Surgical Endoscopy

, Volume 29, Issue 10, pp 2934–2940 | Cite as

Ergon-trial: ergonomic evaluation of single-port access versus three-port access video-assisted thoracic surgery

  • Luca Bertolaccini
  • Andrea Viti
  • Alberto Terzi



Single-port access video-assisted thoracic surgery (VATS), a technique progressively developed from the standard three-port approach in minimally invasive surgery, offers ergonomic advantages but also new challenges for the surgeon. We compared the ergonomics of three-port versus single-port VATS.


Posture analysis of surgeons was evaluated during 100 consecutive VATS wedge resections (50 triportal vs. 50 uniportal). Technically demanding procedures (major lung resection) were excluded. Operating table height, monitor height, distance and inclination were adjusted according to operator preference. Body posture was assessed by measuring head–trunk axial rotation and head flexion. Perceived physical strain was self-evaluated on the Borg Category Ratio (CR-10) scale. Mental workload was assessed with the National Aeronautics Space Administration–Task Load indeX (NASA–TLX), a multidimensional tool that rates workloads on six scales (mental, physical and temporal demand; effort; performance; frustration).


All procedures were completed without complications. Head–trunk axial rotation was significantly reduced and neck flexion significantly improved in uniportal VATS. Viewing direction significantly declined (p = 0.01), body posture as measured on the Borg CR–10 scale was perceived as more stressful and the NASA–TLX score for overall workload was higher (p = 0.04) during triportal VATS. The NASA–TLX score for frustration was higher with uniportal VATS (p = 0.02), but the score for physical demand was higher in triportal VATS (p = 0.006).


The surgeon can maintain a more neutral body posture during uniportal VATS by standing straight and facing the monitor with only minimal neck extension/rotation; however, frustration is greater than with triportal VATS.


Ergonomics Physical workload Mental workload Video-assisted thoracic surgery 



The authors thank Mario Viti, a gifted multimedia artist, for his valuable help with the artwork. The authors thank Dr. Diego Gonzalez Rivas who kindly offered to review this paper.


Luca Bertolaccini, Andrea Viti, and Alberto Terzi declare no conflicts of interest or financial ties to disclose


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Thoracic Surgery UnitSacro Cuore Research HospitalNegrarItaly
  2. 2.Thoracic Surgery UnitS. Croce e Carle HospitalCuneoItaly

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