Page 52 - World Journal of Laparoscopic Surgery

Gurvinder Kaur

Guidelines for the height of the work surfaces for standing
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workers in industry or offices have existed for many years. In
medical literature, there has been, however, less focus on the
ergonomics problem of operating table height during
laparoscopy. Only recently a paper has been published dealing
with the ergonomic problem of incorrect operating table
height. 18
This aim of the study was to find out the ergonomically
optimal operating table height required for the particular height
of the surgeon for laparoscopic surgery in order the surgeon
can perform their task comfortably without the extreme upper
limb joint movements. The approach of this study can be
extended as guidelines for designing of the ergonomically
optimal operating table.

MATERIAL AND METHOD Fig. 1: Abduction of the shoulder were measured
The study was carried out in the Laparoscopic Laboratory of
Laparoscopy Hospital, New Delhi. A literature search was also
performed using Medline and the search engine Google to find
out for any such related article. The following search terms
were used “ergonomics, ergonomics in surgery, ergonomics in
laparoscopy”.
The tests were performed on endo-trainer using the six
different table heights for a particular surgeon for task
performance. All the other variables were kept fixed or constant
(Elevation angle, Manipulation angle, Azimuth angle, Distance
of the Monitor). The coaxial alignments were maintained. The
only variable studied was the OR Table Height. The neutral
zone of joint movements is shown in Table 1.
The ports were introduced keeping in mind the “baseball Fig 2: Flexion of the wrist and elbow were measured
diamond” concept. 19
1. The telescope was fixed in between the working instruments.
2. Level 1 lever system was used for the insertion of the
instrument through the ports, i.e. half the instrument was
inside and half the instrument was kept outside maintaining
the Elevation angle of 30 degree.
3. Manipulation angle was fixed to 60 degree.
4. Azimuth angle was fixed to 30 degree.
TABLE 1: Neutral zone of joint movement (VAN VEELEN)
Joint Movement Neutral zone (degree)
Shoulder Abduction < 30
Adduction < 30

Elbow Flexion > 30 < 130 Fig 3: Operating table height
Extension 0
The joint movement and the angles (abduction of the
shoulder and flexion of the wrist) of the shoulder elbow and
Wrist Ulnar abduction < 15
wrist were measured by video recording and snap shots during
Radial abduction < 15
the task performance (Figs 1 and 2).
Palmer flexion < 15
The results were evaluated by a questionnaire and snap
Dorsal flexion < 15
shots. The optimum operating table height was defined for the
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