Higher physical workload risks with NOTES versus laparoscopy: a quantitative ergonomic assessment (original) (raw)
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A Comparison of the Physical Effort Required for Laparoscopic and Open Surgical Techniques
Archives of Surgery, 2003
Performing complex tasks requires greater muscle effort with laparoscopic instruments than with open surgical instruments. Design: A nonrandomized 2-condition trial. Setting: A semienclosed ergonomics station in the exhibit hall at the Annual Meeting of the Society of American Gastrointestinal Endoscopic Surgeons. Subjects: Twenty-one surgeons volunteered to participate in the study. Interventions: Knot tying during 90 seconds, performed first using a laparoscopic technique (ie, axial instruments in a standard laparoscopic trainer) and then using an open technique (ie, 2 hemostats). Main Outcome Measures: Mean and peak surface elec-tromyographic (EMG) signals collected from the thenar compartment, the flexor digitorum superficialis, and the deltoid muscles of the dominant arm. Results: Compared with open knot-tying, laparoscopic tasks resulted in higher average EMG amplitudes in all 3 muscles (thumb, P =.02; forearm flexor, P=.01; and deltoid, P=.01) and higher peak EMG in the thumb (P=.04) and deltoid (P=.02) muscles. Body part discomfort scores were significantly higher during laparoscopic knot-tying for the forearm flexor and deltoid muscles (P=.02 for both). Conclusion: Complex manipulative tasks using laparoscopic techniques require substantially higher upperextremity muscle effort compared with open surgical techniques.
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
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 ...
The Physical Workload of Surgeons: A Comparison of SILS and Conventional Laparoscopy
Surgical innovation, 2015
As extensively reported in the literature, laparoscopic surgery has many advantages for the patient. Surgeons, however, experience increased physical burden when laparoscopic surgery is compared with open surgery. Single-incision laparoscopic surgery (SILS) has been said to further enhance the patient's benefits of endoscopic surgery. Because in this surgical technique only 1 incision is made instead of the 3 to 5, as in conventional laparoscopic surgery (CLS), it is claimed to further reduce discomfort and pain in patients. Yet little is known about its impact on surgeons. This study aims to contribute by indicating the possible differences in physical workload between single-incision laparoscopy and CLS. A laparoscopic box trainer was used to simulate a surgical setting. Participants performed 2 series of 3 different tasks in the box: one in the conventional way, the other through SILS. Surface electromyography was recorded from 8 muscles bilaterally. Furthermore, questionnair...
Surgical endoscopy, 2018
Our aim was to determine how objectively-measured and self-reported muscle effort and fatigue of the upper-limb differ between surgeons performing laparoscopic (LAP) and robotic-assisted (ROBOT) surgeries. Surgeons performing LAP or ROBOT procedures at a single-institution were enrolled. Objective muscle activation and self-reported fatigue were evaluated, and comparisons were made between approaches. Muscle activation of the upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis (FCR), and extensor digitorum (ED) were recorded during the surgical procedure using Trigno wireless surface electromyography (EMG). The maximal voluntary contraction (MVC) was obtained to normalize root-mean-square muscle activation as %MVC. The median frequency (MDF) was calculated to assess muscle fatigue. Each surgeon also completed the validated Piper Fatigue Scale-12 (PFH-12) before and after the procedure for self-perceived fatigue assessment. Statistical analysis was done using SAS/STAT ...
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.
Operative laparoscopy has changed the concept of surgery from prolonged painful recuperative periods with long scars of open surgery to short stay, painless, and cosmetically satisfying surgery. This has been achieved at the expense of surgeons′ discomfort and fatigue, thus putting both the surgeon and patient at risk. Inadequate knowledge about ergonomics together with ergonomically deficient design of laparoscopic instruments has been cited as possible causes. This paper reviews the various ergonomic variables and recommendations to make laparoscopic surgery safer.