Assessment of the Ergonomically Optimal Operating Surface Height for Laparoscopic Surgery

Abstract

Purpose: The aim of this study was to find the ergonomically optimal operating surface height for laparoscopic surgery in order to reduce discomfort in the upper extremities of the operators and the assistants. The operating surface height was defined as the level of the abdominal wall of a patient with pneumoperitoneum.Materials and Methods: Two pelvi-trainer tests were performed. One test was performed on six different operating surface heights. The (extreme) joint excursions of the shoulder, elbow, and wrist were measured by a video analysis method. Another test was performed by holding a laparoscope for 15 minutes while an electromyelograph of the biceps brachii was made. The results of both tests were evaluated subjectively by a questionnaire.Results: The ergonomically optimal operating surface height lies between a factor 0.7 and 0.8 of the elbow height of the operator/assistant. At this height, the joint excursions stay in the neutral zone for more than 90% of the total manipulation time, and the activity of the biceps brachii when holding the laparoscope stays within 15% of the maximum muscle activity.Conclusions: The operating surface height influences the (extreme) upper joint excursions of the surgeon. The ergonomically optimal operating surface height reduces the discomfort in the shoulders, back, and wrists of the surgeon during laparoscopic surgery. This optimal table height range for laparoscopic surgery is lower than those currently available.

The trainees’ pain with laparoscopic surgery: what do trainees really know about theatre set-up and how this impacts their health

“…As the monitor is often placed on top of a trolley of fixed height, this would disadvantage a shorter surgeon, likely a female whose neck would be extended in viewing the monitor, leading ultimately to neck strain. In addition, as operating tables have traditionally been designed for open surgery, they are not optimal for laparoscopic procedures with the lowest height that most operating tables can be lowered to being only 725 mm, again disadvantaging the usually shorter female surgeon [8]. As our survey shows that female trainees are significantly shorter than their male counterparts, they will be automatically exposed to a greater risk of musculoskeletal injury during laparoscopic procedures.…”

Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons

“…More detailed guidelines for different variables in the operating room are stated concerning the table height [4,9,11,16], the monitor placement [8,9,13,[15][16][17], the instrument's handle design [1,3,5,10,16], the foot pedals [20], and the physical discomfort of the operating team [2,10,12,18,19]. Still, the question is whether these guidelines are known and used.…”

Spine surgeon’s kinematics during discectomy according to operating table height and the methods to visualize the surgical field

“…In terms of operating table height, an optimum table height for laparoscopic surgery should position the laparoscopic instrument handles close to the surgeon's elbow level to minimize discomfort and upper arm and shoulder muscle work [11,22]. In this study, we set the highest table height at the midpoint between the umbilicus and sternum (U-S), which is usually at elbow level.…”