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1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Predict Easy :Pre-eclampsia Risk Stratification Tool

Vaishali Sundaresan , Yaswin K S Sagar, Carolin Solomi, A Revanth
HTIC, IIT Madras Research Park, Chennai, India; Makunda Christian leprosy and General Hospital, Assam, India; St. Joseph’s Institute of Technology, Chennai, India; Healthcubed Pvt Ltd, Bengaluru, India

Problem Statement: Unavailability of accurate screening tool for pre-eclampsia in low resource settings leading to preventable maternal, perinatal mortality and morbidity.

Need of an innovation: Our product Predict Easy is a machine learning based software that provides risk stratification for pre-eclampsia based on routine antenatal markers. Our product will be placed on the cloud, clinicians can access it through the web interface. Input parameters are entered through the portal, risk analysis is performed on the cloud and risk report is generated.

Pre-eclampsia Opportunity: Pre-eclampsia is a multisystem disorder that typically affects 2% – 5% of pregnant women around the world. In India, the incidence is reported to be 8%-10 %. Globally,76,000 women and 500,000 babies die each year because of pre-eclampsia. Thus, identification of women who are at high risk of developing pre-eclampsia at early stage becomes necessary so that necessary measures can be initiated early enough to improve the pregnancy outcome. The current existing screening methods for pre-eclampsia using biophysical and biochemical markers are expensive, require sophisticated equipment and well-trained manpower which might not be available in all the resource settings.

Mean Arterial Pressure, Proteinuria, Red Blood Cell Distribution Width, Maternal Characteristics, Medical history are some of the markers that are routinely collected during antenatal care that are cost effective and require minimal equipment. Multiple studies have been performed to associate these markers with pre-eclampsia individually or in combination of two or three. We intend to combine all these markers and come up with a simple machine learning based risk stratification tool for pre-eclampsia. This tool could be implemented in low resource settings where women with possibility of developing pre-eclampsia can be identified early and frequent antenatal care can be provided to high risk women.

Novelty, Differentiation, Value Proposition:
• Easy to implement
• Simple, based on routine antenatal markers
• No additional tests and sophisticated equipment required
• Risk interpretation based of Indian population
• Best use of available resources
• Cost effective in comparison with the existing the methods.

Impact: Our product Predict Easy will address the need for an accurate screening tool for preeclampsia. In the resource limited settings, it will help the ANMs and healthcare workers in detecting the complication at early stage without having to go for other expensive tests. Product is currently in the development stage with data collection in progress.

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

D-Cleft

Ruchi Gupta
V-Invent, India

Babies born with cleft palate anomaly suffer from feeding problems which interfere with their nutrition for growth and development; thereby, hampering the criteria for subsequent corrective surgery. The palatal cleft interferes with nursing and causes insufficient suckling or aspiration/nasal regurgitation of food. Because of altered anatomy and presence of oro-nasal fistula, baby tends to present suction difficulties due to lack of negative intraoral pressure. Presented here is an innovative solution – D-Cleft – A patented device for attaching on commercially-available feeding bottles to facilitate effective nutrition method.

The device was tried and tested successfully in many neonates born with cleft palate. It has been successfully used to feeding neonates by their mothers/care-takers with almost no training required. D-Cleft provided good seal of palatal defect from nasal regurgitation and was found to act as a scaffold against pressing of feeding-bottle’s nipple during suckling movements. It has overcome several disadvantages presented by in-dwelling tubes or long-term intra-oral attachment methods most importantly constant irritability for child. Other drawbacks such as impression procedure, sterilization and hygiene issues are almost non-existent.

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Lumbar Disc Degeneration, A Transdifferentiation Process-An Electron Microscopic Observation

Prashant B Lakhe
GIPMER, New Delhi, India

Introduction: Lumbar disc degeneration (LDD)is a common condition which affects quality of life. Repeated trauma, ageing and stress predispose to LDD. However exact mechanism is not fully understood. Transdifferentiation refers to a process where a one mature cell switches its phenotype and function to that of another mature differentiated cell type. Such mechanisms have been described in repair following fracture of bones. In order to understand it better, we conducted an electron microscopic study to analyze if LDD is a transdifferentiation process.

Methodology: After institutional ethics committee approval, patients who presented with LDD were subjected to preoperative MRI. Failure of medical management, and occurrence of neurological deficits formed the indication for surgery. Discoidectomy was done by standard microscopic techniques and the disc material was examined under electron microscopy. The disc material was collected and labelled according to proximity to adjoining osteophyte formation. The electron microscopic findings were correlated with clinical and radiological observations.

Results: Study was conducted from Jan 2020 – Dec 2021. A total of 50 patients with 28 males ,22 females with a mean age of 47 years were studied. Majority of the patients(26) had a prolapse at L4- 5 level with the mean duration of symptoms being 12 months. 80 % of patients had a VAS score of 7 and 8. Maximum (72 %) patients showed a Pfirrmann grade 4 of degeneration on MRI and type 2 Modic changes (64 %). Ten patients(20%) showed presence of posterior osteophytes. Electron microscopy showed chondrocyte clustering in 92 % patients, collagen abnormalities in 66% and intracellular inclusions in 60%. Chondrone formation was seen in 12 patients. Patients with higher pain severity and longer duration of symptoms showed increased chondrocyte clustering. Osteophyte formation was seen in patients with longer duration of symptoms. All the patients with osteophytes showed presence of chondrones.

Discussion: LDD is a process which can be explained on electron microscopy. Higher VAS score and longer duration of symptoms results in more chondrocyte clustering. In addition, formation of osteophytes was always associated with chondrone formation. These findings support our hypothesis that lumbar disc degeneration is a transdifferentiation process.

Keywords: lumbar disc degeneration, transdifferentiation, chondrocyte clustering, chondrone

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

SutureSure-A multifunctional laparoscopic device for simple and effortless minimally invasive surgeries

Nikhil Mamoria , Himanshu Laddha
BJGMC and Sassoon General Hospitals, Pune, India

Need of an innovation: Laparoscopic suturing is the most difficult skill to master as the surgeon needs to constantly change the orientation of the needle to find an accurate position because of the limitations of laparoscopic surgery. Without necessary experience and practice, it increases the surgeons’ effort leading to Physical fatigue resulting in an increased level of errors and poor stitches quality, whereas mental stress results in increased operating time and anesthesia used.

The patented product SutureSure is a multifunctional device that makes laparoscopic surgeries simple and effortless by empowering surgeons to do stitching, knotting, and grasping with just 2 clicks. It helps surgeons to perform complex suturing procedures minimally invasively, in an affordable way -by combining the benefits of robotics with the simplicity of laparoscopy. It provides surgeons 6 degrees of freedom through a joystick, thus enabling them to reach the desired angle, control bites, secure, and tighten the knot. It is a reusable autoclavable instrument that uses a disposable suture cartridge to make laparoscopy affordable.

SutureSure will be of great value to surgeons, as it provides easier access, efficient suturing, and more control with greater dexterity. It will remarkably reduce the training time required by new surgeons to master suturing skills. Hospitals will also be benefitted from decreased OR time, Increased MIS procedures, and improved quality of care dispensed to the patient.

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

MeeT: A Platform for Innovation

Kunal Kalani
Gurukool MAMC, Maulana Azad Medical College, New Delhi, India

India’s medical industry and infrastructure is the talk of the world. However, nothing is perfect. Doctors come face to face with the shortcomings of this industry every day. As professionals with a deep understanding of the system, they are the best poised to lay down a foundation to the solutions to these problems. However, modern technological advances, which play a major role in solving such obstacles, is not something that doctors are expected to be experts in. Thus, an idea fails to formulate due to the lack of tools.

Our proposed solution, MeeT, is platform where professionals of the medical and engineering industries can cooperate and coordinate to develop a plethora of answers to the problems the industry feels burdened with. Having a specialist to consult at their fingertips can allow doctors to delve deeper into the mechanisms of these previously unreachable problems and unravel them into achievable goals that can be tackled by the partnership.

Keywords: AI in medical sciences, Bioinformatics, Resource Management, Public Health

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Designing Global Surgical Technology: Benefits of a Participatory Design Approach for the Surgeon

Tim Ho , Millie Marriot-Webb, William Bolton, Noel Aruparayil, Peter Culmer
University of Leeds, Leeds, United Kingdom

Introduction: Participatory Design (PD) is an approach to technology development that aims to improve outcomes through close and equal involvement of stakeholders in the development process. This approach is increasingly prevalent in medical technology development – particularly in Global Surgery and low-resource healthcare interventions, where understanding of the clinical context is vital to design. It has been argued that PD projects should prioritize participant outcomes alongside project objectives to ensure project longevity and success, yet there is a paucity of research regarding the impacts on clinical stakeholders, and how to optimise their collaboration. Better understanding of the benefits for clinical stakeholders will help facilitate these aims and promote better collaborations.

Methodology: Clinical stakeholders, involved in the development of the “RAIS” (Retractor for Abdominal Insufflation-less Surgery) device, were identified for interview. Semi-structured interviews were conducted with each participant to ascertain their personal motivations, experiences of multidisciplinary and international collaboration, and to explore any opportunities or skills that were developed. Personal frustrations and barriers to collaboration were identified and solutions to these concerns explored.

Results: Stakeholders unanimously prioritised clinical results over personal enrichment as the primary motivation for participation, though academic and career opportunities were recognised as key benefits. A non-hierarchical relationship between clinical and design teams allowed the clinicians to contribute and influence the design process to meet their specific needs as the device’s intended users. The geographical distance between teams and the lengthy design process were major sources of frustration. However, effective communication channels, and integration into design considerations, reduced miscommunication and enhanced contributions from the surgical team who were able to provide more detailed and valuable feedback.

Discussion: This study aims to catalyse further research to determine the ideal participant and project outcomes and the optimal approach to facilitate these. Key considerations for innovators considering using a PD approach include:
Project Conception:
1. Prioritize input from a variety of stakeholders based in LMIC’s in the initial design phase
2. Collaborate with local stakeholders throughout the design process to ensure continuity
3. Establish stakeholder-specific goals as part of the project’s objectives
Communication:
4. Communicate interactively to understand the context and form collaborative relationships with stakeholders
5. Espouse an ethos of equal stakeholdership to facilitate bi-directional information flow, encourage feedback and ensure participant motivations
6. Validate interventions with stakeholders in the contextual environment
Sustainability:
7. Support the development of innovation networks and capacities within LMIC’s
8. Empower stakeholders to innovate, collaborate and disseminate their knowledge
9. Employ formal PD frameworks to guide long-term and sustainable stakeholdership

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

RI2 -Retract, Isolate, and Illuminate: 3 in 1 Affordable solution for effective Community Dental Program

Sonal Bhatia , Radhika Gupta , Vikrant Mohanty
Maulana Azad Institute of Dental Sciences, New Delhi, India

Dental surgery, including any preventive or therapeutic dental procedure, requires continuous isolation from saliva, illumination of oral cavity and retraction of soft tissues. There are many commercially available instruments to solve this purpose, but only a handful solves all three problems at once. Furthermore, leading isolation pose certain problems. Hence, there is a dire need for a comprehensive system which provides all three: isolation, illumination and retraction of soft tissues simultaneously. The Retract, Isolate and Illuminate (RI2) system is an economical alternative to current isolation systems so that it can be a feasible option for every community setting which makes isolation easy and efficient.

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

The Metaverse as a platform for education and training within medicine and surgery

Karamveer Narang
VRIMS/NHS, United Kingdom

Introduction: Virtual Reality in Medicine and Surgery (VRiMS) has successfully demonstrated a scalable and affordable method of utilising immersive technology in medical education. VRiMS has hosted 5 one-week cadaveric live streaming courses at Brighton and Sussex Medical School (BSMS) utilising 360VR cameras and the last course co-hosted a global medicine initiative with GASOC (Global Anaesthesia, Surgery and Obstetric Collaborative) streaming the Bellwether procedures of caesarean section, spinal anaesthesia, and gasless laparoscopy to surgeons from 43 countries. The next step in development involves utilisation of the metaverse. The metaverse is, by definition, a virtual-reality space in which users can interact with a computer-generated environment and other users. The development of this resource can have a wide scale impact within global surgery and medicine as it would allow people to meet in an immersive environment to facilitate learning as well as exchange ideas.
Methodology: We utilised Mozilla Hubs in order to develop a meeting space utilising virtual reality and the metaverse. A proof of concept was created, and a meeting held with 5 members of our working group. Content from VRiMS was used to facilitate discussion and the share ideas. The meeting space could be accessed either via a VR headset or via an internet browser.

Results: As this is a proof of concept involving a small sample size, results were predominantly obtained via qualitative methods and consisted mostly of feedback from the users. Feedback obtained was generally positive in terms of the ease of access to the technology and the potential for it to be used as a meeting space. There were also issues identified such as the need for a stable internet connection as well as the limit on what type of content could be shared via the Mozilla Hub platform.

Discussion:The development of remote learning has been accelerated not only within medicine but in all other domains due to the COVID pandemic. We feel that the metaverse could be an exciting way to bridge the gap between face-to-face learning vs online learning. This could have major implications within global medicine and surgery as it allows wider access to training and resources especially towards lower income countries and healthcare systems.

Keywords: Metaverse, Virtual Reality, Education and Training

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Music as an adjunct cost-effective therapeutic innovation for Management of Pain in Trauma Patients: A Systematic Review and Meta-analysis

Pratyush Kumar , Oshin Puri, Yogesh Bahurupi
Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India; AIl India Institute of Medical Sciences, Rishikesh, India

Introduction: Music therapy reduces pain perceived, alleviates mood and promotes relaxation, regular breathing and rest. Being a readily available and inexpensive therapy, its efficacy for Management of Chronic Pain, such as that experienced by Trauma patients needs further exploration in low resource settings.

Objective: To determine the effectiveness of Music Therapy as an adjuvant therapeutic intervention in trauma patients of adult and pediatric age group in the pre and post procedural period.

Method: PubMed (n=175), Trip Medical Database (n=278) and ClinicalTrials.Gov (n=28) were searched for ‘Trauma’, ‘Music’ & ‘Pain’. Studies identified from inception were imported to EndNote X9 Library and duplicates removed. Only completed RCTs (Pubmed; n-16, TMD; n=2, CT.Gov; n=6) were screened using Title, Abstract and full text (n=41). Data extracted from 12 studies, was analyzed in Review Manager 5.4.

Result: Due to significant heterogeneity (Chi² = 365.17, P < 0.00001; I² = 97%), inverse variance random effect meta-analysis was done. Scores of the various pain measurement scales from a total of 852 patients from 12 studies revealed a pooled Standard Mean Difference of 0.31 [-0.61, 1.22]. Test for overall effect Z = 0.66 (P = 0.51) indicates that there is no significant difference in pain outcomes between Music Adjuvant therapy (MAT) Vs. Conventional Analgesic care. Subgroup analysis reveals a significant favor [Z = 1.18 (P = 0.24)] to MAT in patients of non-malignant pain of traumatic origin while in burn trauma patients it has no significant benefit [Z = 2.23 (P = 0.03)]. Similarly, as per pooled evidence, MAT is highly effective in the pediatric age group [Z = 1.00 (P = 0.32)] while no significant benefit in the adult age group [Z = 1.11 (P = 0.27)].

Conclusion: The pooled evidence suggests that both interventions significantly improve pain outcomes but Music therapy does not have any significant benefit over conventional therapy when compared as a whole. Although, in patients of non-malignant pain of traumatic origin, MAT has significantly high benefit while for Burn trauma patients, MAT has no proven significant benefit over conventional therapy. Evidence from the meta analysis indicates high efficacy of MAT in children while non such benefit can be proven in adult age group. Therefore, MAT could be a potential inexpensive therapeutic adjuvant in non-malignant pain of traumatic origin (for example post fracture reduction, post operative pain, etc.) and for pain management in children.

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Need of an Autopsy Kit in resource limited settings

Mrinal Patnaik , Arneet Arora
All India Institute of Medical Sciences Bhopal, Bhopal, India

Introduction: Autopsy is a primary source of anatomical and pathological research in human body. The instruments required in autopsy depend upon the degree of detail required in dissection and the method of autopsy used. Availability of surgical instruments, in adequate quantity or variety, their logistics to the site of autopsy is a challenge.
Methodology: The question was what decisions are made regarding supplies and sterile instruments in autopsies. Systematic analysis of literature was done where research papers dedicated to Operating room inventory, field necropsy procedures and surgical kits for different parts of human body and manuals and/or guidelines for autopsies were reviewed.
Results: The number, type and cost of instruments required in autopsy depend upon the method of dissection and type of autopsy performed, viz. Minimally Invasive Autopsy (MIA), Partial Autopsy, Complete Autopsy, Complete Diagnostic Autopsy (CDA) or Virtual autopsy, decided on technical grounds, feasibility, consent and the mandate of the authority requesting the autopsy.
Discussion: A comprehensive cost effective autopsy kit with necessary inventory of commonly used instruments could be promptly made available upon requirement with essential equipments and additional instruments as needed for special circumstances to satisfy a balanced outcome.

Keywords: Autopsy, Instruments, Postmortem, Kit