Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks

Hallbeck, M. Susan; Lowndes, Bethany R.; McCrory, Bernadette; Morrow, Melissa M.; Kaufman, Kenton R.; LaGrange, Chad A.

doi:10.1016/j.apergo.2017.02.003

Cited by 19 publications

(5 citation statements)

References 82 publications

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“…Some groups are working on defining a standard framework and objective assessment method for ergonomic analysis in laparoscopic surgery. [46][47][48] Taking into account the subjective evaluation regarding the use of 3D imaging systems in urological laparoscopy, improvements in surgical performance and greater comfort for the surgeons have been reported, 23 indicating the suitability of this technology for its use in advanced surgical conditions, in reduced spaces and in complex surgeries. 15 Image quality and depth perception were also positively evaluated with 3D vision systems.…”

Section: Author Evaluation Resultsmentioning

confidence: 99%

Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis

Sánchez‐Margallo

Durán-Rey

Pascual

et al. 2021

Journal of Endourology

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Objective: The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. Methods: A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. Results: A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Conclusions: Three-dimensional laparoscopic systems essentially advance surgical performance in lessexperienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.

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Section: Author Evaluation Resultsmentioning

confidence: 99%

Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis

Sánchez‐Margallo

Durán-Rey

Pascual

et al. 2021

Journal of Endourology

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“…Previous studies have evaluated the kinematics of surgeons during surgery tasks [ 18 , 19 , 20 , 21 , 22 , 23 ], but a detailed analysis of joint angle distribution and joint loads during surgery has not been established yet. To address this need, a validated inertial measurement unit (IMU) system is used to obtain the working postures of surgical trainees [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Load of Neck and Lumbar Joints in Open-Surgery Training

Zhang

Roossien

Verkerke

et al. 2023

Sensors

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The prevalence of musculoskeletal symptoms (MSS) like neck and back pain is high among open-surgery surgeons. Prolonged working in the same posture and unfavourable postures are biomechanical risk factors for developing MSS. Ergonomic devices such as exoskeletons are possible solutions that can reduce muscle and joint load. To design effective exoskeletons for surgeons, one needs to quantify which neck and trunk postures are seen and how much support during actual surgery is required. Hence, this study aimed to establish the biomechanical profile of neck and trunk postures and neck and lumbar joint loads during open surgery (training). Eight surgical trainees volunteered to participate in this research. Neck and trunk segment orientations were recorded using an inertial measurement unit (IMU) system during open surgery (training). Neck and lumbar joint kinematics, joint moments and compression forces were computed using OpenSim modelling software and a musculoskeletal model. Histograms were used to illustrate the joint angle and load distribution of the neck and lumbar joints over time. During open surgery, the neck flexion angle was 71.6% of the total duration in the range of 10~40 degrees, and lumbar flexion was 68.9% of the duration in the range of 10~30 degrees. The normalized neck and lumbar flexion moments were 53.8% and 35.5% of the time in the range of 0.04~0.06 Nm/kg and 0.4~0.6 Nm/kg, respectively. Furthermore, the neck and lumbar compression forces were 32.9% and 38.2% of the time in the range of 2.0~2.5 N/kg and 15~20 N/kg, respectively. In contrast to exoskeletons used for heavy lifting tasks, exoskeletons designed for surgeons exhibit lower support torque requirements while additional degrees of freedom (DOF) are needed to accommodate combinations of neck and trunk postures.

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“…Many studies have demonstrated that LESS is feasible for more complex procedure types (e.g., Nissen Fundoplication), but the technical challenges and learning curve posed by LESS for these procedures makes traditional multi-incision laparoscopy still the preferred technique (McCrory et al, 2014;McCrory, Lowndes, LaGrange, Miller, & Hallbeck, 2013). The primary difficulties faced by surgeons performing LESS are: 1) the path to the target area may be obstructed by other tissue and the instruments may not reach or are inflexible to operate at more extreme angles/positions, 2) multiple instruments are needed simultaneously causing the single insertion point to become constrained, limiting the necessary intracorporeal movements and extracorporeal handling of the instruments, 3) inability to quickly adapt or to positionally fix tools intra-or extracorporeally to aid more complex/advanced procedures, and 4) lack of ergonomically designed and intuitive instruments that facilitate and aide surgeon performance (Brown-Clerk et al, 2011;Hallbeck et al, 2017;Lowndes, Abdelrahman, McCrory, & Hallbeck, 2015;McCrory et al, 2012;Riggle et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Optimizing Surgical Tools for Single-Site Surgery: A Cadaver-Based Design Study

McCrory

Cuevas

Alborano

et al. 2019

Proceedings of the Human Factors and Ergonomics Society Annual

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Background: Laparoendoscopic single site surgery (LESS) is feasible for more complex procedure types, but the technical challenges and learning curve posed by LESS makes traditional multi-incision laparoscopy still the preferred technique. The aims of this study were to understand the restricted mobility and positional requirements of these more complex procedures and to generate innovative instrument designs to overcome these restrictions. Methods: A two-phase study was conducted where three lightly-embalmed (fresh tissue) cadavers were utilized to estimate in vivo mobility restriction and positional requirements. These data were combined to quantifying instrument force and positional requirements to develop a novel design for a LESS-specific grasper. Results: The LESS-specific has an ergonomic curved axial handle and locking mechanism that enables surgeons to relax their grip without the grasper releasing. Conclusion: Further design adaptations are needed to optimize the size, angles, and curvature of the tool, as well as to add two points of articulation for rapid intracorporeal adjustment.

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Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks

Cited by 19 publications

References 82 publications

Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis

Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis

Biomechanical Load of Neck and Lumbar Joints in Open-Surgery Training

Optimizing Surgical Tools for Single-Site Surgery: A Cadaver-Based Design Study

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