A newly designed ergonomic body support for surgeons

Socio-Technical Systems Analysis in Health Care: A Research Agenda

Given the complexity of health care and the 'people' nature of healthcare work and delivery, STSA (Sociotechnical Systems Analysis) research is needed to address the numerous quality of care problems observed across the world. This paper describes open STSA research areas, including workload management, physical, cognitive and macroergonomic issues of medical devices and health information technologies, STSA in transitions of care, STSA of patient-centered care, risk management and patient safety management, resilience, and feedback loops between event detection, reporting and analysis and system redesign.

Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations

BACKGROUND

Robotic thyroidectomy (RT) has recently emerged as a viable approach to thyroid surgery, resulting in better functional and cosmetic outcomes than afforded by open thyroidectomy (OT). The present multicenter study assessed the perioperative outcomes of RT and compared physician perspectives on the musculoskeletal ergonomic parameters associated with OT, endoscopic thyroidectomy (ET), and RT.

MATERIALS AND METHODS

We reviewed the medical records of 2014 consecutive patients who underwent RT, conducted by 7 surgeons, at 4 centers between October 2007 and June 2010. Patient characteristics, perioperative clinical results, complications, and pathologic outcomes were analyzed. Moreover, surgeons were surveyed to gather data on musculoskeletal discomfort experienced during OT, ET, and RT.

RESULTS

Of the 2014 patients, 740 underwent total and 1274 subtotal thyroidectomy. Mean tumor diameter was 0.8 cm, and the mean number of retrieved central lymph nodes was 4.5 ± 3.9 (range 0-28). The rates of permanent recurrent laryngeal nerve injury and permanent hypocalcemia were 0.4 and 0.05%, respectively. Neck and/or back pain after OT, ET, and RT was experienced by 100, 85.7, and 28.6% of surgeons, respectively. When surgeons ranked the operative approaches in decreasing order of associated pain, 57.1% indicated ET > OT > RT, 28.6% selected OT > ET > RT, and 14.3% responded ET > RT > OT.

CONCLUSION

RT is a feasible and safe procedure that may facilitate radical cervical lymph node dissection. Moreover, for surgeons, the RT resulted in less musculoskeletal discomfort than did OT or ET. A larger prospective study, with a longer follow-up, is needed to determine whether RT offers real benefits for both patients and surgeons.

Role of laparoscopy in reconstructive surgery

PURPOSE OF REVIEW

Despite increasing laparoscopic expertise in reconstructive surgery, open procedures still represent the gold standard. Robot-assisted techniques increasingly replace laparoscopy. However, laparoscopy is also developing: by improvement of ergonomics, new instruments, and techniques further reducing access trauma. We evaluated the actual role of laparoscopy focusing on main indications of urologic reconstructive surgery.

RECENT FINDINGS

We analysed the current literature (PubMed/Medline) concerning indications, perioperative results, complications, and long-term outcome of laparoscopy for pyeloplasty, ureteral reimplantation, stone surgery, management of vesico-vaginal fistula, sacrocolpopexy (including evidence level). For all indications, laparoscopy provides the advantages of less postoperative pain, blood loss, shorter convalescence, and minimal disfigurement. However, it requires expertise with endoscopic suturing. Most experience (N > 1000) exists with laparoscopic pyeloplasty and sacrocolpopexy which can be considered as valuable options (IIB). Concerning ureteral reimplantation and repair of vesico-vaginal fistula, only a limited number of cases were reported (N < 150) (III). Laparoscopic stone surgery may gain importance particularly in developing countries. Robot-assistance will definitively increase the application of laparoscopic techniques providing optimal ergonomics, whereas the role of single-port surgery will be limited.

SUMMARY

Laparoscopy will increasingly be used for reconstructive urologic surgery. This trend will be supported by the widespread use of the DaVinci device.

[Analysis of spinal stress during surgery in otolaryngology]

BACKGROUND

Back pain is a common cause of sick leave in industrialized countries. Performing surgery is often associated with considerable cervical spine disorders. However, only a few studies have examined to what extent working posture or individual surgical techniques can be seen as stress indicators.

MATERIAL AND METHODS

Posture and movement of the spine and trunk were assessed by means of a newly developed analysis system (3-D-SMG). The individual-case study was carried out during six sinus operations using varying techniques (microscope, endoscope or headlamp only).

RESULTS

Spine and trunk deviation from neutral position (upright standing) was strongest in the sagittal plane. Awkward distortions were primarily observed in the cervical and lumbar spine. The analysis of work characteristics revealed static postures in 65-90% of sinus operations. Isometric positions were mainly related to microscopic surgery.

CONCLUSIONS

The data from this explorative individual-case study indicate that prevalence and magnitude of forced isometric and awkward postures are strongly associated with work-related spinal stress in sinus surgery. The new measurement device enables not only the recommendation of individual preventive strategies but also the objective evaluation of ergonomics.

Prospective randomized evaluation of FOOT gel pads for operating room staff COMFORT during laparoscopic renal surgery

OBJECTIVES

We evaluated the comfort level of our laparoscopy team during and after laparoscopic renal surgery, with or without the use of gel footpads.

METHODS

Between September 2008 and April 2009 we prospectively randomized 100 consecutive laparoscopic renal procedures to examine whether the use of a foot gel pad altered the surgical team's comfort level. A questionnaire was used to measure the discomfort in 18 different subjects before and during surgery, and one day postoperatively. The procedures performed with or without the foot gel pads were compared.

RESULTS

One hundred laparoscopic procedures were randomized to being performed with and without gel pads. In 50 procedures, the foot gel pad was used. The mean age of the subjects was 36 years (range 25-52). The mean surgical experience was 7 years. The characteristics of the participants in procedures with and without the gel pad were similar. In the immediate postoperative period, there were significantly more breaks taken (P = .001), number of stretches (P = .001), foot pain (P = .003), knee pain (P = .001), back discomfort (P = .001), overall discomfort (P = .001), and diminished level of energy (P = .049) in the group not using the gel pad. Of the 24-hour postoperative time point, evaluation significantly favored the gel pads regarding foot pain (P = .004), overall amount of discomfort (P = .001), and energy level of the participants (P = .044).

CONCLUSIONS

The use of foot gel pads improves surgeon comfort and ergonomics during laparoscopy. The pads have been incorporated into our routine operating room set-up and may improve surgical performance by diminishing fatigue and discomfort.

Robotic approaches to the posterior spine

STUDY DESIGN

This anatomic study described robotic approaches to the posterior thoracolumbar spine in a porcine model. Ergonomics, control, and approach and technical difficulties were noted.

OBJECTIVE

The objective of this study was to develop a robotic approach to the posterior thoracolumbar spine maximizing surgeon ergonomics and control.

SUMMARY OF BACKGROUND DATA

Surgery is both physically and mentally demanding, and strains from ergonomics and the aging process may negatively impact surgical skills. In spine surgery, control and precision are extremely important due to the close proximity to the spinal cord. The da Vinci robotic surgery system has offered better ergonomics and control in urology, gynecology, and cardiac surgery, and is rapidly gaining adoption. To date, there have been no published reports of da Vinci robotic spine surgery, motivating us to assess its potential in posterior spine surgery.

METHODS

Posterior spine da Vinci approaches were tested on a pig without spinal pathology with an open subperiosteal dissection. A laser instrument and prototype robotic burr and rongeur instruments were tested on laminotomy, laminectomy, disc incision, and dural suturing procedures.

RESULTS

Open dissection of the posterior spine provided sufficient access to successfully perform laminotomy, laminectomy, disc incision, and dural suturing procedures. Prototype burr and rongeur instruments were effective with good control. The laser instrument coagulated the epidural venous plexus and incised the anulus. Robot ergonomics allowed the surgeon to perform procedures for a full day with significantly less fatigue and reduced hand tremor.

CONCLUSION

The da Vinci could perform the major noninstrumented procedures of the posterior spine with improved ergonomics and control. Surgeon fatigue and tremor were reduced. With some modification of prototype and commercial instruments a posterior spine surgery instrument kit can be developed. Future clinical studies can better assess patient and surgeon benefits of using the da Vinci robot for posterior spine surgeries.

Ergonomics considerations of radical prostatectomy: physician perspective of open, laparoscopic, and robot-assisted techniques

PURPOSE

To analyze and compare physician perspectives of musculoskeletal ergonomic parameters associated with open, pure laparoscopic, and robot-assisted prostatectomy.

MATERIALS AND METHODS

Survey questions were designed to evaluate physician musculoskeletal discomfort during open and minimally invasive radical prostatectomy. The survey instrument was distributed to physician members of the Endourological Society (ES) and Society of Urologic Oncology (SUO) after approval from the respective organizations. We queried about the presence of chronic neck and/or back pain, relationship of musculoskeletal pain to operating, and pain characteristics associated with open, laparoscopic, and robot-assisted prostatectomies. Physicians were also asked to rank the three operative approaches with respect to associated pain and discomfort and to comment if practice patterns were impacted by these ergonomic variables.

RESULTS

There were 106 urologists who completed the survey. Chronic neck and/or back pain was present in 43% of urologists who responded to this survey. Of those surgeons with baseline neck/back pain, 50% indicated that operating caused or exacerbated this musculoskeletal pain. Furthermore, 25% of respondents indicated that musculoskeletal pain considerations impacted their choice of operative approach. Neck and/or back pain was experienced in 50%, 56%, and 23% of surgeons after open, laparoscopic, and robot-assisted prostatectomy, respectively. When ranking operative approach in order of decreasing amounts of associated pain, 32% indicated open>laparoscopic>robot-assisted, 28% responded that none caused pain, and 25% selected laparoscopic>open>robot-assisted. Three percent selected permutations, with robot-assisted causing the most discomfort.

CONCLUSION

Urologists who responded to our study indicate that open and laparoscopic prostatectomy cause more musculoskeletal discomfort than a robot-assisted approach. Of urologists performing robot-assisted prostatectomies, however, 23% suggested that this approach also was associated with physical pain. Furthermore, physicians do take into account ergonomic considerations when determining an operative approach. Studies with actual physician monitoring and electromyography are requisite to more thoroughly delineate the ergonomics of performing a radical prostatectomy.