Pediatric Surgery International

, Volume 30, Issue 4, pp 395–399 | Cite as

Work-related upper limb musculoskeletal disorders in pediatric minimally invasive surgery: a multicentric survey comparing laparoscopic and sils ergonomy

  • Ciro EspositoEmail author
  • Azad Najmaldin
  • Felix Schier
  • Atsuyuki Yamataka
  • Marcelo Ferro
  • Giovanna Riccipetitoni
  • Piotr Czauderna
  • Todd Ponsky
  • Holger Till
  • Maria Escolino
  • Marianna Iaquinto
  • Antonio Marte
  • Amulya Saxena
  • Alessandro Settimi
  • Steve Rothenberg
Original Article



Surgeons are at risk for developing work-related musculoskeletal symptoms (WMS). The present study aims to compare laparoscopy and SILS ergonomy among pediatric surgeons.


A questionnaire formed by 17 questions was mailed to 14 pediatric surgeons, seven with a large experience in laparoscopy and seven in SILS. All surgeons completed the survey. The questionnaires were focused on the type of laparoscopic or SILS activity, location and type of pain, need for drugs and its physical consequences. Results were analyzed using χ 2 test.


Results indicated a similar incidence of WMS with shoulder symptoms (>75 %) in both groups. In laparoscopic group this pain is evident only after a long lasting procedure, while in SILS group the pain is present after each procedure performed. SILS surgeons used painkillers and other therapies statistically more frequently than laparoscopic group (χ 2 = 0.001).


This study confirms there is a strong association between WMS and MIS surgery. The incidence of pain is similar in both groups. Pain was present only after long lasting procedures in laparoscopic group, while SILS surgeons have pain after each procedure performed. In addition SILS surgeons use more frequently painkillers and other therapies compared to laparoscopic surgeons. In conclusion, it seems that SILS has a worse ergonomy compared to laparoscopy.


Ergonomy Laparoscopy SILS MIS Children Painkillers 


Conflict of interest

All authors declare that they have no conflict of interests or financial ties to disclose.


  1. 1.
    Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC (2009) Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil 19:175–184PubMedCrossRefGoogle Scholar
  2. 2.
    Corlett EN, Bishop RP (1976) A technique for assessing postural discomfort. Ergonomics 19:175–182PubMedCrossRefGoogle Scholar
  3. 3.
    Keyserling WM (1986) A computer-aided system to evaluate postural stress in the workplace. Am Ind Hyg Assoc J 47:641–649PubMedCrossRefGoogle Scholar
  4. 4.
    Riley PO, Mann RW, Hodge W (1990) Modelling of the biomechanics of posture and balance. J Biomech 23:503–506PubMedCrossRefGoogle Scholar
  5. 5.
    Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J (1997) A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc 11:139–142PubMedCrossRefGoogle Scholar
  6. 6.
    Nguyen NT, Ho HS, Smith WD, Philipps C, Lewis C, De Vera RM, Berguer R (2001) An ergonomic evaluation of surgeons’ axial skeletal and upper extremity movements during laparoscopic and open surgery. Am J Surg 182:720–724PubMedCrossRefGoogle Scholar
  7. 7.
    Matern U, Eichenlaub M, Waller P, Ruckauer K (1999) MIS instruments. An experimental comparison of various ergonomic handles and their design. Surg Endosc 13:756–762PubMedCrossRefGoogle Scholar
  8. 8.
    Patkin M, Isabel L (1995) Ergonomics, engineering and surgery of endosurgical dissection. J R Coll Surg Edinb 40:120–132PubMedGoogle Scholar
  9. 9.
    Esposito C, El Ghoneimi A, Yamataka A, Rothenberg S, Bailez M, Ferro M, Gamba P, Castagnetti M, Mattioli G, Delagausie P, Antoniou D, Montupet P, Marte A, Saxena A, Bertozzi M, Philippe P, Varlet F, Lardy H, Caldamone A, Settimi A, Pelizzo G, Becmeur F, Escolino M, De Pascale T, Najmaldin A, Schier F (2013) Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg 48(8):1750–1756PubMedCrossRefGoogle Scholar
  10. 10.
    Osborne A, Lim J, Gash K, Chaudhary B, Dixon AR (2013) Comparison of single-incision laparoscopic high anterior resection with standard laparoscopic high anterior resection. Colorectal Dis 15(3):329–333PubMedCrossRefGoogle Scholar
  11. 11.
    Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427PubMedCrossRefGoogle Scholar
  12. 12.
    Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695PubMedCrossRefGoogle Scholar
  13. 13.
    Chow A, Purkayastha S, Paraskeva P (2009) Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience. Surg Innov 16:211–217PubMedCrossRefGoogle Scholar
  14. 14.
    Canes D, Berger A, Aron M, Brandina R, Goldfarb DA, Shoskes D, Desai MM, Gill IS (2010) Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 57(1):95–101PubMedCrossRefGoogle Scholar
  15. 15.
    Ross H, Steele S, Whiteford M, Lee S, Albert M, Mutch M, Rivadeneira D, Marcello P (2011) Early multi-institution experience with single-incision laparoscopic colectomy. Dis Colon Rectum 54:187–192PubMedCrossRefGoogle Scholar
  16. 16.
    Kravetz AJ, Iddings D, Basson MD, Kia MA (2009) The learning curve with single-port cholecystectomy. JSLS 13:332–336PubMedCentralPubMedGoogle Scholar
  17. 17.
    Neuhaus SJ, Watson DI (1997) Laparoscopic surgeons’ thumb: is it a training phenomenon? Minim Invas Ther Allied Technol 6:31–32CrossRefGoogle Scholar
  18. 18.
    Horgan LF, O’Riordan DC, Doctor N (1997) Neuropraxia following laparoscopic procedures: an occupational injury. Minim Invas Ther Allied Technol 6:33–35CrossRefGoogle Scholar
  19. 19.
    Santos BF, Reif TJ, Soper NJ, Hungness ES (2011) Effect of training and instrument type on performance in single-incision laparoscopy: results of a randomized comparison using a surgical simulator. Surg Endosc 25:3798–3804PubMedCrossRefGoogle Scholar
  20. 20.
    Santos BF, Enter D, Soper NJ, Hungness ES (2011) Single-incision laparoscopic surgery (SILS™) versus standard laparoscopic surgery: a comparison of performance using a surgical simulator. Surg Endosc 25:483–490PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ciro Esposito
    • 1
    Email author
  • Azad Najmaldin
    • 2
  • Felix Schier
    • 3
  • Atsuyuki Yamataka
    • 4
  • Marcelo Ferro
    • 5
  • Giovanna Riccipetitoni
    • 6
  • Piotr Czauderna
    • 7
  • Todd Ponsky
    • 8
  • Holger Till
    • 9
  • Maria Escolino
    • 1
  • Marianna Iaquinto
    • 1
  • Antonio Marte
    • 10
  • Amulya Saxena
    • 11
  • Alessandro Settimi
    • 1
  • Steve Rothenberg
    • 12
  1. 1.“Federico II” University of NaplesNaplesItaly
  2. 2.Children Hospital NHS LeedsLeedsUK
  3. 3.University of MainzMainzGermany
  4. 4.Juntendo UniversityTokyoJapan
  5. 5.Buenos Aires UniversityBuenos AiresArgentina
  6. 6.Buzzi Children HospitalMilanItaly
  7. 7.Children HospitalGanskPoland
  8. 8.University Hospital of ClevelandClevelandUSA
  9. 9.University Hospital of LeipzigLeipzigGermany
  10. 10.Second University of NaplesNaplesItaly
  11. 11.Children HospitalGrazAustria
  12. 12.Children HospitalDenverUSA

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