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Soni S, Ritchie AMA, Liu S, Pacilli M, Nataraja RM. Using wearable technology for Posture Regulation to Improve Surgical Ergonomics in the paediatric operating room: the UPRISE trial: a pilot study. Surg Endosc 2024:10.1007/s00464-024-10933-5. [PMID: 38902409 DOI: 10.1007/s00464-024-10933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The rising prevalence of work-related musculoskeletal disorders has numerous physical, financial, and mental repercussions for surgeons. This study aims to establish whether the use of a wearable posture device can improve the operating time spent in suboptimal, high-risk postures. METHODS Surgeons were recruited in Phase 1 of this prospective randomised study and baseline postural data was obtained. In Phase 2, participants were randomised to receive either a traditional educational workshop or intraoperative vibrations from the device to correct postural lapses. During minor elective day cases, intraoperative postural data was collected and stratified by forward flexion angle, into five risk categories (negligible to very high). Participants' experience with the sensor was also assessed. RESULTS A total of 100 surgical procedures (Phase 1: n = 50; Phase 2: n = 50) were performed by eight surgeons of varying seniority. Exposure to the educational intervention increased time spent in suboptimal posture (Phase 1 vs. Phase 2); 47.5% vs. 67.8%, p = 0.05. However, the vibrational intervention significantly reduced this time; 50.0% vs. 20.7%, p = 0.005. Procedure type didn't influence posture although, laparoscopic interventions spent most time in negligible-risk postures; 47.7% vs. 49.3%, compared to open procedures. Surgical consultants spent less time in suboptimal posture compared to fellow/registrars; 30.3% vs. 72.6% (Phase 1) and 33.8% vs. 65.3% (Phase 2). CONCLUSION Vibrational intervention from the device significantly decreased the time spent in suboptimal, high-risk postures. As procedure type wasn't correlated with postural changes, surgeon-specific factors in regulating posture are paramount. Finally, surgeon experience was positively correlated with improved surgical ergonomics.
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Affiliation(s)
- Suvarna Soni
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Angus M A Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sue Liu
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Departments of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, 3168, Australia
| | - Ramesh M Nataraja
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
- Departments of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, 3168, Australia.
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Dale L, Fiedler J. Risk factors for musculoskeletal disorders in an obstetrician-gynecologist and orthopedic surgeon. Work 2020; 65:749-761. [PMID: 32310206 DOI: 10.3233/wor-203128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Orthopedic and obstetrician-gynecologist (OB/GYN) surgeons have risks for musculoskeletal disorders (MSD) during work in the operating room (OR). Risks for MSD have not been identified as a result of work outside the OR or during non-work tasks. OBJECTIVE The purpose of the study was to determine risk factors for MSD in an orthopedic and OB/GYN surgeon. METHODS A case study format and mixed method design were used to gather data by using the Rapid Upper Limb Assessment (RULA) to measure MSD risks in the OR; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) to measure surgeons' upper extremity disability; observation of surgeon office hours; and semi-structured interviews to gather qualitative data. RESULTS Both surgeons had risks for MSD during occupational performance outside of work, with some risks similar to those experienced at work. Both surgeons had MSD risks during work inside and outside the OR. Both surgeons experienced MSD symptoms exacerbated by work and non-work tasks. CONCLUSIONS Identifying and reducing MSD risk should include a comprehensive analysis of occupational performance for orthopedic and OB/GYN surgeons.
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Affiliation(s)
- Lucinda Dale
- School of Occupational Therapy, University of Indianapolis Indianapolis, IN, USA
| | - Jordan Fiedler
- School of Occupational Therapy, University of Indianapolis Indianapolis, IN, USA
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Sancibrian R, Gutierrez-Diez MC, Redondo-Figuero C, Llata JR, Manuel-Palazuelos JC. Using infrared imaging for assessment of muscular activity in the forearm of surgeons in the performance of laparoscopic tasks. Proc Inst Mech Eng H 2019; 233:999-1009. [PMID: 31307277 DOI: 10.1177/0954411919863547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgeons working in laparoscopic surgery are subjected to hard working conditions because of the poor ergonomic characteristics of the workplace. The improvement in the working conditions requires the use of reliable techniques for the assessment of muscular activity. In this article infrared imaging is used and compared with electromyography for the evaluation of muscle activity in the performance of laparoscopic surgical tasks. Electromyography has been widely used for the evaluation of the electrical activity produced by the muscles in the performance of surgery. On the contrary, infrared imaging is an innovative technique that has not been sufficiently explored. An experimental evaluation was carried out using a thermography camera and recording the infrared images from volunteers in different tests. Pearson's correlation was obtained between the electromyography and thermographic measurements in two stages: Endurance Stage (best value: ρ = 0.8401 with p < 0.01) and Surgical Task (best value: ρ = 0.8309 with p < 0.01). The article demonstrates that infrared imaging is a valuable technique for the evaluation of muscle activity in laparoscopic surgery, and it can be compared with electromyography. The main advantages of infrared imaging are that it allows remote measurement and provides activity information in the whole area of interest. However, drawbacks such as delayed response of the infrared imaging due to thermal conductivity of the skin should be considered. Electromyography only provides information in the location of the electrodes, but it is a real-time response. For these reasons, the techniques complement each other.
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Affiliation(s)
- Ramon Sancibrian
- Department of Structural and Mechanical Engineering, Universidad de Cantabria, Santander, Spain
| | | | | | - Jose R Llata
- Department of Electronic Technology and Systems Engineering and Automation, Universidad de Cantabria, Santander, Spain
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Vocelle AR, Trier T, Bix L, Bush TR. A method for quantifying key components of the opening process for opening pouch-style packages containing medical devices. APPLIED ERGONOMICS 2019; 76:97-104. [PMID: 30642530 DOI: 10.1016/j.apergo.2018.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 06/09/2023]
Abstract
Healthcare-associated infections are a serious worldwide health concern. Although contaminated medical devices are an avenue for infection, little research has evaluated the techniques used to open sterile packages. The goal of this study was to develop a method to quantify aspects of the package opening process in accordance with opening guidelines and then to demonstrate this methodology through a small sample of clinicians opening two sizes of pouch-style packages. Using motion capture techniques, a method was designed to quantify 11 parameters associated with the opening process. The method was then tested with nine healthcare professionals. Results indicated that all participants crossed the sterile field when opening packages. When opening large packages, participants spent significantly more time over the simulated sterile field and there was a trend towards more manipulations as compared to opening smaller packages. This methodology can be used to quantify the opening process, compare opening practices, and for assessment during the learning process.
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Affiliation(s)
- Amber R Vocelle
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Tony Trier
- School of Packaging, Michigan State University, East Lansing, MI, USA
| | - Laura Bix
- School of Packaging, Michigan State University, East Lansing, MI, USA
| | - Tamara Reid Bush
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA.
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Zhu D, Hong P, Chen S, Fan Y, Zhang Z, Zhang X, Yu W, Shen C, Jin J. Lower posterior mediastinal benign schwannoma successfully resected with retroperitoneoscopy using a transdiaphragmatic approach: A case report. Thorac Cancer 2018; 9:1087-1089. [PMID: 29923676 PMCID: PMC6068460 DOI: 10.1111/1759-7714.12786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/13/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022] Open
Abstract
Lower posterior mediastinal tumors are traditionally excised by conventional thoracotomy or thoracoscopic approaches; however, use of the transdiaphragmatic retroperitoneoscopic approach for these tumors has rarely been reported. Herein, we report a case of a left lower posterior mediastinal paravertebral benign schwannoma in an adult male that was successfully treated with transdiaphragmatic retroperitoneoscopic surgery. The patient presented with no symptoms but had noticed a lesion in the left lower posterior mediastinum two months prior. He underwent transdiaphragmatic retroperitoneoscopic surgery with total resection of the mediastinal mass. To the best of our knowledge, this is the most detailed and challenging case of transdiaphragmatic retroperitoneoscopic surgery to treat a schwannoma in the left lower posterior mediastinum reported to date.
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Affiliation(s)
- Dongdong Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shengbin Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiaochun Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Jie Jin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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The Application of Internal Suspension Technique in Retroperitoneal Laparoscopic Partial Nephrectomy for Renal Ventral Tumors. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28630859 PMCID: PMC5467276 DOI: 10.1155/2017/1849649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the feasibility of an internal suspension technique in retroperitoneal laparoscopic partial nephrectomy for the management of renal ventral tumors. Methods Between January 2013 and July 2016, a total of 145 patients underwent retroperitoneal laparoscopic partial nephrectomy with or without internal suspension technique. For patients who underwent internal suspension technique, the surgeons preserved the external fat of the renal tumor as a suspension traction measure when separating the kidney. Propensity score matching (PSM) was performed according to age, gender, body mass index, tumor size, tumor location, and RENAL nephrometry score. Patient characteristics and intraoperative and postoperative outcomes were compared between the groups. Results After PSM, 32 patients treated with the internal suspension technique were compared with 32 cases treated without such technique. Baseline characteristics were statistically similar for the cohorts. The use of our new technique resulted in shorter warm ischemia time (WIT: 15.0 versus 19.0 minutes, P = .002) and tumor resection time (4.0 versus 7.5 minutes, P < 0.001). The rate of WIT >25 minutes decreased (6.3% versus 25%, P = .04) and the trifecta outcomes were significantly improved (87.5% versus 62.5%, P = .02). Conclusion Internal suspension technique is a feasible and safe procedure in retroperitoneal laparoscopic partial nephrectomy for renal ventral tumors.
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Kilkenny J, Larson DJ, MacCormick M, Brown SHM, Singh A. Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study. Vet Surg 2017; 46:868-878. [PMID: 28557023 DOI: 10.1111/vsu.12672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/08/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare upper extremity muscle activity and workload between simulated open surgery, multiple port laparoscopic surgery (MLS), and single incision laparoscopic surgery (SLS) techniques in veterinary students. STUDY DESIGN Pilot study. POPULATION Veterinary students (n = 10) from years 1 to 4. METHODS Bipolar skin surface electrodes were fixed bilaterally to the forearm flexor, forearm extensor, biceps brachii, triceps brachii, and upper trapezius muscles. Electromyography data were recorded during one repetition of 2 simulated surgical exercises via open surgery, MLS, and SLS. Participants completed a validated workload survey after each simulated surgical technique. Muscle activity and perceived workload were compared between surgical techniques with 1-way ANOVAs and Fisher's LSD post hoc tests. RESULTS Muscle activity during peg transfer was higher with MLS and SLS compared to simulated open surgery in the right and left forearm extensors (both P < .0001), right (P < .0001) and left biceps (P = .0005), right triceps (P = .0004), and right upper trapezius muscles (P = .0211). Similar results were found for the right and left forearm extensors (both P < .0001), right (P = .0381) and left (P = .0147) forearm flexors, right biceps (P < .0001), and right triceps (P = .0004) during a simulated suture task. Participants found laparoscopic techniques more mentally demanding, physically demanding, complex, and stressful compared to a simulated open surgical technique. CONCLUSION In veterinary students, average muscle activity and perceived workload were highest using MLS and SLS compared to an open surgical technique when performing simulated surgical exercises in a laparoscopic box trainer.
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Affiliation(s)
- Jessica Kilkenny
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Dennis J Larson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Mathew MacCormick
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Mirbagher Ajorpaz N, Zagheri Tafreshi M, Mohtashami J, Zayeri F, Rahemi Z. The effect of mentoring on clinical perioperative competence in operating room nursing students. J Clin Nurs 2016; 25:1319-25. [PMID: 26990142 DOI: 10.1111/jocn.13205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to investigate the effects of mentoring on the clinical perioperative competence of nursing operating room students in Iran. BACKGROUND Mentoring is an essential part of clinical education, which has been studied in different populations of students. However, there is a need to assess its effectiveness in operating room students' competence. DESIGN A randomised controlled trial was performed. METHODS Sixty nursing operating room students were randomly assigned to experimental and control groups. Both the control and experimental groups had routine training in the form of faculty supervision. The experimental group had an additional mentoring program. Using the Persian Perceived Perioperative Competence Scale-Revised, clinical competence was compared between the two groups, before and after the intervention. Using SPSS 19, descriptive and inferential statistics, including chi-square and t-tests, were conducted. RESULTS In the experimental group, the difference between the mean scores of clinical competence before (19·43 ± 2·80) and after (27·86 ± 1·87) the intervention was significant (p ≤ 0·001). After intervention, the difference between the mean scores of the control (3·9 ± 0·15) and experimental (8·61 ± 0·68) groups was significant (p ≤ 0·003). CONCLUSION Findings affirmed the positive effect of mentorship programmes on clinical competence in nursing operating room students. RELEVANCE TO CLINICAL PRACTICE Mentoring is an effective method for preparing nursing students in practice. Health care systems may improve as a result of staff-student relationships that ultimately increase the quality care for patients.
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Affiliation(s)
- Neda Mirbagher Ajorpaz
- School of Nursing & Midwifery, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mansoureh Zagheri Tafreshi
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamileh Mohtashami
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, School of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Rahemi
- Florida Atlantic University, Boca Raton, FL, USA
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Zhang C, Li X, Yu W, Zhang Q, Zhou L, He Z. Ring Suture Technique in Retroperitoneal Laparoscopic Partial Nephrectomy for Hilar Cancer: A New Renorrhaphy Technique. J Endourol 2015; 30:390-4. [PMID: 26577028 DOI: 10.1089/end.2015.0691] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the safety and efficacy of a ring suture technique during retroperitoneal laparoscopic partial nephrectomy (RLPN) for management of renal cell carcinoma (RCC) in the renal hilum. PATIENTS AND METHODS Data for patients with renal hilar cancer who underwent RLPN from January 2010 to March 2015 were collected. All surgeries involved the ring suture technique, following the same procedure: the renal artery was dissected and clamped, the tumor was enucleated from the kidney, defects of the vascular and collecting system were repaired, and then the edge of the renal parenchyma was sutured continuously along the border. Finally, the renal artery clamp was removed, and any injury of the vascular system was repaired if necessary. We retrospectively analyzed renal ischemic time, blood loss, and postoperative complications. RESULTS Among the 17 patients, 11 were male (median age 61 years, range 42-71 years). Mean tumor diameter was 3.4 ± 0.9 cm and median R.E.N.A.L. nephrometry score was 8 (range 6-10). The mean warm ischemic time was 23.0 ± 9.2 minutes and median blood loss during surgery was 110 mL (range 70-350 mL); we had no case of uncontrollable massive bleeding. Radical nephrectomy was used in one case because of tumor embolus in a branch of the renal vein. All patients recovered well following surgery. Pathology confirmed the diagnosis of RCC in all cases, with the main subtype clear-cell carcinomas (88.2%). CONCLUSIONS The ring suture technique is safe and effective for management of renal hilar cancer during RLPN for selected patients.
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Affiliation(s)
- Cuijian Zhang
- 1 Department of Urology, Peking University First Hospital , Beijing, China .,2 Institute of Urology, Peking University , Beijing, China .,3 National Urological Cancer Center , Beijing, China
| | - Xuesong Li
- 1 Department of Urology, Peking University First Hospital , Beijing, China .,2 Institute of Urology, Peking University , Beijing, China .,3 National Urological Cancer Center , Beijing, China
| | - Wei Yu
- 1 Department of Urology, Peking University First Hospital , Beijing, China .,2 Institute of Urology, Peking University , Beijing, China .,3 National Urological Cancer Center , Beijing, China
| | - Qian Zhang
- 1 Department of Urology, Peking University First Hospital , Beijing, China .,2 Institute of Urology, Peking University , Beijing, China .,3 National Urological Cancer Center , Beijing, China
| | - Liqun Zhou
- 1 Department of Urology, Peking University First Hospital , Beijing, China .,2 Institute of Urology, Peking University , Beijing, China .,3 National Urological Cancer Center , Beijing, China
| | - Zhisong He
- 1 Department of Urology, Peking University First Hospital , Beijing, China .,2 Institute of Urology, Peking University , Beijing, China .,3 National Urological Cancer Center , Beijing, China
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