Current state of ergonomics of operating rooms of Dutch hospitals in the endoscopic era

Abstract

Laparoscopic procedures are mostly performed in operating rooms which have been designed for conventional surgery. The ergonomic layout of these operating rooms is not suited for endoscopic surgery. This study reports on the current state of ergonomics of Dutch operating rooms for laparoscopic surgery. Number of trolleys, presence of ceiling-mounted booms, and number, positioning and size of monitors were recorded. The floor surface of operating rooms and lowest and highest positions of operating tables were documented. Positioning of the surgical team and monitors during laparoscopic surgery were assessed. Twenty-nine hospitals participated in this study. The average number of trolleys per hospital was 2.4. The mean height of the center of the monitors was 163 cm. Average floor surface of operating rooms was 37.45 m<dformgrp> <dformula> 2 </dformula> </dformgrp>. Only one of the 29 hospitals had a ceiling-mounted boom. The height of operating tables varied between 725 and 1215 mm. The floor space of current operating rooms is too small to allow use of space occupying technological systems. Less than 4% of operating rooms are equipped with permanent monitors mounted on booms. Operating tables cannot be lowered to a position which allows an ergonomic posture of the surgical team.

Ergonomics in the operating room

“…Surgeons’ static pose during minimally invasive operations resulted in increased muscle fatigue, especially in the neck and back [11, 13]. Additionally, insufficient monitor position causes cervical torsion and results in complaints considering the cervical spine and the upper extremities, including the shoulders [19, 20, 23]. Studies have shown that laparoscopic instruments, which are longer than instruments used in open surgery, cause abduction of the arms during manipulation, also resulting in complaints of the neck and shoulders [42, 43].…”

“…These guidelines have led to ergonomic proposals in the operating theatre during minimally invasive surgery. Firstly, two or more monitors should be present, which are adjustable in height to prevent discomfort in the neck [19, 20]. Secondly, special features of endoscopic instruments led to non-ergonomic position of the wrist and fingers and adjusted redesigned instruments should be the preferred choice [18].…”

Ergonomic Considerations of Radical Prostatectomy: Physician Perspective of Open, Laparoscopic, and Robot-Assisted Techniques

“…Consequently, the majority of surgeon strain for these procedures is transmitted to the neck, which is hyperextended to look at the video display while the arms are working at a lower-than optimal height on tables that were initially designed for open procedures. 25 Laparoscopic prostatectomy, however, is quite different, because it requires the surgeon to operate in a craniocaudal (or parallel) axis to the patient. Thus, ports are placed on both sides of the midline and operative work necessitates reaching over the patient and across the midline.…”

A newly designed ergonomic body support for surgeons

“…Because the current operating tables are originally designed for open surgery, they are not optimal for minimally invasive procedures with regard to ergonomic guidelines. The current operating tables are adjustable in height to between 725 and 1,215 mm [2]. A previous study showed that the discomfort and difficulty ratings were lowest when instruments handles were positioned at elbow height of the surgeon [7].…”

“…Additionally, because operating tables were originally designed for open surgery, they are not optimal for minimally invasive procedures. The operating tables are adjustable in height to between 725 and 1,215 mm [2].…”