Page 38 - World Journal of Laparoscopic Surgery

Ergonomics
influenced either directly or indirectly even in decision making for Exclusion Criteria
the patients and even affected the surgical planning. • Studies on ergonomic research in labs other than the operating
The next big concern is the interest of the future medical room.
students on whether this will influence the career option to choose • Non-surgeon participants
to be a surgeon. A study showed that many students did not • Studies on custom-made equipment.
prefer surgery as their subject of choice due to the lingering fear
of musculoskeletal injuries. 33 Intervention(s)
A solution to handle this situation is the immediate need for • Engineering intervention is the modification that makes
ergonomic corrections. This can be conveniently divided into the structural changes in the operating room such as the operating
following three groups: table and laparoscopic instruments such as changes in
1. Engineering controls instrument handle design, using 3D/HD monitor, proper monitor
2. Administrative controls position, and exact camera position.
3. Personal protective equipment • The term administrative controls mean the external control or
regulator which here is the surgeon’s hand movement holding
Engineering controls are mainly focused on physical structural the instruments, neck rotation during surgery, and load on the
changes in the operating room, such as manipulating the table dominant or non-dominant shoulder, shoulder position during
height, and equipment changes, such as changes in instrument surgery, neck stiffness, back stiffness, and back pain during
handles design, using 3D/high definition (HD) monitor, proper surgery, musculoskeletal disorders during surgery, and need
monitor position, and exact camera position. of ergonomic training programs.
Administrative controls are mainly the workforce or human
factors. These include maintaining a neutral body posture such as The surgeon may use an additional supportive measure such as the
altering wrist posture during surgery, reducing neck rotation during exosuit to enhance his ability which becomes the personal gear or
surgery and balancing the load on dominant or non-dominant the personal protective equipment.
shoulder.
Personal protective equipment are the tools individual results
surgeons might use, such as customized surgical exosuits or body
support equipment. With the filtering using the criteria, only 12 studies qualified. A
12,34–43
These three categories of control intertwine and each total of six of them studied on specialized instruments.
plays a role in potential improvement. In this study, we aim to (Flowchart 1). Of these, six studies investigated the use of
22,34–37
perform a review of the literature on Engineering interventions, engineering interventions. Five studies investigated the
39–44
administrative interventions and personal protective equipment use of administrative interventions. One study investigated
12
used to reduce musculoskeletal occupational injury in surgeons. the use of personal protective equipment. Table 1 provides
This is because these interventions are internationally available a description of the engineering intervention studies; Table 2
and require a relatively small amount of resources to incorporate provides a description of the administrative intervention studies;
into practice. Table 3 provides a description of the study of intervention by
The term administrative controls mean the external control personal protective equipment.
or regulator which here is the surgeon’s hand movement holding Participants
the instruments. The participants of the studies were from various branches of
The surgeon may use an additional supportive measure such surgery and specialties such as general, urology, gynecology,
as the exosuit to enhance his ability which becomes the personal surgeons. 12,22,34–43
gear or the personal protective equipment. These are additionally
used to reduce any health or occupational injuries. Few of such Outcome Measures and Results
equipment are available across the world and with such easy access, Since there is methodological diversity and can instill bias the
the utilization in everyday practice is highly likely.
outcome along with the results will be separately discussed.
Engineering Interventions
Methods
Information Sources and Search Matern et al. arrived at a conclusion with the electromyography
(EMG) data that the monitor positioned at the level of the eye is
Literature was searched in free access search engines such as the recommended. Based on the individual surgeon’s choice and skill,
Google Scholar, PubMed, and journal websites such as Springer. it is definitely an advantage with two monitors situated, one at
The technical terms were used to filter the right and relevant position A for complex tasks or procedures and the lowest muscular
articles. The duplicate articles were excluded. The abstracts along fatigue at the position B. Either way, the position of the monitor
with the title was used as the key search factor. lateral to the surgeon is not recommended. 34
Gallagher et al. concluded that the camera has to be steady and
Inclusion Criteria any movement which is unwarranted would result in complications
• Studies on ergonomics of the operative room. or risk safety. 35
• Studies involving ergonomics of the operating surgeons and Manasnayakorn et al. opined that for the hand-assisted
the instrumentation. laparoscopic procedures the operating table height should be
• Studies on innovation in a surgical instrument for reducing the 5 cm above the elbow or the surface of the hand instruments
ergonomic errors. used. 22

World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023) 37