Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy

Vereczkei, András; Feußner, H.; Negele, Thomas; Fritzsche, Florian; Seitz, T.; Bubb, Heiner; Horváth, Örs Péter

doi:10.1007/s00464-003-9157-y

Cited by 54 publications

(43 citation statements)

References 12 publications

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“…The side-standing position was associated with increased upper-arm flexion and abduction, shoulder elevation, neck flexion, and twisting. As was the case in a prior study [27], increases in trunk side-bending and flexion were confirmed. It is often assumed that laparoscopy is associated with greater wrist Fig.…”

Section: Discussionsupporting

confidence: 75%

Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position

et al. 2011

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Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for the surgeon. Though further investigations should be conducted, adopting the between-standing position deserves serious consideration as it may be the best short-term ergonomic alternative.

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Section: Discussionsupporting

confidence: 75%

Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position

et al. 2011

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“…Complaints concerning the neck and back can be caused by an uncomfortable and static posture in relation to the position of the monitor. Studies examining the most comfortable posture advise a viewing direction straight ahead and at a slightly downward angle [9,12,20]. In this monitor configuration, the working posture is the most neutral.…”

Section: Discussionmentioning

confidence: 99%

“…Due to this positioning, the line of vision is diverted away from the line of action, creating an awkward posture including rotation of the spine, extension of the neck, and elevation of the upper extremities. This causes musculoskeletal complaints and possibly compromises surgical task performance [9][10][11][12].…”

mentioning

confidence: 99%

Ergonomic assessment of neck posture in the minimally invasive surgery suite during laparoscopic cholecystectomy

et al. 2008

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Background With the expanding implementation of minimally invasive surgery, the operating team is confronted with challenges in the field of ergonomics. Visual feedback is derived from a monitor placed outside the operating field. This crossover trial was conducted to evaluate and compare neck posture in relation to monitor position in a dedicated minimally invasive surgery (MIS) suite and a conventional operating room. Methods Assessment of the neck was conducted for 16 surgeons, assisting surgeons, and scrub nurses performing a laparoscopic cholecystectomy in both types of operating room. Flexion and rotation of the cervical spine were measured intraoperatively using a video analysis system. A two-question visual analog scale (VAS) questionnaire was used to evaluate posture in relation to the monitor position. Results Neck rotation was significantly reduced in the MIS suite for the surgeon (p = 0.018) and the assisting surgeon (p \ 0.001). Neck flexion was significantly improved in the MIS suite for the surgeon (p \ 0.001) and the scrub nurse (p = 0.018). On the questionnaire, the operating room team scored their posture significantly higher in the MIS suite and also indicated fewer musculoskeletal complaints.Conclusions The ergonomic quality of the neck posture is significantly improved in the MIS suite for the entire operating room team.Keywords Ergonomics Á Laparoscopic cholecystectomy Á Minimally invasive surgery Á Neck Á Operating room Á Posture Minimally invasive surgery (MIS) plays a major part in modern abdominal surgery, urology, and gynecology and has become the treatment of choice for a still growing number of procedures. Most of the advantages with MIS are patient related. Less blood loss, less postoperative pain, shorter hospital admissions, quicker reintroduction into society, and a superior cosmetic result are some wellestablished MIS advantages [1][2][3][4].On the other hand, MIS confronts the surgeon and his or her team with some challenging aspects, primarily in the area of ergonomics and efficiency [5,6]. The necessity of additional equipment-including electrocautery and insufflation devices, monitors, video equipment, wiring, and tubing, usually stored outside the operating room on large heavy trolleys-has compromised operating room efficiency and prolonged turnover times [7].During the procedure, the surgeon must work with long instruments that move invertedly inside the abdomen and with a certain scaling effect, also known as the fulcrum effect [8]. The entire operating team derives the visual feedback of their actions from a monitor positioned on top of a laparoscopic trolley that stands outside the operative field and away from the patient. Due to this positioning, the

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“…The unusual posture of upper limbs combined with the weak mechanical efficiency (friction) in the opening mechanism of instruments are reported to increase muscles recruitment. This overall lack of ergonomics in laparoscopy is at the source of pain and feeling of discomfort [2], [3], [6]. Most of these aches are due to the increase of muscular efforts in the upper limb.…”

Section: Introductionmentioning

confidence: 99%

“…Several reasons are pointed out: 2D monoscopic vision on screen, indirect vision of hands and unnatural line of sight, inversion and variable scaling of motions, reduced intra-abdominal mobility due to the fulcrum effect of the small incisions [1]- [3].…”

Section: Introductionmentioning

confidence: 99%

Ergonomic and gesture performance of robotized instruments for laparoscopic surgery

Herman

Zahraee

Szewczyk

et al. 2011

2011 IEEE/RSJ International Conference on Intelligent Robots and Systems

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Abstract-Shape and mechanical structure of instruments play a large part in the lack of ergonomics during laparoscopic surgery. Providing intra-abdominal mobility and rethinking handles design are two solutions to increase comfort and precision of gestures. Based on previous work that determined the optimal intra-abdominal kinematics, this study analyses the influence of handle design on both gesture and ergonomic performance. A virtual reality laparoscopic simulator was developed to perform an experimental comparison between two novel robotized instruments and standard ones. A group of 10 surgeons and 6 researchers in robotics carried out two representative surgical tasks with each instrument. Based on instrument and arm segments tracking, a gesture performance index and an ergonomic performance index were computed. The study demonstrates that distal mobilities combined with improved handle design and integration increase ergonomic level during laparoscopy and facilitate complex gestures.

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Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy

Cited by 54 publications

References 12 publications

Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position

Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position

Ergonomic assessment of neck posture in the minimally invasive surgery suite during laparoscopic cholecystectomy

Ergonomic and gesture performance of robotized instruments for laparoscopic surgery

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