Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery
Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery
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DOI：
10.1007/s00464-017-5568-z
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发表时间：
2017-12-01
影响因子：
3.1
通讯作者：
Sengupta, Shomik
中科院分区：
文献类型：
--
作者：
Al-Hakim, Latif;Xiao, Jiaquan;Sengupta, Shomik
本研究的目的是检查在泌尿外科腹腔镜手术期间手术野内发生的手术流中断（内部手术流中断（OFD）），并将这些事件与外部人机工程学环境（监视器位置、器械手柄水平和手术团队成员位置）相关。据我们所知，这是第一个此类研究。一个结合真实的和视频辅助的观察性研究在澳大利亚和中国的医院手术室进行。首先进行头脑风暴会议，以确定主要的内部OFD事件，并列出可观察到的原因，潜在的外部和潜在的人体工程学因素。然后进行了一项前瞻性观察研究。分析观察者的记录和内手术野的相关录像。根据人机工程学环境的相似性将程序进行分组，映射过程显示了由六种原因导致的39种内部OFD事件。共选择24例手术，并分为两组，每组12例手术。A组在满意的人机环境下进行，B组在不满意的人机环境下进行。共检测到1178起OFD事件，使观察到的总手术时间（2966 min）延迟220 min（7.43%）。A组的平均OFD/h小于15，而B组约为29 OFD/h。影响外科医生表现的主要潜在工效学因素有两个：非生理姿势和长时间静止姿势。在不满意的外部人体工程学环境下进行手术的情况下，内部OFD的延迟和数量几乎翻了一番。在长时间手术过程中，一些事件（如停止手术和不相关的谈话）可能会对外科医生的表现产生积极影响。
The aim of this study is to examine operative flow disruption that occurs inside the surgical field, (internal operative flow disruption (OFD)), during urological laparoscopies, and to relate those events to external ergonomics environment in terms of monitor location, level of instruments' handles, and location of surgical team members. According to the our best knowledge, this is the first study of its kind.A combination of real and video-aided observational study was conducted in the operating rooms at hospitals in Australia and China. Brain storming sessions were first conducted to identify the main internal OFD events, and the observable reasons, potential external, and latent ergonomic factors were listed. A prospective observational study was then conducted. The observer's records and the related video records of internal surgical fields were analysed. Procedures were categorised into groups based on similarity in ergonomics environment.The mapping process revealed 39 types of internal OFD events resulted from six reasons. A total of 24 procedures were selected and arranged into two groups, each with twelve procedures. Group A was carried out under satisfactory ergonomics environment, while Group B was conducted under unsatisfactory ergonomics environment. A total of 1178 OFD events were detected delaying the total observed operative times (2966 min) by 220 min (7.43%). Average OFD/h in group A was less than 15, while in group B about 29 OFD/h.There are two main latent ergonomics factors affecting the surgeon's performance; non-physiological posture and long-period static posture. The delays and number of internal OFD were nearly doubled where procedures were conducted under unsatisfactory external ergonomics environment. Some events such as stopping operation and irrelevant conversations during long procedures may have a positive influence on the surgeon's performance.