Frugal Exoscope: A Minimal Cost Option for Microsurgery and Training Program in Male Infertility

Abstract

Background: Conventional microscopes and exoscopes currently play pivotal roles in the microsurgery or training for male infertility. However, they are expensive and unaffordable in low-resource settings, which limits training or application of advanced methods. Objectives: To introduce a new, low-cost exoscope system and to determine whether it is an effective frugal innovation. Methods: Using animal models, we evaluated a new frugal exoscope system named DKTA in experimental microsurgery of vas deferens repair. Five experts in male infertility surgery undertook an anonymous survey to elucidate their experience with DKTA system use. Three crucial criteria (i.e., substantial cost reduction, concentration on core functionalities, and optimized performance level) were evaluated to determine whether the DKTA is effective as frugal innovation. The survey used a 5-point Likert scale of responses to eight statements investigating surgical, ergonomic, and educational aspects. Results: The DKTA system, including an optical microscope and ultra-high-definition (UHD) camera (4K), was an exoscope placed between 20 and 40 cm from the surgical field. It was held in position with a camera support arm on casters and connected to a 65-in. smart TV. DKTA system met the three crucial criteria of frugal innovation. Five male infertility microsurgeons reported positive evaluations based on modal scores of the DKTA system when performing experimental vasovasostomy. Conclusions: DKTA system, a frugal innovation, has a valuable contribution to the training program and performance of male infertility microsurgery in low-resource settings.