Ergonomics Of Laparoscopic Surgery Research Articles

Impact of Ergonomics in Laparoscopic Surgery on Surgeon Health: An Analytical Study

Impact of Ergonomics in Laparoscopic Surgery on Surgeon Health: An Analytical Study

Ergonomics in laparoscopic surgery

Ergonomics in laparoscopic surgery

P-BN48 Utilising spatial geometry to obtain the ideal needle mount for laparoscopic intracorporeal suturing

Abstract Background Intracorporeal suturing is an essential component of any advanced laparoscopic procedure like fundoplication, bypass surgery or common bile duct exploration. Obtaining the appropriate needle mount during suturing can be challenging. Spatial geometry defines points in three-dimensional space. Ergonomics in laparoscopic surgery identifies a manipulation angle of 60o to target as being optimal. This knowledge, in combination with the principles of light reflection can be used to understand needle orientation in laparoscopic suturing. Methods An experiment was designed on a laparoscopic trainer with three participants. Using the principles of spatial geometry and light reflection, four different points were identified on an angle chart and labelled for a right-hand dominant participant as; centre, right off-centre (5.5cm), right lateral (10 cm) and left off-centre (5.5cm). Each participant was instructed to mount the needle at the defined points using light reflection on the needle shaft as a reference guide. Three readings were taken for each position. Mounted angle was defined as the angle between the shaft of needle holder and long axis of the needle. This was measured using a special application and an average value determined for each position. Results The average values for the mounted angle measurements for each spatial position were: Centre(112o), Right off centre(101o), Right lateral (88.8o) and Left off centre (124.6o). Conclusions This study describes a novel and reproducible technique to obtain an ideal needle mount. For a needle mount greater than 100o either the centre position or the left off-centre position should be considered.

Ergonomics in Laparoscopic Surgery: The Case Study in Hospitals of Tehran University of Medical Sciences

Ergonomics in Laparoscopic Surgery: The Case Study in Hospitals of Tehran University of Medical Sciences

19 - The Ergonomics of Laparoscopic Surgery: a Quantitative Study of the Time and Motion of Laparoscopic Surgeons in Live Surgical Environments

19 - The Ergonomics of Laparoscopic Surgery: a Quantitative Study of the Time and Motion of Laparoscopic Surgeons in Live Surgical Environments

Improving Precision in Navigating Laparoscopic Surgery Instruments toward a Planar Target Using Haptic and Visual Feedback

The poor ergonomics of laparoscopic surgery are a widely recognized source of difficulty for surgeons, leading to sub-optimal surgeon performance and sometimes injury to the patient. The main causes for this are lost and distorted perception of interaction forces and instrument position. The latter, due to losses in visual and kinaesthetic depth perception and modified hand-eye coordination, can prevent precise navigation of instruments towards surgical targets or away from sensitive anatomic structures. This situation prompts us to explore methods for efficiently assisting the surgeon during instrument navigation. Here, we present experiments aimed at providing insights into the effectiveness of haptic (tactile and kinaesthetic), visual and combined feedback in assisting the navigation of a laparoscopic instrument tip towards a surgical target. Subjects placed in front of a laparoscopic trainer were tasked with following various instrument tip trajectories within a target plane while minimizing both deviations and task execution times. Feedback on the level of deviation was provided alternately through visual on-screen cues, tactile cues provided by vibration motors and / or kinaesthetic cues provided by a haptic interface co-manipulating the surgical instrument. Evaluations of these forms of feedback over two series of experiments implicating a total of 35 subjects (34 non-surgeon novices, 1 surgeon intern with experience in laparoscopy) show positive impacts of providing such feedback on precision in instrument navigation. Visual, tactile and combined cues lead to increased precision in navigation (up to 25\% increase in time spent on target, and 32\% reduction in deviation amplitudes), but usually at the cost of reduced task execution speed. However, the use of kinaesthetic feedback through soft virtual fixtures provided in a co-manipulated robot-assisted surgery set-up both significantly improved precision (32\% increase in time spent on target, and 70\% reduction in deviation amplitudes) and task execution speed (30\% reduction in task completion times). The combination of visual and tactile feedback was shown to be helpful in correcting larger deviations from the target. These preliminary results are promising for implementation of low-cost tactile or combined visual and tactile feedback in applications to conventional laparoscopic instrument navigation, as well as to robot-assisted laparoscopic surgery.

The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments.

Laparoscopic surgery presents multiple ergonomic difficulties for the surgeon, requiring awkward body postures and prolonged static muscle loading that increases risk of musculoskeletal strain and injury. This prospective study quantitatively measures the biomechanical movements of surgeons during laparoscopic procedures to determine at-risk movements from prolonged static muscle loading and repetitive motions that may lead to injury. A total of 150 video recordings of 18 surgeons, standing at the patient's left, were captured from three fixed camera positions during live gynecological laparoscopic surgery. Postoperative processing quantified surgeon movements at the neck, shoulders and elbows using computer software to measure extreme joint angles and time spent within defined joint angle ranges. Surgeons spent a median of 98% (range 77-100%) of surgical time with their neck rotated at 21° (range 0°-52°). The non-dominant arm was subjected to more extreme positions for significantly longer periods of time compared to the dominant, with shoulder flexion at 45°-90° for 35 vs. 0% (p<0.001) and elbow flexion at >120° for 31 vs. 0% (p<0.001) of total surgical time. Procedures involving power morcellation required significantly greater number of instrument insertion/removals-119 (range 56-182) compared with 12 (range 2-122) when morcellation was not used (p<0.001). Shorter surgeons maintained significantly greater degrees of neck rotation when viewing the monitor (p<0.003) and surgeons with shorter arm lengths spent longer in extreme positions with their non-dominant shoulder at >90° (p=0.04) and elbow at >120° (p<0.001) compared with taller surgeons. No significant correlations were found between BMI or surgical experience and more extreme joint positions. Four primary areas have been identified where surgeons are consistently demonstrating movements that increase their risk of harm: (1) extended periods of neck rotation; (2) asymmetrical loading between the dominant and non-dominant shoulders; (3) power morcellation and frequent insertions/removals of laparoscopic instruments resulting in repetitions of the most extreme shoulder positions and (4) a negative correlation between height and percentage time spent in more extreme positions.

Ergonomics in Laparoscopic Surgery--A Survey of Symptoms and Contributing Factors.

We aimed to investigate physical/cognitive symptoms experienced by clinicians undertaking laparoscopic surgery (LS) in relation to demographics, operating factors, and instruments. Fifty trainees/consultants practicing LS in Southeast England completed a 17-question survey. Results were analyzed using nonparametric tests of metric, ordinal, and binomial data. Forty-five percent of respondents reported moderate/severe symptoms during long cases (>2 h). Worse neck/shoulder (N=45, P=0.01), back (N=44, P=0.002), and fatigue/irritability (N=42, P=0.02) symptoms were reported for long (vs. short) cases. Assistants reported worse back symptoms than principle operators (N=43, P=0.02, long cases). Females (vs. males), glove size ≤6.5 (vs. ≥7.0), and experience ≤5years (vs. 5 to 10, >10 y) reported worse symptoms relating to handle dimensions (N=45, P=0.004, 0.001, 0.01, respectively). Ninety-six percent believe ergonomics should be incorporated into LS courses. Principle and assistant surgeons experience adverse symptoms during LS; ergonomics training and handles dimensions, accommodating female surgeons, and smaller glove sizes may reduce this.

The Ergonomics of Laparoscopic Surgery in Live Surgical Environments

The Ergonomics of Laparoscopic Surgery in Live Surgical Environments

Development of an arm support system to improve ergonomics in laparoscopic surgery: study design and provisional results

BackgroundLaparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder–neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operation room settings.MethodsA systematic approach to develop an ASsyst started in October 2012 consisting of five consecutive steps. In step 1, 14 laparoscopic interventions were observed using subjective and objective measures to determine key indicators for the conception of an ASsyst in LS. In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods. During the third step, prototypes of ASsyst were tested in an experimental setting. Steps 4 and 5 are currently in process and include the final development of the ASsyst using the most promising concept for the evaluation during simulated LS.ResultsIncreased levels of physical stress were found in LS. Asymmetric strains were common. Three prototypes of ASsyst emerged from step 1 and 2. These prototypes were a cable construction with a noose for the lower arm, a support from below the elbow and a pneumatic vest supporting the upper arm. The experimental testing of these prototypes demonstrated reduced physical stress when compared to the unsupported environment. The support from below the elbow seemed to be the most practical in terms of implementation in various operation room settings and acceptance by surgeons. Step 4 and 5 are still in process.ConclusionsErgonomic problems have been identified in LS that could be addressed by an ASsyst. The concept of supporting the elbow from below has been found to be the most promising approach.

Ergonomics in laparoscopic surgery

Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comfortable in the operating room but also reduce physical strains on surgeon.

Ergonomic testing of two different types of handles via virtual reality simulation

Ergonomics in laparoscopic surgery is an unsolved problem. Deficiencies of the instrument handles are well-known and described in several reports and studies. Today, virtual training modules for laparoscopic surgery are available. The aim of this study was to evaluate the ability of a virtual reality (VR) simulator to determine the ergonomic properties of two different laparoscopic instrument handles. Two different types of handles, a ring and an axial handle from Richard Wolf, were used to perform the short clip and cut task of the Xitact 500 LS simulator. The task was repeated every 2 days for a period of 5 weeks. After every trial the volunteers were asked structured questions about their preferences while using the two handles. The axial handle was superior or equal to the ring handle in all criteria. Learning curves over the entire time and day by day were similar. No differences were found for travel distances and error rates, but task times were different for both handles. The subjects preferred the axial handle at the end of the study. It is possible to determine differences in ergonomics of handle design with a VR trainer. In this study, the Richard Wolf axial handle was superior to the ring handle.

Assessment of ergonomics in laparoscopic surgery

At Delft University designers are educated to design 'products for people'. Therefore the field of ergonomics has been divided along the human functions: physical, sensorial and cognitive ergonomics. This article gives an overview of the assessment of these aspects of ergonomics in laparoscopic surgery. It is concluded that a systematic approach is needed, in which knowledge that has already been accumulated for different workplaces (for example, in industry) is applied to the surgeon's circumstances. Such an approach would lead to a set of objectively testable ergonomic requirements for all kinds of products that are used by surgeons in the operating room.