The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments
The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments
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DOI：
10.1007/s00464-016-4855-4
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发表时间：
2016-11-01
影响因子：
3.1
通讯作者：
Abbott, Jason
中科院分区：
文献类型：
--
作者：
Aitchison, Lucy Ping;Cui, Cathy Kexin;Abbott, Jason
腹腔镜手术对外科医生来说存在多种人体工程学困难，需要笨拙的身体姿势和长时间的静态肌肉负荷，这增加了肌肉骨骼拉伤和损伤的风险。这项前瞻性研究定量测量了腹腔镜手术中外科医生的生物力学运动，以确定可能导致损伤的长时间静态肌肉负荷和重复运动的危险运动。在妇科腹腔镜手术中，从三个固定的摄像机位置拍摄了18名外科医生站在患者左侧的150个视频记录。术后处理使用计算机软件量化外科医生在颈部、肩部和肘部的运动，以测量极端关节角度和在定义的关节角度范围内花费的时间。外科医生在颈部旋转21 A度（范围0A度-52 A度）时花费的手术时间中位数为98%（范围77- 100%）。与优势臂相比，非优势臂承受更极端位置的时间明显更长，肩关节屈曲45 A度-90 A度为35% vs. 0%（p < 0.001），肘关节屈曲> 120 A度为31% vs. 0%（p < 0.001）。涉及电动粉碎的手术需要明显更多的器械插入/取出次数-119（范围56-182），而不使用粉碎时为12（范围2-122）（p < 0.001）。与高个子外科医生相比，矮个子外科医生在观察监视器时保持的颈部旋转角度明显更大（p < 0.003），臂长较短的外科医生在极端位置花费的时间更长，其非优势肩部> 90 A度（p = 0.04）和肘部> 120 A度（p < 0.001）。BMI或手术经验与更极端的关节位置之间没有显著的相关性，已经确定了四个主要领域，外科医生不断证明运动会增加他们的伤害风险：（1）长时间的颈部旋转;（2）优势肩和非优势肩之间的不对称负荷;（3）长时间的颈部旋转。（3）强力粉碎和频繁插入/取出腹腔镜器械，导致重复最极端的肩关节位置，以及（4）身高和在极端位置上花费的时间百分比之间呈负相关。
Laparoscopic surgery presents multiple ergonomic difficulties for the surgeon, requiring awkward body postures and prolonged static muscle loading that increases risk of musculoskeletal strain and injury. This prospective study quantitatively measures the biomechanical movements of surgeons during laparoscopic procedures to determine at-risk movements from prolonged static muscle loading and repetitive motions that may lead to injury.A total of 150 video recordings of 18 surgeons, standing at the patient's left, were captured from three fixed camera positions during live gynecological laparoscopic surgery. Postoperative processing quantified surgeon movements at the neck, shoulders and elbows using computer software to measure extreme joint angles and time spent within defined joint angle ranges.Surgeons spent a median of 98 % (range 77-100 %) of surgical time with their neck rotated at 21A degrees (range 0A degrees-52A degrees). The non-dominant arm was subjected to more extreme positions for significantly longer periods of time compared to the dominant, with shoulder flexion at 45A degrees-90A degrees for 35 vs. 0 % (p < 0.001) and elbow flexion at > 120A degrees for 31 vs. 0 % (p < 0.001) of total surgical time. Procedures involving power morcellation required significantly greater number of instrument insertion/removals-119 (range 56-182) compared with 12 (range 2-122) when morcellation was not used (p < 0.001). Shorter surgeons maintained significantly greater degrees of neck rotation when viewing the monitor (p < 0.003) and surgeons with shorter arm lengths spent longer in extreme positions with their non-dominant shoulder at > 90A degrees (p = 0.04) and elbow at > 120A degrees (p < 0.001) compared with taller surgeons. No significant correlations were found between BMI or surgical experience and more extreme joint positions.Four primary areas have been identified where surgeons are consistently demonstrating movements that increase their risk of harm: (1) extended periods of neck rotation; (2) asymmetrical loading between the dominant and non-dominant shoulders; (3) power morcellation and frequent insertions/removals of laparoscopic instruments resulting in repetitions of the most extreme shoulder positions and (4) a negative correlation between height and percentage time spent in more extreme positions.