annals of Biomed Eng, 2021.