Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Laparoscopic surgery in middle- and low-income countries: gasless lift laparoscopic surgery



Surgically treatable conditions are an increasing burden in low- and middle-income countries, and recent studies suggest they have overtaken the “big three” (malaria, tuberculosis and HIV) as a cause of mortality.


In this context, we have worked to modify standard laparoscopic equipment to allow laparoscopy in remote areas without support services such as bottled gases or disposable instruments.


A simple and reliable system of gasless laparoscopy has been developed using robust reusable instruments, widening the potential availability of laparoscopic surgery in remote and rural areas.


Our findings suggest that, using this equipment, appropriately trained surgeons can provide minimally invasive surgery in even the most remote locations.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


  1. 1.

    Ameh EA, Chirdan LB (2012) Untreated surgical conditions: time for global action. Lancet 380:1040–1041

  2. 2.

    Kim JY, Farmer PE (2008) Surgery and Global Health: a view from beyond the OR. World J Surg 32:533–536

  3. 3.

    Kushner AL, Groen RS, Bae JY (2011) Surgery as a public health intervention: common misconceptions versus the truth. Bull World Health Organ 89:394

  4. 4.

    McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: What can it mean for emergency obstetric care? Int J Gynaecol Obstet 81:83–92

  5. 5.

    Gosselin RA, Thind A, Bellardinelli A (2006) Cost/DALY averted in a small hospital in Sierra leone: What is the relative contribution of different services? World J Surg 30:505–511

  6. 6.

    Petroze RT, Groen RS, Niyonkuru F et al (2013) Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda. Surgery 153:457–464

  7. 7.

    Satava RM (2005) Telesurgery, robotics, and the future of telemedicine. Eur Surg 37(5):304–307

  8. 8.

    Nande AG, Shrikhande SV, Rathod V, Adyanthaya K, Shrikhande VN (2002) Modified technique of gasless laparoscopic cholecystectomy in a developing country: a 5-year experience. Dig Surg 19(5):366–371 (discussion 372)

  9. 9.

    Dakshinamoorthy K (2003) Cost effective and Gas less laparoscopic surgeries for rural hospitals. Indian J Surg 65(1):99–101

  10. 10.

    Poluci V, Gutt CN, Schaeff B, Encke A (1995) Gasless laparoscopy in abdominal surgery. Surg Endosc 9(5):497–500

  11. 11.

    Ge B, Zhao H, Chen Q, Jin W, Liu L, Huang Q (2014) A randomized comparison of gasless laparoscopic appendectomy and conventional laparoscopic appendectomy. World J Emerg Surg 9:3

  12. 12.

    Chang T-C, Wu M-H, Wu Y-M, Lee P-H, Lin M-T (2009) Technical innovation: gasless laparoscopic hepatectomy using self-designed abdominal lifting system. J Laparoendosc Adv Surg Tech A 19(4):541–544

  13. 13.

    Kruschinski D (2007) Atlas of lift-laparoscopy: the new concept of gasless laparoscopy. Taylor & Francis, London, ISBN 10: 184214118X

Download references

Author information

Correspondence to M. Rhodes.

Ethics declarations


Michael Rhodes and Jesudian Gnanaraj have no conflict of interest and no relationships with any pharmaceutical or device company.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gnanaraj, J., Rhodes, M. Laparoscopic surgery in middle- and low-income countries: gasless lift laparoscopic surgery. Surg Endosc 30, 2151–2154 (2016). https://doi.org/10.1007/s00464-015-4433-1

Download citation


  • CO2
  • General < technical
  • Instruments < technical
  • Surgical < technical