Frugal Innovation: A Modified Conduit to Enhance the Utility of Semirigid Thoracoscopy

The landscape of modern healthcare is becoming increasingly complex, with rising costs of diagnostic and therapeutic interventions. In low- and middle-income countries, such as India, affordability remains a major barrier to accessing advanced medical care. The All India Institute of Medical Sciences (AIIMS), Patna, India, was established with the aim of providing high-quality care at minimal cost, ensuring access even for the most underserved patients. Medical thoracoscopy is an invaluable diagnostic and therapeutic procedure for pleural diseases. Semirigid thoracoscopes, such as the Olympus EVIS EXERA LTF-160 (Olympus America, Center Valley, PA, USA), allow direct visualization and biopsy of pleural pathology under local anesthesia. However, their use is restricted in resource-limited settings due to the high cost of proprietary accessories, specifically the single-use trocar and cannula systems (e.g., Olympus MAJ-1058, Olympus Medical Systems Corp., Tokyo, Japan), which are not economically viable for repeated use in underfunded public healthcare systems. To address this challenge, we developed a frugal and functional innovation to replace the proprietary trocar-cannula system. This system integrates a reusable surgical accessory with a nonreusable medical device to substitute for the costly, manufacturer-provided single-use accessory. This report presents the technique, cost-benefit analysis, and preliminary safety evaluation of this innovation in clinical use.