BackgroundLaparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder–neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operation room settings.MethodsA systematic approach to develop an ASsyst started in October 2012 consisting of five consecutive steps. In step 1, 14 laparoscopic interventions were observed using subjective and objective measures to determine key indicators for the conception of an ASsyst in LS. In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods. During the third step, prototypes of ASsyst were tested in an experimental setting. Steps 4 and 5 are currently in process and include the final development of the ASsyst using the most promising concept for the evaluation during simulated LS.ResultsIncreased levels of physical stress were found in LS. Asymmetric strains were common. Three prototypes of ASsyst emerged from step 1 and 2. These prototypes were a cable construction with a noose for the lower arm, a support from below the elbow and a pneumatic vest supporting the upper arm. The experimental testing of these prototypes demonstrated reduced physical stress when compared to the unsupported environment. The support from below the elbow seemed to be the most practical in terms of implementation in various operation room settings and acceptance by surgeons. Step 4 and 5 are still in process.ConclusionsErgonomic problems have been identified in LS that could be addressed by an ASsyst. The concept of supporting the elbow from below has been found to be the most promising approach.

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The aim of this article is the analysis of a multidisciplinary developed first prototype of an innovative Arm-Support-Device (ASD) for laparoscopic surgery. This device follows the motions of the leaned lower arm of the surgeon and supports the posture in order to relief the surgeon. During the multidisciplinary development process, important requirements of surgeons from gynecology and urology were compiled. Requirements like physical relief and usability-enhancement when using comparable techniques are shown in some studies. The fulfillment of further important requirements concerning the human-machine-interaction between surgeon and ASD as well as the effects of the ASD on the body-, arm-and hand-posture of the surgeon are analyzed in this study. Therefore 12 surgeons performed simulated laparoscopic static and dynamic tasks on a so-called pelvi-trainer in laboratory-setting using the developed ASD and without using the ASD. For analysis life-record data from two perspectives (frontal and sagittal), the method of thinking aloud and the interview were used. The analysis shows that body-, arm-and hand postures of the surgeons are mainly similar independent of the use of the ASD. The surgeons used the ASD intuitively for getting in, operating and getting out, which were important requirements. Nevertheless a familiarization is necessary. It is expected that some deficits of the ASD-prototype can be avoided in the possible next step of developing an end-design-product by using the results of this study. These deficits are skidding down of the arm of the surgeon from the support for some steeper arm-postures and rarely appearing collision of the support with the fixed endoscope.