Abstract
BackgroundLaparoscopic surgery potentially increases the physical burden to operating theater personnel and can cause physical discomfort. This study aims to evaluate if a robotic camera holder (AutoLap™ system) can improve ergonomics for the surgeon and the camera assistant during laparoscopic procedures.MethodsA total of thirty cases were included and randomized (15 AutoLap™, 15 control). Five types of surgery were included: right hemicolectomy, fundoplication, sigmoid resection, rectopexy, and low anterior resection. The posture of the surgeon and assistant was photographed during predefined steps of the procedure. MATLAB was used to calculate angles relevant for the RULA score. The RULA score is a validated method to evaluate body posture, force and repetition of the upper extremities. Two investigators assessed the RULA score independently. Three subjective questionnaires (SMEQ, NASA TLX, and LED) were used to assess mental and physical discomfort.ResultsNo differences in patient characteristics were observed. Sixteen fundoplications, seven right hemicolectomies, five sigmoid resections, one rectopexy, and one low anterior resection were included. The mean RULA score of the surgeon was comparable in both groups, 2.58 (AutoLap™) versus 2.72 (control). The mean RULA score of the assistant was significantly different in both groups, with 2.55 (AutoLap™) versus 3.70 (control) (p = 0.001). The inter-observer variability (ICC) was excellent with 0.93 (surgeon) and 0.97 (assistant). The questionnaires showed a significant difference in physical discomfort for the assistant. The LED and SMEQ score were significantly lower in the robotic group. The NASA TLX demonstrated a significant reduction in scores in all domains when using robotics with the exception of the mental domain.ConclusionUse of the AutoLap™ system shows improvement in ergonomics and posture of the first assistant, and ergonomics of the surgeon are not affected. Furthermore, the subjective work load is significantly reduced by using a robotic camera holder.Trial registration numberNCT0339960, https://clinicaltrials.gov/ct2/show/study/NCT03339960?term=autolap&rank=5.
Highlights
Laparoscopic surgery potentially increases the physical burden to operating theater personnel and can cause physical discomfort
The subjective work load is significantly reduced by using a robotic camera holder
All with extensive laparoscopic experience and well trained with the AutoLapTM system, performed all surgical procedures. 17 cases were performed in the Meander Medical and 13 cases were performed in the Wilhelmina Hospital
Summary
Laparoscopic surgery potentially increases the physical burden to operating theater personnel and can cause physical discomfort. This study aims to evaluate if a robotic camera holder (AutoLapTM system) can improve ergonomics for the surgeon and the camera assistant during laparoscopic procedures. Three subjective questionnaires (SMEQ, NASA TLX, and LED) were used to assess mental and physical discomfort. The mean RULA score of the surgeon was comparable in both groups, 2.58 (AutoLapTM) versus 2.72 (control). The mean RULA score of the assistant was significantly different in both groups, with 2.55 (AutoLapTM) versus 3.70 (control) (p = 0.001). The questionnaires showed a significant difference in physical discomfort for the assistant. The ergonomics of the first assistant are frequently compromised while displaying an optimal image for the surgeon This is usually caused by standing outside the central working axis causing torsion in the back and asymmetrical burden to legs and shoulders.
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