Ergonomic and gesture performance of robotized instruments for laparoscopic surgery (original) (raw)
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Surgical Endoscopy and Other Interventional Techniques, 2018
Introduction Traditional laparoscopic surgery (TLS) has increasingly been associated with physical muscle strain for the operating surgeon. Robot-assisted laparoscopic surgery (RALS) may offer improved ergonomics. Ergonomics for the surgeon on these two platforms can be compared using surface electromyography (sEMG) to measure muscle activation, and the National Aeronautics and Space Administration Task Load Index (NTLX) survey to assess workload subjectively. Methods Subjects were recruited and divided into groups according to level of expertise in traditional laparoscopic (TLS) and robot-assisted laparoscopic surgery (RALS): novice, traditional laparoscopic surgeons (TL surgeons), robot-assisted laparoscopic surgeons (RAL surgeons). Each subject performed three fundamentals of laparoscopic surgery (FLS) tasks in randomized order while sEMG data were obtained from bilateral biceps, triceps, deltoid, and trapezius muscles. After completing all tasks, subjects completed the NTLX survey. sEMG data normalized to the maximum voluntary contraction of each muscle (MVC%), and NTLX data were compared with unpaired t tests and considered significant with a p ≤ 0.05. Results Muscle activation was higher during TLS compared to RALS in most muscle groups for novices except for the trapezius muscles. Muscle activation scores were also higher for TLS among the groups with more experience, but the differences were less significant. NTLX scores were higher for the TLS platform compared to the RALS platform for novices. Discussion TLS is associated with higher muscle activation in all muscle groups except for trapezius muscles, suggesting greater strain on the surgeon. Increased trapezius muscle activation on RALS has previously been documented and is likely due to the position of the eye piece. The differences seen in muscle activation diminish with increasing levels of expertise. Experience likely mitigates the ergonomic disadvantage of TLS. NTLX survey data suggest there are subjective benefits to RALS, namely in the perception of temporal demand. Further research to correlate NTLX data and sEMG measurements, and to investigate whether these metrics affect patient outcomes is warranted. Keywords Robot-assisted laparoscopic surgery • Laparoscopic surgery • Ergonomics Minimally invasive surgery has become the mainstay in a variety of surgical disciplines. In addition to smaller incisions, laparoscopy has well-documented benefits for patients including shorter length of hospitalization, decreased
Assessment of joystick and wrist control in hand-held articulated laparoscopic prototypes
Surgical Endoscopy, 2012
Background Various steerable instruments with flexible distal tip have been developed for laparoscopic surgery. The problem of steering such instruments, however, remains a challenge, because no study investigated which control method is the most suitable. This study was designed to examine whether thumb (joystick) or wrist control method is designated for prototypes of steerable instruments by means of motion analysis. Methods Five experts and 12 novices participated. Each participant performed a needle-driving task in three directions (right ? left, up ? down, and down ? up) with two prototypes (wrist and thumb) and a conventional instrument. Novices performed the tasks in three sessions, whereas experts performed one session only. The order of performing the tasks was determined by Latin squares design. Assessment of performance was done by means of five motion analysis parameters, a newly developed matrix for assigning penalty points, and a questionnaire. Results The thumb-controlled prototype outperformed the wrist-controlled prototype. Comparison of the results obtained in each task showed that regarding penalty points, the up ? down task was the most difficult to perform. Conclusions The thumb control is more suitable for steerable instruments than the wrist control. To avoid uncontrolled movements and difficulties with applying forces to the tissue while keeping the tip of the instrument at the constant angle, adding a ''locking'' feature is necessary. It is advisable not to perform the needle driving task in the up ? down direction.
Application of a motion capture data glove for hand and wrist ergonomic analysis during laparoscopy
Minimally Invasive Therapy & Allied Technologies, 2014
Objectives: This study aims to analyze the surgeons' hand spatial configuration during the use of two different instrument handles for laparoscopy, by obtaining information from the data glove CyberGlove Ò , and establishing existing risk levels for wrist disorders. Material and methods: Fifty surgeons participated in this study and were distributed into three groups (novices, intermediate and experts). Each subject carried out suturing and dissection tasks on a physical simulator, using axialhandled or ring-handled instruments, respectively. Hand and wrist positions were registered by the CyberGlove Ò and a modified RULA method was applied to establish appropriate risk levels for wrist disorders. Results: We found statistically significant differences in seven of the eleven glove sensors when comparing both tasks. RULA method showed that all subjects, with the exception of the experts using an axial-handled instrument, assume a prejudicial wrist posture during the practice of suturing and dissection tasks on the simulator. Conclusions: Data glove CyberGlove Ò allows for the distinction between two laparoscopic exercises performed with different instruments. Also, laparoscopic intracorporeal suturing when performed with an axial-handled needle holder entails a more ergonomic posture for the wrist joint. Previous minimally invasive surgical experience is a positive influencing factor on the surgeons' wrist postures during laparoscopy.
Advanced Ergonomics in Laparoscopic Surgery
2019
Applied ergonomics is very important in minimally invasive surgery (MIS), especially with the introduction of robotized techniques that have changed the surgeons’ work conditions. However, the main aim remains the engineering to enable the compatibility of fulfillment of surgeons’ tasks in a physical, logical, and organizational environment with security, comfort, and efficiency. Ergonomics contribution is oriented both to design and redesign utilized material and to work organization. Epidemiological studies have shown the appearance of musculoskeletal pathologies in surgeons performing MIS; therefore, it is relevant to identify the intensity, frequency, and duration of risk factors (posture, repeatability, level of effort, touch pressure, and vibration if relevant) associated with this profession. A further relevant consequence of the effort applied during MIS is local muscle fatigue (LMF), an important factor to consider in musculoskeletal pathologies. The aim of this chapter is ...
Human Factors Refinement of a Multimodal Laparoscopic Hand Tool
2019 Design of Medical Devices Conference, 2019
Laparoscopic surgery offers multiple clinical advantages over open surgical procedures. The rise in adoption of laparoscopic surgery brings with it unique human factors challenges for surgeons and device developers. The design of laparoscopic surgical tools requires specialized human factors analysis and ergonomic considerations to overcome these challenges. Often, this necessary ergonomic design refinement is a secondary effort after proof-of-concept engineering prototypes demonstrate technological feasibility. In this paper, the evaluation and redesign of an engineering proof-of-concept multimodal hand tool, is presented. The baseline design, a three-in-one laparoscopic hand tool for liver resection, merged three distinct devices into one integrated solution for dissection, vessel sealing, and tissue cautery. The work described herein evolves the initial prototype using a multifaceted human factors analysis and design process. This included the use of operating room and laboratory contextual inquiry, simulated use studies, anthropometric underlays, an iterative design process, and expert reviews. The revised design reduced ulnar deviation based on directed hand position via design, provided dual grip options, added over-molded interaction points, incorporated end-effector rotation, and implemented a new handle and controls layout based on anthropometric underlays. The outcome reinforces the notion that human factors and industrial design principles are required elements of a successful user centered design process.
Ergonomics in Laparoscopic Surgery
Laparoscopic Surgery, 2017
Despite the many advantages for patients, laparoscopic surgery entails certain ergonomic inconveniences for surgeons, which may result in decreasing the surgeons' performance and musculoskeletal disorders. In this chapter, the current status of ergonomics in laparoscopy, laparoendoscopic single-site surgery (LESS), and robotassisted surgery will be reviewed. Ergonomic guidelines for laparoscopic surgical practice and methods for ergonomic assessment in surgery will be described. Results will be based on the scientific literature and our experience. Results showed that the surgeon's posture during laparoscopic surgery is mainly affected by the static body postures, the height of the operating table, the design of the surgical instruments, the position of the main screen, and the use of foot pedals. Ergonomics during the laparoscopic surgical practice is related to the level of experience. Better ergonomic conditions entail an improvement in task performance. Laparoscopic instruments with axial handle lead to a more ergonomic posture for the wrist compared to a ring handle. LESS is physically more demanding than conventional and hybrid approaches, requiring greater level of muscular activity in the back and arm muscles, but better wrist position compared with traditional laparoscopy. Physical and cognitive ergonomics with robotic assistance were significantly less challenging when compared to conventional laparoscopic surgery.
Laparoscopy’s Gestures Assessment: A Construct Study for the Validation of an Instrumented Glove
Proceedings
The GIBIC research team, from UdeA, and S4M from LAAS-CNRS, designed a glove with inertial sensors (IMU) for quantifying surgeons’ dexterity. A previous study validated its capacity to accurately rank participants, compared to a video evaluation, during neurosurgery training. The objective of this work is to check this validity for laparoscopic surgery, compared with a “gold-standard” simulator, the LapSim (Surgical Science®). For this purpose, the inertial basic data of the sensors were processed into quantified score comparable with the LapSim scores. A trial was designed and conducted during one month with nine students training on specific LapSim tasks.
Implementation and evaluation of a gesture-based input method in robotic surgery
2011
The introduction of robotic master-slave systems for minimally invasive surgery has created new opportunities in assisting surgeons with partial or fully autonomous functions. While autonomy is an ongoing field of research, the question of how the growing number of offered features can be triggered in a time-saving manner at the master console is not well investigated. We have implemented a gesturebased user interface, whereas the haptic input devices that are commonly used to control the surgical instruments, are used to trigger actions. Intuitive and customizable gestures are learned by the system once, linked to a certain command, and recalled during operation as the gesture is presented by the surgeon. Experimental user studies with 24 participants have been conducted to evaluate the efficiency, accuracy and user experience of this input method compared to a traditional menu. The results have shown the potential of gesture-based input, especially in terms of time savings and enhanced user experience.
Analysis of selected ergonomic problems in the use of surgical laparoscopic tools
2013
The article demonstrates the important problematic areas associated to the ergonomics of surgical instruments during their usage. For this purpose, an analysis of cholecystectomy surgery with the use of laparoscopic instruments was conducted. There was identified the individual operations performed by surgeon, as well as the particular laparoscopic instruments. The prepared in this way study material, allowed for evaluation of design features of tools used in laparoscopic surgery from functional and ergonomic point of view and developing special research procedure for ergonomic assessment. Particularly, the critical states within the selected body postures in the system were identified: an operator (surgeon) and a surgical tool, as well as the areas of ergonomics corrective intervention in the process of using laparoscopic instruments.