Page 51 - World Journal of Laparoscopic Surgery

Role of OT Table Height on the Task Performance of Minimal Access Surgery
World Journal of Laparoscopic Surgery, January-April 2008;1(1):49-55
Role of OT Table Height on the Task

Performance of Minimal Access Surgery

Gurvinder Kaur
,
Western Coalfields Ltd Coal Estate, Civil Lines, Nagpur 44001

Abstract: The advent of laparoscopic surgery has changed the concept the United States, it is the psychological and physical interaction
of surgery from prolonged painful to painless, cosmetically satisfying between the user (e.g. surgeon, assistants or nurse) and their
and short stay. In the past few years many instruments have been tools. 1
developed and introduced into the operating room (OR), but there has Since the past fifteen years laparoscopic surgery has
been ongoing debate about the optical ergonomic posture of the become part of the visceral surgery, providing the patient short
operating surgeon. painless and a quick recovery. In the literature laparos-
One of the main ergonomic problem in our currently available
operating room table is that they are designed for the open surgery and copic surgery is in many cases associated with ergonomics
2-4
are not ideal (suitable) for the laparoscopic surgery. Since laparoscopic problems. Infact poor ergonomics has always been one of
surgery requires the use of longer instruments than open surgery, thus the major drawbacks of endoscopic surgery. In the last decade
changing the relation between the height of the surgeon and the desirable or so, many new instruments and devices have been developed
height of the operating room table. for the laparoscopic surgery. The handling of these tools has a
This study aims to understand an ergonomically optimal operating sizeable impact on the length of the procedure in terms of time
table height required for the particular height of the surgeon from the and the overall morbidity. The relationship between the surgeon
floor so that they can perform their surgery comfortably. and the tools also determine how much effort is expended by
The operating table height was defined as the upper level of the the surgeon.
table from the floor. The study was undertaken keeping all other The fatigue and discomfort of the surgeon’s complaints
variables fixed (Elevation angle, Manipulation angle, Azimuth angle, during laparoscopy have led to several studies which investigate
Distance of monitor.) Coaxial alignments were maintained. The only 5-9
variable was the operating room (OR) table height. the origin of the physical problems.
A comparative study of the surgeon’s posture during open
6
Keywords: Ergonomics, Laparoscopy, Operation Table Height. and laparoscopic surgery showed more upright head and back
posture with less body movements during laparoscopic surgery.
Definitions There were significant musculoskeletal complaints of neck and
arms. One study has shown that laparoscopy instruments
Elevation angle: It is an angle between the instrument and the body of causes excessive flexion and ulnar deviation of the surgeon’s
the patient. wrist with abduction of arm during manipulation. 7-10 This
Manipulation angle: It is an angle between the two working ergonomic problem results from the combined effect of the fixed
instruments. point of insertion of the laparoscope through the body wall, a
large external arc of the arm movement due to greater length of
Azimuth angle: It is an angle between the one side of instrument and the instrument and the poorly adjusted operating table height.
the telescope. The Society of American Gastrointestinal Endoscopic
Coaxial alignment: The axis joining the eye of the surgeon, target of Surgeons (SAGES) realized the importance and established a
dissection and the center of monitor. study group for improving the ergonomics in the operating
room. 11-13 DeQuervain pointed out the importance of adjusting
of the table for the positioning of the patients in relation to the
INTRODUCTION surgeon for open surgery. 14-15 In laparoscopic surgery the
Ergonomics is the study (or science) of the interaction between situation differs, since the table cannot be lowered sufficiently
human and their working environment in terms of equipment for precise and relaxed work. To overcome this problem the
design, work place layout the working environment, safety, surgeon compensates by elevating their arms which is
productivity and training. Often called the “human factors” in fatiguing. 16

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