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Hislop J, Tirosh O, Isaksson M, McCormick J, Hensman C. Perceived comfort and tool usability during robot-assisted and traditional laparoscopic surgery: a survey study. J Robot Surg 2024; 18:15. [PMID: 38217625 PMCID: PMC10787683 DOI: 10.1007/s11701-023-01785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
It is known that over half of previously surveyed surgeons performing Robot-Assisted Laparoscopic Surgery (RALS) and three-quarters of those performing Traditional Laparoscopic Surgery (TLS) experience intraoperative pain. This survey study aimed to expand upon the ongoing impact of that pain as well as perceived tool usability associated with TLS and RALS, for which considerably less documentation exists. A survey regarding the presence and impact, either immediate or ongoing, of intraoperative pain and Likert scale questions regarding tool usability was administered to TLS and RALS surgeons on the European Association for Endoscopic Surgery (EAES) mailing list. Prevalence statistics as well as trends based on biological sex and glove size were obtained from the 323 responses. Most respondents were right-handed European males (83-88%) with a medium glove size (55.8%). Moderate or severe shoulder symptoms were experienced by one-third of TLS surgeons. Twenty-one percent of RALS surgeons experienced neck symptoms that impacted their concentration. Small-handed surgeons experienced wrist symptoms significantly more frequently than large-handed surgeons, regardless of modality. RALS was associated with a significantly more optimal back and wrist posture compared to TLS. TLS surgeons reported increased ease with applying and moderating force while operating. These results suggest that intraoperative pain may be severe enough in many cases to interfere with surgeon concentration, negatively impacting patient care. Continuing to understand the relationship between tool usability and comfort is crucial in guaranteeing the health and well-being of both surgeons and patients.
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Affiliation(s)
- Jaime Hislop
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Oren Tirosh
- School of Health and Biomedical Sciences, RMIT, Melbourne, Australia
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
- Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Mats Isaksson
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia
| | - John McCormick
- Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, Australia.
| | - Chrys Hensman
- Swinburne University of Technology, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
- University of Adelaide, Adelaide, Australia
- LapSurgery Australia, Melbourne, Australia
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Gorce P, Jacquier-Bret J. Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6419. [PMID: 37510651 PMCID: PMC10379148 DOI: 10.3390/ijerph20146419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I2 statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.
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Affiliation(s)
- Philippe Gorce
- International Institute of Biomechanics and Occupational Ergonomics, ErBio, Avenue du Dr Marcel Armanet, 83400 Hyères, France
- Université de Toulon, CS60584, CEDEX 9, 83041 Toulon, France
| | - Julien Jacquier-Bret
- International Institute of Biomechanics and Occupational Ergonomics, ErBio, Avenue du Dr Marcel Armanet, 83400 Hyères, France
- Université de Toulon, CS60584, CEDEX 9, 83041 Toulon, France
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:916-923. [PMID: 36175710 DOI: 10.1245/s10434-022-12548-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard laparoscopy (SL) is responsible for musculoskeletal disorders in surgeons because of poor ergonomic positions, which could be reduced by robot-assisted laparoscopy (RAL) owing to the surgeons' seated position. One of the aims of the ROBOGYN-1004 study (NCT01247779) was to evaluate surgeons' workloads during real-time procedures of gynecological oncological surgery. METHODS Patients with gynecological cancer eligible for minimally invasive surgery were recruited from 13 French centers between December 2010 and December 2015. Physical workload was evaluated using the Borg scale every hour over the surgery duration and the perception of workload evaluated using NASA-TLX at the end of surgery. RESULTS A total of 369 patients were recruited, of whom 176 underwent RAL and 193 underwent SL (per-protocol analysis). Posture during SL was significantly more challenging for all body parts except the back. There was an increase in discomfort over time (up to 4 h) for the hands and arms, neck, and legs in SL compared with RAL. Perceived physical activity and abilities were rated higher in SL than in RAL (p < 0.01), whereas perceived personal performance was higher in SL (p < 0.01). Perceived physical effort during surgery was lower in RAL than in SL. CONCLUSIONS RAL improves the perception of physical workload. Compared with SL, the perceived effort is lower in RAL regardless of the complexity of the surgery.
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Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France
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Gabrielson AT, Clifton MM, Pavlovich CP, Biles MJ, Huang M, Agnew J, Pierorazio PM, Matlaga BR, Bajic P, Schwen ZR. Surgical ergonomics for urologists: a practical guide. Nat Rev Urol 2021; 18:160-169. [PMID: 33432182 DOI: 10.1038/s41585-020-00414-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
Poor ergonomics in the operating room can have detrimental effects on a surgeon's physical, psychological and economic well-being. This problem is of particular importance to urologists who are trained in nearly all operative approaches (open, laparoscopic, robotic-assisted, microscopic and endoscopic surgery), each with their own ergonomic considerations. The vast majority of urologists have experienced work-related musculoskeletal pain or injury at some point in their career, which can result in leaves of absence, medical and/or surgical treatment, burnout, changes of specialty and even early retirement. Surgical ergonomics in urology has been understudied and underemphasized. In this Review, we characterize the burden of musculoskeletal injury in urologists and focus on various ergonomic considerations relevant to the urology surgeon. Although the strength of evidence remains limited in this space, we highlight several practical recommendations stratified by operative approach that can be incorporated into practice without interrupting workflow whilst minimizing injury to the surgeon. These recommendations might also serve as the foundation for ergonomics training curricula in residency and continuing medical education programmes. With improved awareness of ergonomic principles and the sequelae of injury related to urological surgery, urologists can be more mindful of their operating room environment and identify ways of reducing their own symptoms and risk of injury.
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Affiliation(s)
- Andrew T Gabrielson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Marisa M Clifton
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mitchell Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacqueline Agnew
- Department of Environmental Health and Engineering, Johns Hopkins Education and Research Center for Occupational Safety and Health, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian R Matlaga
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad R Schwen
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Knuttinen MG, Zurcher KS, Wallace A, Doe C, Naidu SG, Money SR, Rochon PJ. Ergonomics in IR. J Vasc Interv Radiol 2020; 32:235-241. [PMID: 33358387 DOI: 10.1016/j.jvir.2020.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022] Open
Abstract
Ergonomic research in the field of interventional radiology remains limited. Existing literature suggests that operators are at increased risk for work-related musculoskeletal disorders related to the use of lead garments and incomplete knowledge of ergonomic principles. Data from existing surgical literature suggest that musculoskeletal disorders may contribute to physician burnout and female operators are at a higher risk of developing musculoskeletal disorders. This review article aims to summarize the existing ergonomic challenges faced by interventional radiologists, reiterate existing solutions to these challenges, and highlight the need for further ergonomic research in multiple areas, including burnout and gender.
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Affiliation(s)
| | - Kenneth S Zurcher
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona.
| | - Alex Wallace
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona
| | - Christopher Doe
- Department of Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sailendra G Naidu
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona
| | - Samuel R Money
- Department of Surgery, Ochsner Clinic, New Orleans, Louisiana
| | - Paul J Rochon
- Department of Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
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Hislop J, Hensman C, Isaksson M, Tirosh O, McCormick J. Self-reported prevalence of injury and discomfort experienced by surgeons performing traditional and robot-assisted laparoscopic surgery: a meta-analysis demonstrating the value of RALS for surgeons. Surg Endosc 2020; 34:4741-4753. [DOI: 10.1007/s00464-020-07810-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022]
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Aykan S, Temiz MZ, Duymaz T, Ural IH, Colakerol A, Muslumanoglu AY, Semercioz A. Effects of the Three-Dimensional Vision System on Surgical Performance, Muscular Fatigue, and Pain During Urologic Laparoscopic Tasks: Results of Objective Assessments and a Mini Questionnaire Survey. J Laparoendosc Adv Surg Tech A 2019; 29:346-352. [PMID: 30136883 DOI: 10.1089/lap.2018.0328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The three-dimensional (3D) vision system was released to the medical market to improve laparoscopic outcomes. We analyzed the muscular pain and fatigue, and the performance outcomes after several laparoscopic urologic tasks were completed with the 3D vision system. METHODS A total of 49 participants with different surgical expertise levels were enrolled in the study. All the participants performed some laparoscopic urologic tasks using two-dimensional (2D) and 3D vision systems separately. A mini questionnaire survey was also completed by the participants. The duration and quality of the tasks and the muscular fatigue and pain were objectively determined. All the parameters were compared between the 2D and 3D systems. RESULTS Although all the tasks were completed in significantly shorter times with the 3D vision system in each expertise level, maximal shortening was seen in the residents. The overall quality scores were significantly higher with the 3D vision system. However, a maximal increase was seen in the residents. The muscular pain of the participants was lower with 3D vision system. The overall handgrip strength significantly increased from 41.2 to 42.4 kg after the tasks with the 3D vision system, but the difference was significant in only the residents. Twenty-seven participants (56.2%) declared that the 3D system contributed to their performance, and most of the participants (83.3%) preferred the 3D system in the questionnaire survey. CONCLUSION 3D technology may be effective for use in urologic laparoscopic training programs of novice surgeons. It may also contribute to the skills of specialists and experts, shortening the surgical time, which may decrease the surgical morbidity.
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Affiliation(s)
- Serdar Aykan
- 1 Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | | | - Tomris Duymaz
- 3 Department of physiotherapy, Faculty of Health Sciences, Bilgi University, Istanbul, Turkey
| | - Ibrahim Halil Ural
- 4 Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Aykut Colakerol
- 5 Department of Urology, Sancaktepe Martyr Professor Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | | | - Atilla Semercioz
- 1 Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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8
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Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery. Ann Surg 2017; 266:905-920. [DOI: 10.1097/sla.0000000000002223] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Yang K, Perez M, Perrenot C, Hubert N, Felblinger J, Hubert J. A new system for evaluation of armrest use in robotic surgery and validation of a new ergonomic concept - armrest load. Int J Med Robot 2016; 12:604-612. [DOI: 10.1002/rcs.1723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/28/2022]
Affiliation(s)
- K. Yang
- IADI/Inserm U947; Lorraine University; Nancy France
- Wuhan University; Department of Urology, Zhongnan Hospital; Wuhan People's Republic of China
- Department of Urology; CHU Nancy; France
| | - M. Perez
- IADI/Inserm U947; Lorraine University; Nancy France
- Department of Emergency and General Surgery; CHU Nancy; France
| | - C. Perrenot
- IADI/Inserm U947; Lorraine University; Nancy France
- Department of Emergency and General Surgery; CHU Nancy; France
| | - N. Hubert
- IADI/Inserm U947; Lorraine University; Nancy France
- Department of Urology; CHU Nancy; France
| | | | - J. Hubert
- IADI/Inserm U947; Lorraine University; Nancy France
- Department of Urology; CHU Nancy; France
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10
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Ruitenburg MM, Frings-Dresen MHW, Sluiter JK. Current and future healthcare needs of future hospital physicians. Occup Med (Lond) 2015; 66:122-7. [PMID: 26400971 DOI: 10.1093/occmed/kqv146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Work-related health problems can impair the work ability of hospital physicians and pose a threat to patient safety. Understanding the health status and care needs of young hospital physicians is therefore essential to providing job-specific health services and ensuring good future quality of care. AIMS To investigate the current health status of future hospital physicians and their current and future care needs and to explore their preferences regarding occupational health services. METHODS We gathered data concerning worries about current health, current and future care needs and preferred ways of receiving feedback and interventions when using occupational health services from the 2013 wave of a cohort study of Dutch medical students (original population: n = 4961). We also calculated the relationship between current health status and future care needs. RESULTS We obtained data from 647 future physicians. Irrespective of their stage of training, most (73%) had few worries about their current health. However, two-fifths felt in need of care for psychological (42%) or physical (40%) complaints. More than half (52%) anticipated future care needs by indicating they would consider using occupational health services when offered in the future. General health status was not significantly related to feeling in need of future care. Preferences regarding feedback on health results were to receive this by email (54%) or from an occupational physician (51%) and in their own teaching hospital (68%). CONCLUSIONS Future hospital physicians expressed a need for current and future occupational healthcare, irrespective of current worries about health.
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Affiliation(s)
- M M Ruitenburg
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - M H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - J K Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
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Ruitenburg MM, Frings-Dresen MH, Sluiter JK. How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians? Saf Health Work 2015; 7:18-31. [PMID: 27014487 PMCID: PMC4792917 DOI: 10.1016/j.shaw.2015.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/31/2015] [Accepted: 08/26/2015] [Indexed: 11/19/2022] Open
Abstract
Background A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps should be taken to determine the content of a job-specific WHS for hospital physicians and outlines that content. Methods Based on four questions, decision trees were developed for physical and psychological job demands and for biological, chemical, and physical exposures to decide whether or not to include work-related health effects related to occupational exposures or aspects of health reflecting insufficient job requirements. Information was gathered locally through self-reporting and systematic observations at the workplace and from evidence in international publications. Results Information from the decision trees on the prevalence and impact of the health- or work-functioning effect led to inclusion of occupational exposures (e.g., biological agents, emotionally demanding situations), job requirements (e.g., sufficient vision, judging ability), or health effects (e.g., depressive symptoms, neck complaints). Additionally, following the Dutch guideline for occupational physicians and based on specific job demands, screening for cardiovascular diseases, work ability, drug use, and alcohol consumption was included. Targeted interventions were selected when a health or work functioning problem existed and were chosen based on evidence for effectiveness. Conclusion The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.
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Affiliation(s)
| | | | - Judith K. Sluiter
- Corresponding author. Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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Abstract
A number of tools have been introduced to make laparoscopy easier. Some, such as 3D video systems, are interesting, and may add a modicum of benefit in some situations, but overall, have not had substantial impact. Others, such as robotic surgery, clearly have great potential, but are simply too expensive for widespread use. A few, such as the argon beam coagulator, are helpful only in particular situations. One technique has lived up to its billing and moreover, can be applied in almost any laparoscopic procedure, it is cost effective and actually does make laparoscopy easier. Hand-assisted laparoscopic surgery is a useful adjunct to the laparoscopic surgeon, and should be considered by all interested in this endeavor. This review summarizes the current hand-assistance devices and their use.
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Affiliation(s)
- J Stuart Wolf
- University of Michigan, Department of Urology, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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13
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Cass GKS, Vyas S, Akande V. Prolonged laparoscopic surgery is associated with an increased risk of vertebral disc prolapse. J OBSTET GYNAECOL 2013; 34:74-8. [DOI: 10.3109/01443615.2013.831048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Hubert N, Gilles M, Desbrosses K, Meyer JP, Felblinger J, Hubert J. Ergonomic assessment of the surgeon's physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot 2013; 9:142-7. [PMID: 23529792 DOI: 10.1002/rcs.1489] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Standard laparoscopy is responsible for musculoskeletal problems because of surgeons anti-ergonomic positions. Robot-assisted laparoscopy seems to reduce these musculoskeletal disorders thanks to the surgeons seated position. The objective of this study is to evaluate the muscular strain and cognitive stress induced by these two techniques during real operations conducted on the pig. METHODS Electromyographic activities, heart rate, physical and mental workloads (NASA Tlx and Borg CR-10) were recorded. RESULTS Physical workload and perception of the effort invested was significantly greater during the standard laparoscopies (p<0.05). Mental stress was however identical for the two techniques. In Standard Laparoscopic group, greater physical activity was found for trapezius and dorso-lumbar muscles, and significant appearance of fatigue of the trapezius muscles should also be noted. Finally, heart rate during standard laparoscopy was increased (92.1 ± 1.6 bpm vs 83.7 ± 1.8, p<0,01), confirming greater physical expenditure. CONCLUSIONS Robot-assisted laparoscopy is a less physically stressful surgical technique than standard laparoscopy.
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Affiliation(s)
- N Hubert
- Urology Department, CHRU Nancy-Brabois, rue du Morvan, 54511, Vandœuvre-les-Nancy, France
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Corcione F, Pirozzi F, Cuccurullo D, Piccolboni D, Caracino V, Galante F, Cusano D, Sciuto A. Laparoscopic pancreaticoduodenectomy: experience of 22 cases. Surg Endosc 2013; 27:2131-6. [PMID: 23355144 DOI: 10.1007/s00464-012-2728-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 12/01/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laparoscopic pancreatic surgery has gradually expanded its applications to include pancreaticoduodenectomy. However, the benefits of the laparoscopic approach are still debated. This article aims to present data regarding the efficacy of laparoscopic pancreaticoduodenectomy in a single center. METHODS From March 2003 to June 2010, a total of 22 patients underwent pancreaticoduodenectomy with a totally laparoscopic approach, using a five-trocar technique. Reconstruction of the digestive tract was adapted to the aspect of the pancreatic stump, with 6 patients having Wirsung duct occlusion and 16 patients pancreaticodigestive anastomosis. Patient selection, short-term outcomes, oncologic results, and technical issues were retrospectively reviewed. RESULTS Mean operative time was 392 (range, 327-570) min. Conversion was required in 2 patients (9.1 %) as a result of bleeding and difficult dissection. Major intraoperative complications included an injury to the right hepatic artery (4.5 %). Postoperative mortality was 4.5 %. Surgery-related morbidity occurred in 14 patients (63.6 %) and included bleeding (n = 5), pancreatic fistula (n = 6), biliary fistula (n = 2), and dumping syndrome (n = 1). Pancreatic fistulas occurred in 4 patients with duct occlusion and in 2 patients with pancreaticojejunostomy, and they all healed with conservative treatment. Mean hospital stay was 23 (range, 12-35) days. Pathologic diagnoses were pancreatic ductal adenocarcinoma (n = 11), ampullary adenocarcinoma (n = 8), and duodenal adenocarcinoma (n = 3). The resection margins were all free from disease; the mean number of collected lymph nodes was 15 (range, 14-20). CONCLUSIONS The complexity of pancreaticoduodenectomy entails some issues, including patient selection and management of the pancreatic stump, that are not related to the approach used. Laparoscopic pancreaticoduodenectomy is feasible, safe, and oncologically adequate, but only if performed in selected cases by highly skilled laparoscopic surgeons. Laparoscopy does not provide any significant advantage over traditional surgery, but it may improve postoperative outcomes in the so-called excellence centers, once the learning curve has been overcome. Multicenter randomized trials are needed.
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Affiliation(s)
- Francesco Corcione
- Department of Laparoscopic and Robotic Surgery, Azienda Ospedaliera dei Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
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Yin G, Han WK, Faddegon S, Tan YK, Liu ZW, Olweny EO, Scott DJ, Cadeddu JA. Laparoendoscopic Single Site (LESS) In Vivo Suturing Using a Magnetic Anchoring and Guidance System (MAGS) Camera in a Porcine Model: Impact on Ergonomics and Workload. Urology 2013; 81:80-4. [PMID: 23153954 DOI: 10.1016/j.urology.2012.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 07/17/2012] [Accepted: 09/17/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Gang Yin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA
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Hampel C, Thomas C, Thüroff JW, Roos F. [Sacropolpopexy - pro robotic]. Urologe A 2012; 51:700-4. [PMID: 22526191 DOI: 10.1007/s00120-012-2892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abdominal sacrocolpopexy is a standard procedure for the correction of pelvic organ prolapse of all three compartments and can also be performed minimally invasively without compromising efficacy as by open techniques. In comparison to conventional laparoscopy robotic-assisted laparoscopic sacrocolpopexy benefits from several technical stand-alone features, such as three-dimensional view, increased degrees of freedom through angulated instruments, tremor filter and up and down scaling of instrument movements. These advantages facilitate preparation of the vesicovaginal and rectovaginal spaces as well as suturing and reperitonealization, which should lead to decreased operation time and anesthesia time in extreme Trendelenburg position. Surgeon also benefit from the much more ergonomic working conditions of the da Vinci® system: however, comparative studies are rare and conclusions are preliminary. The German reimbursement system (DRG) does not adequately cover da Vinci expenses which, despite the obvious advantages represents the most significant obstacle in the propagation of this technique.
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Affiliation(s)
- C Hampel
- Urologische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55131 Mainz, Deutschland.
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Physical job demands and related health complaints among surgeons. Int Arch Occup Environ Health 2012; 86:271-9. [PMID: 22456979 PMCID: PMC3602608 DOI: 10.1007/s00420-012-0763-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 03/09/2012] [Indexed: 11/13/2022]
Abstract
Purpose Surgeons’ poor physical health and high physical job demands might threaten good quality of care. We aimed to compare the prevalence of physical complaints of surgeons, their physical work ability and the physical job demands of surgeons with that of other hospital physicians. Methods All medical doctors (n = 958) of one academic medical center were invited to complete the online questionnaire to assess the physical work ability and the prevalence of regional musculoskeletal complaints. A purposive sample of 44 surgeons and 82 other hospital physicians were systematically observed during work to quantify the physical job demands for an average working day. Results More surgeons found their work to be physically strenuous (41 vs. 13 %, p < .000) and more were bothered by working in uncomfortable or exhausting postures (73 vs. 27 %, p < .001). Both groups reported that most of their physical complaints were in the neck (39 and 32 %) and arm regions (36 and 27 %). The majority of surgeons (86 %) and other hospital physicians (79 %) experienced difficulties coping with their job demands because of their physical state once a month or less. Compared with other hospital physicians, surgeons stand longer (4 vs. 3 h, p = .004) and perform fine repetitive movements longer (80 vs. 3 min, p < .001) during an average working day. Conclusions Exposure to several physical job demands that are perceived as uncomfortable and exhausting and the presence of physical health complaints reduce surgeons’ work functioning.
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Graversen JA, Korets R, Mues AC, Katsumi HK, Badani KK, Landman J, Gupta M. Prospective Randomized Evaluation of Gel Mat Foot Pads in the Endoscopic Suite. J Endourol 2011; 25:1793-6. [DOI: 10.1089/end.2011.0155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joseph A. Graversen
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ruslan Korets
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Adam C. Mues
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Hiroshi K. Katsumi
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ketan K. Badani
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, University of California in Irvine, Orange, California
| | - Mantu Gupta
- Department of Urology, Columbia University Medical Center, New York, New York
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Healy KA, Pak RW, Cleary RC, Colon-Herdman A, Bagley DH. Hand problems among endourologists. J Endourol 2011; 25:1915-20. [PMID: 22004843 DOI: 10.1089/end.2011.0128] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Endourology has evolved rapidly for the management of both benign and malignant disease of the upper urinary tract. Limited data exist, however, on the occupational hazards posed by complex endourologic procedures. The aim of this study was to determine the prevalence and possible causes of hand problems among endourologists who routinely perform flexible ureteroscopy compared with controls. MATERIALS AND METHODS An online computer survey targeted members of the Endourological Society and psychiatrists in academic and community settings. A total of 600 endourologists and 578 psychiatrists were contacted by e-mail. Invited physicians were queried regarding their practice settings and symptoms of hand pain, neuropathy, and/or discomfort. RESULTS Survey responses were obtained from 122 (20.3%) endourologists and 74 (12.8%) psychiatrists. Of endourologists, 61% were in an academic setting and 70% devoted their practice to endourology. Endourologists were in practice for a mean 13 years, performing 4.5 ureteroscopic cases per week with a mean operative time of 50 minutes. Hand/wrist problems were reported by 39 (32%) endourologists compared with 14 (19%) psychiatrists (P=0.0486, relative risk [RR]=1.69). Surgeons who preferred counterintuitive ureteroscope deflection were significantly more likely to have problems (56%) compared with intuitive users (27%) (RR 2.07, P=0.0139) or those with no preference (26%) (RR 2.15, P=0.0451). Overall, most respondents (85%) with hand/wrist problems needed either medical or surgical intervention. CONCLUSIONS Hand and wrist problems are very common among endourologists. Future studies are needed to develop more ergonomic platforms and thereby reduce the endourologist's exposure to these occupational hazards.
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Affiliation(s)
- Kelly A Healy
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Abstract
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.
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Oude Hengel KM, Visser B, Sluiter JK. The prevalence and incidence of musculoskeletal symptoms among hospital physicians: a systematic review. Int Arch Occup Environ Health 2010; 84:115-9. [PMID: 20686782 PMCID: PMC3020318 DOI: 10.1007/s00420-010-0565-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 07/21/2010] [Indexed: 11/30/2022]
Abstract
Objective Physicians are exposed to a range of work-related risk factors that may result in occupational diseases. This systematic review aims at shedding light on the prevalence and incidence of musculoskeletal complaints among hospital physicians. Methods A systematic literature search was performed in Pubmed and EMBASE (1990–2010), and methodological quality criteria were applied. A search was done for musculoskeletal complaints. Results Five medium-quality studies and three high-quality studies were included in this review. The definitions and assessment used in the studies for musculoskeletal complaints were different. In short, the frequently reported prevalence for hand and wrist pain was 8–33 and 0%, 17% for shoulder pain, and 9–28% for neck pain. Moreover, the annual prevalence of low back pain was between 33 and 68%. Interpretation The limited number of studies makes it difficult to draw conclusions, and the results should be intepreted with care. In conclusion, musculoskeletal complaints may be work-related complaints in hospital physicians, which need future attention.
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Affiliation(s)
- Karen M Oude Hengel
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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Rassweiler J, Hruza M, Klein J, Goezen AS, Teber D. The Role of Laparoscopic Radical Prostatectomy in the Era of Robotic Surgery. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eursup.2010.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Haramis G, Rosales JC, Palacios JM, Okhunov Z, Mues AC, Lee D, Badani K, Gupta M, Landman J. Prospective randomized evaluation of FOOT gel pads for operating room staff COMFORT during laparoscopic renal surgery. Urology 2010; 76:1405-8. [PMID: 20350745 DOI: 10.1016/j.urology.2010.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/08/2009] [Accepted: 01/14/2010] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Georgios Haramis
- Columbia University School of Medicine, Department of Urology, New York, NY, USA
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25
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Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 2009; 24:377-82. [PMID: 19536599 DOI: 10.1007/s00464-009-0578-0] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 04/29/2009] [Accepted: 05/14/2009] [Indexed: 01/09/2023]
Abstract
BACKGROUND Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room. METHODS Medical students (n = 34), without prior laparoscopic suturing experience, were enrolled in an Institutional Review Board-approved, randomized protocol. After viewing an instructional video, subjects were tested in intracorporeal suturing on two identical, live, porcine Nissen fundoplication models; they placed three gastro-gastric sutures using conventional laparoscopic instruments in one model and using robotic assistance (da Vinci) in the other, in random order. Each knot was objectively scored based on time, accuracy, and security. Injuries to surrounding structures were recorded. Workload was assessed using the validated National Aeronautics and Space Administration (NASA) task load index (TLX) questionnaire, which measures the subjects' self-reported performance, effort, frustration, and mental, physical, and temporal demands of the task. Analysis was by paired t-test; p < 0.05 was considered significant. RESULTS Compared with laparoscopy, robotic assistance enabled subjects to suture faster (595 +/- 22 s versus 459 +/- 137 s, respectively; p < 0.001), achieve higher overall scores (0 +/- 1 versus 95 +/- 128, respectively; p < 0.001), and commit fewer errors per knot (1.15 +/- 1.35 versus 0.05 +/- 0.26, respectively; p < 0.001). Subjects' overall score did not improve between the first and third attempt for laparoscopic suturing (0 +/- 0 versus 0 +/- 0; p = NS) but improved significantly for robotic suturing (49 +/- 100 versus 141 +/- 152; p < 0.001). Moreover, subjects indicated on the NASA-TLX scale that the task was more difficult to perform with laparoscopic instruments compared with robotic assistance (99 +/- 15 versus 57 +/- 23; p < 0.001). CONCLUSIONS Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing performance and safety of novices in the operating room while decreasing their workload. Moreover, the robot significantly shortened the learning curve of this difficult task. Further study is needed to assess the value of robotic assistance for experienced surgeons, and validated robotic training curricula need to be developed.
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Bagrodia A, Raman JD. Ergonomics considerations of radical prostatectomy: physician perspective of open, laparoscopic, and robot-assisted techniques. J Endourol 2009; 23:627-33. [PMID: 19358686 DOI: 10.1089/end.2008.0556] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Urolithiasis, Endourology and Laparoscopy. J Urol 2008. [DOI: 10.1016/j.juro.2008.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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van der Schatte Olivier RH, van‘t Hullenaar CDP, Ruurda JP, Broeders IAMJ. Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 2008; 23:1365-71. [PMID: 18855053 PMCID: PMC2687080 DOI: 10.1007/s00464-008-0184-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 07/31/2008] [Accepted: 08/13/2008] [Indexed: 12/29/2022]
Abstract
Background Robot-assisted surgical systems have been introduced to improve the outcome of minimally invasive surgery. These systems also have the potential to improve ergonomics for the surgeon during endoscopic surgery. This study aimed to compare the user’s mental and physical comfort in performing standard laparoscopic and robot-assisted techniques. Surgical performance also was analyzed. Methods In this study, 16 surgically inexperienced participants performed three tasks using both a robotic system and standard laparoscopic instrumentation. Distress was measured using questionnaires and an ambulatory monitoring system. Surgical performance was analyzed with time-action analysis. Results The physiologic parameters (p = 0.000), the questionnaires (p = 0.000), and the time-action analysis (p = 0.001) favored the robot-assisted group in terms of lower stress load and an increase in work efficiency. Conclusion In this experimental setup, the use of a robot-assisted surgical system was of value in both cognitive and physical stress reduction. Robotic assistance also demonstrated improvement in performance.
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Affiliation(s)
| | - C. D. P. van‘t Hullenaar
- Department of Surgery, University Medical Center, Utrecht, The Netherlands
- Department of Surgery, Meander Medical Center, P.O. Box 1502, 3800 BM Amersfoort, The Netherlands
| | - J. P. Ruurda
- Department of Surgery, University Medical Center, Utrecht, The Netherlands
| | - I. A. M. J. Broeders
- Department of Surgery, Meander Medical Center, P.O. Box 1502, 3800 BM Amersfoort, The Netherlands
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Gofrit ON, Mikahail AA, Zorn KC, Zagaja GP, Steinberg GD, Shalhav AL. Surgeons' perceptions and injuries during and after urologic laparoscopic surgery. Urology 2008; 71:404-7. [PMID: 18342173 DOI: 10.1016/j.urology.2007.07.077] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2006] [Revised: 04/15/2007] [Accepted: 07/12/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The biomechanical and mental strains placed on the surgeon while performing laparoscopic procedures are significantly higher compared with open surgical techniques. We undertook this study to assess the prevalence of surgeons' deleterious perceptions or injuries related to laparoscopic urologic surgery. METHODS Members of endourological society were mailed a questionnaire evaluating their laparoscopic experience, total number of standard laparoscopic surgeries (SLS), hand-assisted laparoscopic surgeries (HALS), and robotic-assisted laparoscopic surgeries (RALS) they performed. The subjects reported any neuromuscular or arthritic injuries sustained during laparoscopic surgery, and graded the degree of pain, numbness, and fatigue they experienced. RESULTS A total of 73 urologists completed the questionnaires. The average responder was 44 years old, had completed a median of 117 procedures, and was performing 3 laparoscopic surgeries per week. Neuromuscular or arthritic symptoms during surgery were reported by 22 responders (30%), the most common was finger paresthesia (18%). At the conclusion of HALS, 45% of the surgeons suffered from hand and wrist numbness and 37% reported pain in these areas. A significant association was observed between the risk of sustaining injury during surgery and the total number of laparoscopic procedures performed by the responder (P = 0.016). RALS was the procedure least associated with injuries, and HALS the most. CONCLUSIONS The laparoscopic operating theater is a hostile ergonomic environment. Surgeons' awareness of the common injuries associated with laparoscopic surgery and careful equipment adjustments before surgery are mandatory to minimize injury. Future improvements in instrument design according to ergonomic principles are highly warranted.
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Affiliation(s)
- Ofer N Gofrit
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois 60637, USA.
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Ost MC, VanderBrink BA, Rastinehad AR, Smith AD, Lee BR. Hand Pain During Hand Assisted Laparoscopic Nephrectomy—An Ischemic Event? J Urol 2006; 176:149-54. [PMID: 16753390 DOI: 10.1016/s0022-5347(06)00514-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE The etiology of hand discomfort during hand assisted laparoscopic nephrectomy may be ischemic in nature. We determined if pneumoperitoneal pressure sustained to the hand during hand assisted laparoscopic nephrectomy poses an occupational risk, contributing to local hand hypoxia and resultant extremity pain. MATERIALS AND METHODS A total of 442 measurements of hand oxygen saturation were made during hand assisted laparoscopic nephrectomy. A Nellcor OxiMax Max-1 oxygen sensor was attached to the left index finger of each surgeon and hand assisted laparoscopic nephrectomy was performed using a LapDisc at 15 mm Hg pneumoperitoneal pressures. Local hand oximetry readings and a numerical pain distress scale (range 0 to 10) were recorded every 2 minutes. To control for motion artifact oximetry readings were taken during hand motion and at rest. The Student t test was used to compare differences in local hand oxygen saturation and hand pain in and between study groups. RESULTS A history of hand pain during hand assisted laparoscopic nephrectomy was significantly associated with local hypoxia during operative motion and at rest (p = 0.023 and 0.012, respectively), even with an adequate fascial incision and standard pneumoperitoneal pressures. During hand assisted laparoscopic nephrectomy hand pain was most significantly associated with local hypoxia after 24 minutes (p = 0.0002), when local oxygen saturation was 56% to 88%. CONCLUSIONS A cohort of urologists is predisposed to ischemic hand pain during hand assisted laparoscopic nephrectomy. The etiology of this pain may be hypoxic in nature, attributable to pneumoperitoneal pressure decreasing perfusion and causing venous congestion or regional local ischemia. Circumferential antebrachial constriction from the LapDisc does not seem to be a significant contributing factor in the presence of an adequate fascial incision. Hand pain secondary to ischemia is most significant after 24 minutes at 15 mm Hg. Future studies in more subjects are called for to validate these findings to elucidate which surgeons are predisposed to this potential occupational hazard and what perioperative measures can be taken to avoid hand pain during hand assisted laparoscopic nephrectomy.
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Affiliation(s)
- Michael C Ost
- Department of Urology, North Shore-Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA
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LiteratureWatch. J Endourol 2005; 19:1045-62. [PMID: 16253079 DOI: 10.1089/end.2005.19.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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