Ergonomic assessment of the first assistant during robot-assisted surgery

A multimodal virtual vision platform as a next-generation vision system for a surgical robot

Robot-assisted surgery platforms are utilized globally thanks to their stereoscopic vision systems and enhanced functional assistance. However, the necessity of ergonomic improvement for their use by surgeons has been increased. In surgical robots, issues with chronic fatigue exist owing to the fixed posture of the conventional stereo viewer (SV) vision system. A head-mounted display was adopted to alleviate the inconvenience, and a virtual vision platform (VVP) is proposed in this study. The VVP can provide various critical data, including medical images, vital signs, and patient records, in three-dimensional virtual reality space so that users can access medical information simultaneously. An availability of the VVP was investigated based on various user evaluations by surgeons and novices, who executed the given tasks and answered questionnaires. The performances of the SV and VVP were not significantly different; however, the craniovertebral angle of the VVP was 16.35° higher on average than that of the SV. Survey results regarding the VVP were positive; participants indicated that the optimal number of displays was six, preferring the 2 × 3 array. Reflecting the tendencies, the VVP can be a neoconceptual candidate to be customized for medical use, which opens a new prospect in a next-generation surgical robot.

Physical and psychological impact of surgery on the operating surgeon

The impact of surgery on the surgeon's well-being encompasses both physical and psychological aspects. Physically, surgeons are at risk of work-related musculoskeletal symptoms due to the nature of their work, and this risk can be impacted by theater environment, equipment design, and workload. Many symptoms will be self-limiting, but work related musculoskeletal symptoms can lead to the development of an injury, which can have far reaching effects, including the need for medical or surgical treatment, time away from work, or a change in clinical duties. Additionally, surgery can place a significant cognitive workload on the lead operator and this can be exacerbated, or alleviated, by the surgical environment, experience of the assistance, surgical modality, and case complexity. Measuring and quantifying the impact of surgery on the surgeon is a challenging undertaking. Tools such as motion capture, physiological markers, including heart rate variability and salivary cortisol, and questionnaires can provide insights into understanding the overall impact of surgery on the surgeon. A holistic approach that incorporates injury prevention strategies, communication, and support, is vital in assessing and mitigating risk factors. Injury prevention assessment tools and interventions that can be used within the busy surgical environment are needed, alongside increased ergonomic awareness. Addressing the impact of surgery on the surgeon is a multifaceted challenge, and long term positive changes can only be sustained with the support of the whole surgical team and healthcare organizations by developing and maintaining a supportive working environment.

Improving ergonomics for the bedside assistant in robotic colorectal surgery

The aim of the study was to document when significant bedside assistant (BA) and robotic arm collisions occurred during robotic colorectal surgery (RCS). An observational study of 10 consecutive RCS cases, from May 2022 to September 2022, was performed. Situations when there was significant collision between BA arm and robotic arm (to cause inadvertent movement of the assistant instrument) were documented. The assistant port was randomly placed to the right or the left side of the camera port. Situations which led to detrimental BA ergonomics include dissection at the most peripheral working field, proximity of the target (mesenteric vessels), small bowel retraction, placement of the assistant port in the medial position (on the left side of the camera port), during intra-corporeal suturing and robotic stapler use. The robotic console surgeon can predictably identify and avoid situations when injury to the BA may occur.

Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: A retrospective study

The aim of this study was to explore whether a robot-assisted (RA) technique has advantages over the conventional fluoroscopy-assisted (FA) technique in clinical and radiological outcomes and whether it could decrease the incidence of mis-implantations of pedicle screws in adolescent idiopathic scoliosis (AIS) correction surgery. A total of 101 patients with AIS were recruited (RA group: 45 patients underwent RA screw insertion; FA group: 56 patients underwent FA screw insertion). When comparing the radiological data between the two groups, the major and secondary curves were both corrected proficiently with no difference in Cobb angle comparison at the last follow-up, suggesting that both the RA technique and the FA technique could lead to efficient radiographic correction and similar clinical outcomes (all, p > 0.05). In the RA group, operation time, blood loss, and transfusion volume were significantly greater than those in the FA group, while the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve in the RA group was higher than that in the FA group. In conclusion, both the RA and FA techniques could approach proficient radiographic correction and similar clinical outcomes in AIS surgery. Compared with the conventional fluoroscopy technique, the RA technique might improve the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve, while the increased operation time, blood loss, and transfusion volume might be the disadvantages due to the preliminary stage of the learning curve.

Application of the rapid upper limb assessment tool to assess the level of ergonomic risk among health care professionals: A systematic review

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) and ergonomic risk factors are widespread problems in the healthcare sector. OBJECTIVE: The primary objective of this review is to evaluate the application of the Rapid Upper Limb Assessment (RULA) tool in various healthcare professionals and to assess the level of ergonomic risk among them. METHODS: The databases MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, DOAJ, PubMed, and PEDro were searched with terms associated with ergonomics, assessment, health care providers, risk factors, workplace, and RULA. We reviewed the literature from 2000 to 2020, including studies assessing RULA’s effectiveness for evaluating the WMSD’s and ergonomic risk in health care practitioners. We excluded the studies which were not open access and freely available. RESULTS: Overall, 757 records were screened; of these 40 potential studies, 13 different healthcare professionals were identified as eligible for inclusion. In most studies, the RULA tool was established as an effective tool in application and evaluating the level of the ergonomic risk among them. CONCLUSIONS: The RULA tool assessed the high ergonomic risk levels in dental professionals and low ergonomic risk levels in professionals working in the pharmacy department, clearly suggesting potential changes in work postures were necessary to prevent or reduce these risk factors.

Study on augmented reality for robotic surgery bedside assistants

Robotic surgery bedside assistants play an important role in robotic procedures by performing intra-corporeal tasks while accommodating the physical presence of the robot. We hypothesized that an augmented reality headset enabling 3D intra-corporeal vision while facing the surgical field could decrease time and improve accuracy of robotic bedside tasks. Bedside assistants (one physician assistant, one medical student, three surgical trainees, and two attending surgeons) performed validated tasks within a mock abdominal cavity with a surgical robot docked. Tasks were performed with a bedside monitor providing 2D or 3D vision, or an optical see-through head-mounted augmented reality device with 2D or 3D vision. The effect of augmented reality device resolution on performance was also evaluated. For the simplest task of touching a straw, performance was generally high, regardless of mode of visualization. With more complex tasks, including stapling and pulling a ring along a path, 3D augmented reality decreased time and number of errors per task. 3D augmented reality allowed the physician assistant to perform at the level of an attending surgeon using 3D augmented reality (p = 0.08). All participants had improved times for the ring path task with better resolution (lower resolution 23 ± 11 s vs higher resolution 14 ± 4 s, p = 0.002). 3D augmented reality vision with high resolution decreased time and improved accuracy of more complex tasks, enabling a less experienced robotic surgical bedside assistant to function similar to attending surgeons. These data warrant further study with additional complex tasks and bedside assistants at various levels of training.

Single-docking robotic-assisted artery-guided segmental splenic flexure colectomy for splenic flexure cancer-a propensity score-matching analysis

Background

Splenic flexure cancer (SFC) is a rare condition in colorectal cancer (CRC). The appropriate surgical treatment for SFC remains controversial. In recent years, we have used artery-guided segmental splenic flexure colectomy (ASFC) to treat SFC in which robotic access is gradually applied. The study sought to assess the clinical and oncologic outcomes of robotic-assisted ASFC compared to laparoscopic-assisted ASFC for SFC by undertaking a propensity score-matching analysis.

Methods

Seventy patients underwent a robotic-assisted ASFC (n=19) or laparoscopic-assisted ASFC (n=51) to treat SFC from Dec 2015 to Dec 2019. Their data were prospectively collected. The patients were matched at a ratio of 1:1 according to sex, age, body mass index (BMI), comorbidities, the American Society of Anesthesiologists (ASA) score (≤2 or >2), previous abdominal surgeries, and pathologic stage.

Results

No statistically significant differences were found between the robotic- and laparoscopic-assisted ASFC groups in relation to operation time, estimated blood loss, length of postoperative hospital stay, time to liquid diet, postoperative complications, tumor size, distal resection margins, histology, lymph node harvest, metastatic lymph nodes, and neuro-vascular invasion. Additionally, no case was converted to a laparotomy. There were no cases readmission or mortality within 30 days of surgery. The distal resection margins were longer in the robotic-assisted ASFC group than the laparoscopic-assisted ASFC group. The robotic-assisted ASFC group had significantly higher operation expenses than the laparoscopic-assisted ASFC group. However, there was no significant difference in the surgical material expenses between the two groups. There were 2 cases of complications in each group; both cases were classified as grade I or II under Dindo's classification of surgical complications.

Conclusions

With the exception of operation expenses, robotic-assisted ASFC rivals laparoscopic-assisted ASFC in many respects. ASFC meets the recommended oncological criteria in terms of resection margins and lymph node harvest. We await the results for the long-term oncologic outcomes.

How can robot-assisted surgery provide value for money?

Objectives

To develop an interactive tool that estimates what potential benefits are needed for the robot to provide value for money when compared with endoscopic or open surgical interventions.

Design

A generic online interactive tool was developed to analyze the (health) effects needed to compensate for the additional costs of using a surgical robotic system from a healthcare perspective. The application of the tool is illustrated with a hypothetical new surgical robotic platform. A synthesis of evidence from different sources was used combined with interviews with surgeons.

Setting

Flexible tool that can be adapted to flexible settings.

Participants

Any hospital patient group for which robotic, endoscopic or open surgical procedures may be considered as appropriate treatment alternatives (eg, urology, gynecology, and so on).

Intervention

Robotically assisted surgical interventions.

Comparator

Endoscopic or open surgical interventions.

Main outcome measures

Thresholds of how much (health) effect is needed for robot-assisted surgery to provide value for money and to become cost-effective.

Results

The utilization rate of the surgical robotic system and a reduction in complications appeared to be important aspects in determining the value for money. To become cost-effective, it was deemed important for new surgical robotic systems to have added clinical benefit and become less costly than the current system.

Conclusions

This paper and its assisting interactive tool can be used by clinicians, researchers, and policymakers to gain insight in the benefit needed to provide value for money when using a (new) surgical robotic system or, when the effects are known or can be estimated, to assess the value for money for a specific indication. For robotic surgery to provide most value for money, we recommend assessing for each indication whether the necessary effects seem achievable.

Work-system interventions in robotic-assisted surgery: a systematic review exploring the gap between challenges and solutions

BACKGROUND

The introduction of a robot into the surgical suite changes the dynamics of the work-system, creating new opportunities for both success and failure. An extensive amount of research has identified a range of barriers to safety and efficiency in Robotic Assisted Surgery (RAS), such as communication breakdowns, coordination failures, equipment issues, and technological malfunctions. However, there exists very few solutions to these barriers. The purpose of this review was to identify the gap between identified RAS work-system barriers and interventions developed to address those barriers.

METHODS

A search from three databases (PubMed, Web of Science, and Ovid Medline) was conducted for literature discussing system-level interventions for RAS that were published between January 1, 1985 to March 17, 2020. Articles describing interventions for systems-level issues that did not involve technical skills in RAS were eligible for inclusion.

RESULTS

A total of 30 articles were included in the review. Only seven articles (23.33%) implemented and evaluated interventions, while the remaining 23 articles (76.67%) provided suggested interventions for issues in RAS. Major barriers identified included disruptions, ergonomic issues, safety and efficiency, communication, and non-technical skills. Common solutions involved team training, checklist development, and workspace redesign.

CONCLUSION

The review identified a significant gap between issues and solutions in RAS. While it is important to continue identifying how the complexities of RAS affect operating room (OR) and team dynamics, future work will need to address existing issues with interventions that have been tested and evaluated. In particular, improving RAS-associated non-technical skills, task management, and technology management may lead to improved OR dynamics associated with greater efficiency, reduced costs, and better systems-level outcomes.

Musculoskeletal Risks: RULA Bibliometric Review

The objective of this study was to reveal RULA method applications in terms of the knowledge, country, year and journal categories. The search was performed using the "Web of Science Core Collection". The period from 1993 to April 2019 was selected. Eight hundred nine results were obtained, of which 226 were used. The largest number of publications was determined to be in the fields of industry and health and social assistance, which coincides with the OWAS and Standardized Nordic Questionnaire methods. By country, the USA stands out for its greater number of research studies and categories that are encompassed. By date, 2016 was the year when more studies were carried out, again coinciding with the Standardized Nordic Questionnaire. By journal, "Work-A Journal of Prevention Assessment and Rehabilitation" is highlighted, as it is for the REBA method as well. It was concluded that RULA can be applied to workers in different fields, usually in combination with other methods, while technological advancement provides benefits for its application.