Improved performance and design of a low-cost laparoscope to enable laparoscopic surgery in low-income countries.

Significance: Laparoscopy has become the standard of care for surgery in the chest and abdomen but is typically unavailable in low- and middle-income countries (LMICs). This inaccessibility is partly due to a high initial equipment purchase price, ongoing maintenance costs, unreliable electricity, shortage of biomedical technicians, and limited sterilization facilities. Aim: To address these challenges, a low-cost, durable, reusable laparoscopic system (KeyScope) was designed for use in LMICs. Approach: Through an iterative human-centered design approach, the performance of the KeyScope was optimized by comparing standard image quality metrics to a commercially available standard-of-care (SOC) laparoscope. Results: The latest version of the KeyScope has comparable or better resolving power, lens distortion, field of view, depth of field, and color reproduction accuracy to a SOC laparoscope (Precision Ideal Eyes HD Laparoscope, Stryker) at working distances commonly used during laparoscopic surgery (3 to 13 cm). Interference from electrocautery was eliminated by shielding the camera ground from the housing ground. Finally, the entire KeyScope is equipped for production and implementation in sub-Saharan Africa, as the device can be submerged in Cidex and can be easily assembled in Uganda in under 1 h. Conclusion: These results suggest that the KeyScope has achieved the performance criteria needed for surgical care in LMICs.