Ergonomic risk associated with assisting in minimally invasive surgery
- First Online:
- 415 Downloads
Given the physical risks associated with performing laparoscopic surgery, ergonomics to date has focused on the primary minimally invasive surgeon. Similar studies have not extended to other operating room staff. Simulation of the assistant’s role as camera holder and retractor during a Nissen fundoplication allowed investigation of the ergonomic risks involved in these tasks.
Seven subjects performed camera navigation and retraction tasks using a box trainer on an operating room table that simulated an adult patient in low lithotomy position. Each subject stood on force plates at the simulated patient’s left side. A laparoscope was introduced through a port into the training box with four 2-cm circles as rear-panel targets located in relation to the assistant as distal superior, proximal superior, distal inferior, and proximal inferior target effects. The subjects held the camera with their left hand, pointing it at a target. The task was to match the target to a circle overlaid on the monitor. Simultaneously, a grasper in the right hand grasped and pulled a panel-attached band. A minute signal moved the subject to the next target. Each trial had three four-target repetitions (phase effect). The subjects performed two separate trials: one while holding the camera from the top and one while holding it from the bottom (grip effect). A 4 × 3 × 2 (target × phase × grip) repeated-measures design provided statistics. Dividing the left force-plate vertical ground reaction forces (VGRF) by the total VGRF from both plates provided a weight-loading ratio (WLR).
The WLR significantly increased (p < 0.005) with proximal targets (2 by 80% and 4 by 79%). The WLR decreased 75%, 74%, and 71% over time. No difference existed between the grip strategies (grip effect, p > 0.5).
A high-risk ergonomic situation is created by the assistant’s left or caudal leg disproportionately bearing 70–80% of body weight over time. A distance increase between the camera head location and the camera holder increases ergonomic risk. The phase effect was interpreted as a compensatory rebalancing to reduce ergonomic risk. Ergonomic solutions minimizing ergonomic risks associated with laparoscopic assistance should be considered.
KeywordsCamera assistant Ergonomics Force plate Laparoscopic assistance Postural analysis Simulation
- 5.Winter DA (1995) Human balance and posture control during standing and walking. J Biomech 3:193–214Google Scholar
- 17.Lee G, Kavic SM, George IM, Park AE (2006) Correlation between postural stability and performance time during fundamentals of laparoscopic surgery (FLS) tasks. Br J Surg 93(Suppl):S206Google Scholar
- 19.Lee G, Park AE (2007) Development of a more robust tool for postural stability analysis of laparoscopic surgeons. Surg Endosc 22:1087–1092Google Scholar
- 22.Smith WD, Berguer R, Nguyen NT (2005) Monitor height affects surgeons’ stress level and performance on minimally invasive surgery tasks. Stud Health Technol Inform 111:498–501Google Scholar