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Published in: Globalization and Health 1/2014

Open Access 01-12-2014 | Commentary

Value innovation: an important aspect of global surgical care

Authors: Michael Cotton, Jaymie Ang Henry, Lauren Hasek

Published in: Globalization and Health | Issue 1/2014

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Abstract

Introduction

Limited resources in low- and middle-income countries (LMICs) drive tremendous innovation in medicine, as well as in other fields. It is not often recognized that several important surgical tools and methods, widely used in high-income countries, have their origins in LMICs. Surgical care around the world stands much to gain from these innovations. In this paper, we provide a short review of some of these succesful innovations and their origins that have had an important impact in healthcare delivery worldwide.

Review

Examples of LMIC innovations that have been adapted in high-income countries include the Bogotá bag for temporary abdominal wound closure, the orthopaedic external fixator for complex fractures, a hydrocephalus fluid valve for normal pressure hydrocephalus, and intra-ocular lens and manual small incision cataract surgery. LMIC innovations that have had tremendous potential global impact include mosquito net mesh for inguinal hernia repair, and a flutter valve for intercostal drainage of pneumothorax.

Conclusion

Surgical innovations from LMICs have been shown to have comparable outcomes at a fraction of the cost of tools used in high-income countries. These innovations have the potential to revolutionize global surgical care. Advocates should actively seek out these innovations, campaign for the financial gains from these innovations to benefit their originators and their countries, and find ways to develop and distribute them locally as well as globally.
Literature
1.
go back to reference Govindarajan VTC, Trimble C: Reverse innovation: create far from home, win everywhere. 2012, Boston: Harvard Business School Publishing Govindarajan VTC, Trimble C: Reverse innovation: create far from home, win everywhere. 2012, Boston: Harvard Business School Publishing
2.
go back to reference Borraez OA: Manejo del Abdomen Séptico. Utilización del Polivinilo. Avances en Cirugíae e Infección. (Presentations of the XV Congress). 1989, Bogotá: Editorial Medica (Panamericana) Internacional, Colombia Borraez OA: Manejo del Abdomen Séptico. Utilización del Polivinilo. Avances en Cirugíae e Infección. (Presentations of the XV Congress). 1989, Bogotá: Editorial Medica (Panamericana) Internacional, Colombia
3.
go back to reference Kirshtein B, Roy-Shapira A, Lantsberg L, Mizrahi S: Use of the “Bogotá bag” for temporary abdominal closure in patients with secondary peritonitis. Am Surg. 2007, 73 (3): 249-252.PubMed Kirshtein B, Roy-Shapira A, Lantsberg L, Mizrahi S: Use of the “Bogotá bag” for temporary abdominal closure in patients with secondary peritonitis. Am Surg. 2007, 73 (3): 249-252.PubMed
4.
go back to reference Brox-Jimenez A, Ruiz-Luque V, Torres-Arcos C, Parra-Membrives P, Diaz-Gomez D, Gomez-Bujedo L, et al: Experience with the Bogotá bag technique for temporary abdominal closure. Cir Esp. 2007, 82 (3): 150-154. 10.1016/S0009-739X(07)71690-1.PubMedCrossRef Brox-Jimenez A, Ruiz-Luque V, Torres-Arcos C, Parra-Membrives P, Diaz-Gomez D, Gomez-Bujedo L, et al: Experience with the Bogotá bag technique for temporary abdominal closure. Cir Esp. 2007, 82 (3): 150-154. 10.1016/S0009-739X(07)71690-1.PubMedCrossRef
5.
go back to reference Ferrada R, Birolini D: New concepts in the management of patients with penetrating abdominal wounds. Surg Clin North Am. 1999, 79 (6): 1331-1356. 10.1016/S0039-6109(05)70081-5.PubMedCrossRef Ferrada R, Birolini D: New concepts in the management of patients with penetrating abdominal wounds. Surg Clin North Am. 1999, 79 (6): 1331-1356. 10.1016/S0039-6109(05)70081-5.PubMedCrossRef
6.
go back to reference Fernandez L, Norwood S, Roettger R, Wilkins HE: Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma. 1996, 40 (2): 258-260. 10.1097/00005373-199602000-00014.PubMedCrossRef Fernandez L, Norwood S, Roettger R, Wilkins HE: Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma. 1996, 40 (2): 258-260. 10.1097/00005373-199602000-00014.PubMedCrossRef
7.
go back to reference Argenta LC, Morykwas MJ: Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997, 38 (6): 563-576. 10.1097/00000637-199706000-00002.PubMedCrossRef Argenta LC, Morykwas MJ: Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997, 38 (6): 563-576. 10.1097/00000637-199706000-00002.PubMedCrossRef
9.
go back to reference Mayberry JC: Bedside open abdominal surgery. Utility and wound management. Crit Care Clin. 2000, 16 (1): 151-172. 10.1016/S0749-0704(05)70102-0.PubMedCrossRef Mayberry JC: Bedside open abdominal surgery. Utility and wound management. Crit Care Clin. 2000, 16 (1): 151-172. 10.1016/S0749-0704(05)70102-0.PubMedCrossRef
11.
go back to reference Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR: Ilizarov principles of deformity correction. Ann R Coll Surg Engl. 2010, 92: 101-105. 10.1308/003588410X12518836439326.PubMedPubMedCentralCrossRef Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR: Ilizarov principles of deformity correction. Ann R Coll Surg Engl. 2010, 92: 101-105. 10.1308/003588410X12518836439326.PubMedPubMedCentralCrossRef
12.
go back to reference Höntzsch D, Bavonratanavech S: AO Principles of fracture management. 2007, Davos, Switzerland: AO Publishing Höntzsch D, Bavonratanavech S: AO Principles of fracture management. 2007, Davos, Switzerland: AO Publishing
13.
go back to reference Burny F: Elastic external fixation of tibia fractures: a study of 1421 cases. External Fixation: The Current State of the Art. Edited by: Brooker AF, Edwards CC. 1979, London: Williams & Wilkins, 55-73. Burny F: Elastic external fixation of tibia fractures: a study of 1421 cases. External Fixation: The Current State of the Art. Edited by: Brooker AF, Edwards CC. 1979, London: Williams & Wilkins, 55-73.
14.
go back to reference Edwards C: The timing of external fixation. Current concepts of external fixation of fractures. Edited by: Uhthoff HK. 1982, Berlin Heidelberg New York: Springer, 27-42.CrossRef Edwards C: The timing of external fixation. Current concepts of external fixation of fractures. Edited by: Uhthoff HK. 1982, Berlin Heidelberg New York: Springer, 27-42.CrossRef
15.
go back to reference Fernandez A, Masliah R: Modular External Fixation in Emergency. 1991, Montevideo: Ingraf Fernandez A, Masliah R: Modular External Fixation in Emergency. 1991, Montevideo: Ingraf
16.
go back to reference Vidal J, Buscayret C, Coones H: Treatment of articular fractures by “ligamentotaxis” with external fixation. External fixation: the current state of the art. Edited by: Brooker AF, Edwards CC. 1979, London: Williams & Wilkins, 75-82. Vidal J, Buscayret C, Coones H: Treatment of articular fractures by “ligamentotaxis” with external fixation. External fixation: the current state of the art. Edited by: Brooker AF, Edwards CC. 1979, London: Williams & Wilkins, 75-82.
17.
go back to reference Pape HC, Krettek C: Damage control orthopedic surgery. Unfallchirurg. 2003, 106 (2): 85-86. 10.1007/s00113-003-0589-6.PubMedCrossRef Pape HC, Krettek C: Damage control orthopedic surgery. Unfallchirurg. 2003, 106 (2): 85-86. 10.1007/s00113-003-0589-6.PubMedCrossRef
18.
go back to reference Giannoudis PV: Surgical priorities in damage control in polytrauma. J Bone Joint Surg. 2003, 85 (4): 478-483. 10.1302/0301-620X.85B4.14217.CrossRef Giannoudis PV: Surgical priorities in damage control in polytrauma. J Bone Joint Surg. 2003, 85 (4): 478-483. 10.1302/0301-620X.85B4.14217.CrossRef
20.
go back to reference Sung JK, Levin R, Siegel J, et al: Reuse of external fixation components: a randomized trial. J Orthop Trauma. 2008, 22 (2): 126-130. 10.1097/BOT.0b013e318162e55c.PubMedCrossRef Sung JK, Levin R, Siegel J, et al: Reuse of external fixation components: a randomized trial. J Orthop Trauma. 2008, 22 (2): 126-130. 10.1097/BOT.0b013e318162e55c.PubMedCrossRef
21.
go back to reference Dirschl DR, Smith IJ: Reuse of external skeletal fixator components: effects on costs and complications. J Trauma. 1998, 44 (5): 855-858. 10.1097/00005373-199805000-00018.PubMedCrossRef Dirschl DR, Smith IJ: Reuse of external skeletal fixator components: effects on costs and complications. J Trauma. 1998, 44 (5): 855-858. 10.1097/00005373-199805000-00018.PubMedCrossRef
22.
go back to reference Padhi NR, Padhi P: Use of external fixators for open tibial injuries in the rural third world: panacea of the poor?. Injury. 2007, 38 (2): 150-159. 10.1016/j.injury.2006.08.053.PubMedCrossRef Padhi NR, Padhi P: Use of external fixators for open tibial injuries in the rural third world: panacea of the poor?. Injury. 2007, 38 (2): 150-159. 10.1016/j.injury.2006.08.053.PubMedCrossRef
23.
go back to reference Ilizarov GA, Deviatov AA: Surgical lengthening of the shin with simultaneous correction of deformities. Ortop Travmatol Protez. 1969, 30 (3): 32-37.PubMed Ilizarov GA, Deviatov AA: Surgical lengthening of the shin with simultaneous correction of deformities. Ortop Travmatol Protez. 1969, 30 (3): 32-37.PubMed
24.
go back to reference Hakim S: Hydraulic and mechanical mis-matching of valve shunts used in the treatment of hydrocephalus: the need for a servo-valve shunt. Dev Med Child Neurol. 1973, 15 (5): 646-653.PubMedCrossRef Hakim S: Hydraulic and mechanical mis-matching of valve shunts used in the treatment of hydrocephalus: the need for a servo-valve shunt. Dev Med Child Neurol. 1973, 15 (5): 646-653.PubMedCrossRef
26.
go back to reference Warf BJ: Comparison of 1-year outcomes for the Chhabra and Codman-Hakim micro precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg. 2005, 102: 358-362.PubMed Warf BJ: Comparison of 1-year outcomes for the Chhabra and Codman-Hakim micro precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg. 2005, 102: 358-362.PubMed
27.
go back to reference Ruit S, Tabin GC, Nissman SA, Paudyal G, Gurung R: Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal. Ophthalmology. 1999, 106 (10): 1887-1892. 10.1016/S0161-6420(99)90397-4.PubMedCrossRef Ruit S, Tabin GC, Nissman SA, Paudyal G, Gurung R: Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal. Ophthalmology. 1999, 106 (10): 1887-1892. 10.1016/S0161-6420(99)90397-4.PubMedCrossRef
28.
go back to reference Ruit S, Paudyal G, Gurung R, Tabin G, Moran D, Brian G: An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation. Clin Experiment Ophthalmol. 2000, 28 (4): 274-279. 10.1046/j.1442-9071.2000.00316.x.PubMedCrossRef Ruit S, Paudyal G, Gurung R, Tabin G, Moran D, Brian G: An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation. Clin Experiment Ophthalmol. 2000, 28 (4): 274-279. 10.1046/j.1442-9071.2000.00316.x.PubMedCrossRef
29.
go back to reference Ruit S, Tabin G, Chang D, Bajracharya L, Kline DC, Richheimer W, et al: A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007, 143 (1): 32-38. 10.1016/j.ajo.2006.07.023.PubMedCrossRef Ruit S, Tabin G, Chang D, Bajracharya L, Kline DC, Richheimer W, et al: A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007, 143 (1): 32-38. 10.1016/j.ajo.2006.07.023.PubMedCrossRef
30.
go back to reference Amid PK, Shulman AG, Lichtenstein IL: A critical evaluation of the Lichtenstein tension-free hernioplasty. Int Surg. 1994, 79 (1): 76-79.PubMed Amid PK, Shulman AG, Lichtenstein IL: A critical evaluation of the Lichtenstein tension-free hernioplasty. Int Surg. 1994, 79 (1): 76-79.PubMed
31.
go back to reference Horharin P, Wilasrusmee C, Cherudchayaporn K, Pinyaku N, Phanpradi O, Phromsopha N: Comparative study of tailor-made mesh plug herniorrhaphy versus Lichtenstein herniorrhaphy versus Bassini operation: a prospective clinical trial. Asian J Surg. 2006, 29 (2): 74-78. 10.1016/S1015-9584(09)60111-1.PubMedCrossRef Horharin P, Wilasrusmee C, Cherudchayaporn K, Pinyaku N, Phanpradi O, Phromsopha N: Comparative study of tailor-made mesh plug herniorrhaphy versus Lichtenstein herniorrhaphy versus Bassini operation: a prospective clinical trial. Asian J Surg. 2006, 29 (2): 74-78. 10.1016/S1015-9584(09)60111-1.PubMedCrossRef
32.
go back to reference Freudenberg S, Sano D, Ouangré E, Weiss C, Wilhelm TJ: Commercial mesh versus Nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso. World J Surg. 2006, 30 (10): 1784-1789. 10.1007/s00268-006-0108-3.PubMedCrossRef Freudenberg S, Sano D, Ouangré E, Weiss C, Wilhelm TJ: Commercial mesh versus Nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso. World J Surg. 2006, 30 (10): 1784-1789. 10.1007/s00268-006-0108-3.PubMedCrossRef
33.
go back to reference Stock FE: Repair of large herniae with nylon mesh. Lancet. 1954, 263: 395-396. 10.1016/S0140-6736(54)90930-7.CrossRef Stock FE: Repair of large herniae with nylon mesh. Lancet. 1954, 263: 395-396. 10.1016/S0140-6736(54)90930-7.CrossRef
34.
go back to reference Tongaonkar RRB, Mehta VK, Singh NS, Shivade S: Preliminary multicentric trial of cheap indigenous mosquito-net cloth for tension-free hernia repair. Indian J Surg. 2003, 65: 89-95. Tongaonkar RRB, Mehta VK, Singh NS, Shivade S: Preliminary multicentric trial of cheap indigenous mosquito-net cloth for tension-free hernia repair. Indian J Surg. 2003, 65: 89-95.
35.
go back to reference Stephenson BM, Kingsnorth AN: Inguinal hernioplasty using mosquito net mesh in low income countries: an alternative and cost effective prosthesis. BMJ. 2012, 343: d7448-CrossRef Stephenson BM, Kingsnorth AN: Inguinal hernioplasty using mosquito net mesh in low income countries: an alternative and cost effective prosthesis. BMJ. 2012, 343: d7448-CrossRef
36.
go back to reference Yang J, Papandria D, Rhee D, Perry H, Abdullah F: Low-cost mesh for inguinal hernia repair in resource-limited settings. Hernia. 2012, 15 (5): 485-489.CrossRef Yang J, Papandria D, Rhee D, Perry H, Abdullah F: Low-cost mesh for inguinal hernia repair in resource-limited settings. Hernia. 2012, 15 (5): 485-489.CrossRef
37.
go back to reference Sanders DL, Kingsnorth AN, Stephenson BM: Mosquito net mesh for abdominal wall hernioplasty: a comparison of material characteristics with commercial prosthetics. World J Surg. 2013, 37 (4): 737-745. 10.1007/s00268-012-1900-x.PubMedCrossRef Sanders DL, Kingsnorth AN, Stephenson BM: Mosquito net mesh for abdominal wall hernioplasty: a comparison of material characteristics with commercial prosthetics. World J Surg. 2013, 37 (4): 737-745. 10.1007/s00268-012-1900-x.PubMedCrossRef
38.
go back to reference Heimlich HJ: Heimlich flutter valve: effective replacement for drainage bottle. Hosp Top. 1965, 43: 122-PubMed Heimlich HJ: Heimlich flutter valve: effective replacement for drainage bottle. Hosp Top. 1965, 43: 122-PubMed
39.
40.
go back to reference Fuld H: Simple device for control of tension pneumothorax. BMJ. 1944, 2: 503.3- Fuld H: Simple device for control of tension pneumothorax. BMJ. 1944, 2: 503.3-
42.
go back to reference McKenna RJ, Fischel RJ, Brenner M, Gelb AF: Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema. Ann Thorac Surg. 1996, 61 (4): 1215-1217. McKenna RJ, Fischel RJ, Brenner M, Gelb AF: Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema. Ann Thorac Surg. 1996, 61 (4): 1215-1217.
43.
go back to reference Waller DA, Edwards JG, Rajesh PB: A physiological comparison of flutter valve drainage bags and underwater seal systems for postoperative air leaks. Thorax. 1999, 54 (5): 442-443. 10.1136/thx.54.5.442.PubMedPubMedCentralCrossRef Waller DA, Edwards JG, Rajesh PB: A physiological comparison of flutter valve drainage bags and underwater seal systems for postoperative air leaks. Thorax. 1999, 54 (5): 442-443. 10.1136/thx.54.5.442.PubMedPubMedCentralCrossRef
44.
go back to reference Driver AG, Peden JG, Adams HG, Rumley RL: Heimlich valve treatment of Pneumocystis carinii-associated pneumothorax. Chest. 1991, 100: 281-812. 10.1378/chest.100.1.281.PubMedCrossRef Driver AG, Peden JG, Adams HG, Rumley RL: Heimlich valve treatment of Pneumocystis carinii-associated pneumothorax. Chest. 1991, 100: 281-812. 10.1378/chest.100.1.281.PubMedCrossRef
45.
go back to reference Repanshek ZD, Ufberg JW, Vilke GM, Chan TC, Harrigan RA: Alternative Treatments of Pneumothorax. J Emerg Med. 2013, 44 (2): 457-466. 10.1016/j.jemermed.2012.02.049.PubMedCrossRef Repanshek ZD, Ufberg JW, Vilke GM, Chan TC, Harrigan RA: Alternative Treatments of Pneumothorax. J Emerg Med. 2013, 44 (2): 457-466. 10.1016/j.jemermed.2012.02.049.PubMedCrossRef
46.
go back to reference Niemi T, Hannukainen J, Aarnio P: Use of the Heimlich valve for treating pneumothorax. Ann Chir Gynaecol. 1999, 88 (1): 36-37.PubMed Niemi T, Hannukainen J, Aarnio P: Use of the Heimlich valve for treating pneumothorax. Ann Chir Gynaecol. 1999, 88 (1): 36-37.PubMed
47.
go back to reference Campisi P, Voitk AJ: Outpatient treatment of spontaneous pneumothorax in a community hospital using a Heimlich flutter valve: a case series. J Emerg Med. 1997, 15 (1): 125-129. Campisi P, Voitk AJ: Outpatient treatment of spontaneous pneumothorax in a community hospital using a Heimlich flutter valve: a case series. J Emerg Med. 1997, 15 (1): 125-129.
Metadata
Title
Value innovation: an important aspect of global surgical care
Authors
Michael Cotton
Jaymie Ang Henry
Lauren Hasek
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2014
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/1744-8603-10-1

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