Page 41 - World Journal of Laparoscopic Surgery

Ergonomics

Table 3: Interventions by personal protective equipment studies
S. No. Title of abstract First author Year Conclusion
1. Solving the surgeon Liu et al. 12 2018 The progressive arm support exosuit can be a minimally intrusive device that
ergonomic crisis with laparoscopic surgeons wear to reduce pain and fatigue of surgery without
surgical exosuit significantly interfering with operative skills or manual dexterity

The influence of ergonomics on the performance of the issues in the last 1 year, and the majority were work-related common
surgeon is quite evident. This particularly is more in the surgeons sites of these were in the neck and shoulder.
performing minimally invasive surgeries which reduce the freedom About one-third of the participating urologist accepted to
of movement and the instruments push the surgeons toward an have poor or minimal knowledge about the ergonomic principles
unfavorable and uncomfortable position. 44 and the influence of these on the outcome. Half of them were
This very important factor can be understood from a study quite agreeable to the special training on ergonomics to be
22
by Manasnayakorn et al. The experiment assessed three differ- included along with the training in their urology skills. This led
ent positions of the elbow above the table. First 10 cm revealed a to the recommendation of including the module in the surgical
long time to do tasks such as the intracorporeal suturing. Even the curriculum. This will be the first step in preventing the health hazard
second position, that is, 15 cm also showed a negative impact on the to come down in the future. 41
outcome. This laid heavy strain, particularly on the deltoid, trapezius, The study by Aitchison et al. found that BMI had no influence
and the paraspinal muscles. and lastly, the strain was observed on ergonomics and so was the experience which did not contribute
on the flexor muscles of the arm in the final position of 5 cm. 22 to this. 42
Sancibrian et al. evaluated the ergonomics of newer and The study by Bartnicka et al. arrived at a conclusion that task
innovative handpiece of laparoscopic instruments. This was specification was important including the pattern of movement
compared with that of the conventional ring handle. and the and dynamics. 43
results were encouraging for the newly designed device. Majority
of the participants (64%) liked the new device as it reduced pain Personal Protective Equipment
and fatigue. the key to the new instrument was less need for the In the study conducted by Liu et al., they gave attention to the
hyperflexion at the wrist. 36 influence of any additional devices which can be used to enhance
Tung et al. studied the comparison between the pistol grip and ergonomics or provide support to the body posture, but at the
the pinch grip. Volunteers who participated preferred the pistol same time not hamper the movement or dexterity of the surgeon.
grip which is ergonomic friendly whereas the other group suffered A total of 20 surgeons were part of this study which used an
from pain and discomfort., further the duration in completing the exosuit and assessed its influence of it. They found that these
tasks was shorter with the pistol grip (p < 0.05). They did not find suits do not interfere with the performance of the surgeon
37
any correlation between the tool and the type of error and the (p = 0.15–0.84). They did a comparative study between a group
study by Harada et al. noted the advantage the 2D/4K monitors that used and a control group that did not use the exosuit. The
have over the 3D/HD in visualizing target organs in very narrow task was holding the camera for 15 minutes. It was found that the
38
spaces due to the high resolution. group without the suit experienced more pain and discomfort
as compared to the ones who were wearing the suit (3.11 vs
Administrative Interventions 5.88; p = 0.019). Most of the surgeons (~85%), who used the suit
12
Not many studies have been conducted on the role of administrative were more comfortable at the end of the day.
39
interventions. In the study by Stomberg et al., they recorded It is becoming clearer about the necessity of a structured
that most of the surgeons who conduct these minimally invasive training program in the curriculum. A small study showed that more
surgeries suffered from some form of musculoskeletal problems. than half of the participants (53.2%; n = 5,125) accepted about the
Discomfort if not pain was found to be very high among them. At lack of formal training and were keen on getting the training. 45
least around 70% of surgeons admitted to behaving some injuries. It was observed that many of the surgeons who are facing
joint stiffness was quite a common issue apart from headaches and the work-related musculoskeletal problems were the ones who
problems with vision. lacked the training programs in ergonomics. A total of 21% sought
Gender played a significant role with lady surgeons expressing for right suggestions and modifications to reduce the non-neutral
more discomforts (p < 0.01). The time was a vital factor in position themselves and follow the right postures during the
determining the possibility of developing the injuries. The longer procedure, and many (69.9%) after practicing ergonomics observed
the duration of surgery more injuries were noted (p < 0.01). improvement in their health and were free of pain or discomfort.
The non-neutral position when held for a long time contributes However, it appears that we are far from achieving a complete
to these injuries. It is not uncommon among surgeons and application of the right ergonomics in the operating table. The lack
gynecologists who have these long-duration procedures. 39 of time for the surgeon sort of pushes the importance of ergonomic
Miller et al. found that those who gave the option of undecided settings to be made in the operating room. More research is now
in the questionnaire were more likely be suffering from this begun in this highly vital area.
occupational hazard as compared to those who were well aware Regulations on the design of instruments do not usually
of the ergonomic principles. A few of the common symptoms were consider ergonomics and might be contributing the non-
stiffness in neck and back. 40 ergonomic instruments in to the hands of the surgeons, more
46
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Tjiam et al. had a total of 285 responses. Among these, almost regulations are needed to end this practice. A recent meta-analysis
86% of urologist had suffered from some form of musculoskeletal showed something glaring, that is, the lack of knowledge among
40 World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023)