An analysis of the ergonomic risk of surgical trainees and experienced surgeons during laparoscopic procedures

Athanasiadis, Dimitrios I.; Monfared, Sara; Asadi, Hamed; Colgate, Cameron L.; Yu, Denny; Stefanidis, Dimitrios

doi:10.1016/j.surg.2020.10.027

Cited by 19 publications

(11 citation statements)

References 21 publications

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“…The presence of outliers, above and below the median indicates that MS comparison was not fully adapted to study the postural skills and that this metric alone does not sufficiently describe interfering movements. In future this analysis will be paired with a gold standard ergonomic assessment because even expert clinicians often lack postural self-awareness skills, thus increasing the risk of injury [16,17]. This was noted by our clinical collaborators especially concerning ergonomic differences resulting in using the endoscope and surgical instruments with both the dominant and non-dominant hands depending on the surgical side (i.e.…”

Section: Discussionmentioning

confidence: 98%

“…This study wanted to assess surgical postural skills in line with other studies in this domain. Previous studies analysed surgical ergonomics to estimate risks [16,17,37], or to compare open and laparoscopic surgical procedures [19]. The most common methods rely on physical markers or sensors directly placed on the surgeon, such as Inertial Measurement Units (IMU), electromyographic sensors, or reflective bulbs [16,17,19,37], that can be cumbersome.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies analysed surgical ergonomics to estimate risks [16,17,37], or to compare open and laparoscopic surgical procedures [19]. The most common methods rely on physical markers or sensors directly placed on the surgeon, such as Inertial Measurement Units (IMU), electromyographic sensors, or reflective bulbs [16,17,19,37], that can be cumbersome. Concerning marker-less assessment, some studies used OpenPose to assess the surgeon's cognitive skills [38] or to perform automatic surgical procedure recognition [39].…”

Section: Discussionmentioning

confidence: 99%

“…Surgeon's posture can be detected using cameras and/or electromyographic sensors (EMGs) [13][14][15][16]. These technologies allow analysing the surgeon's ergonomic dynamics by estimating postural angles and muscle tension [17,18] and by providing information to limit musculoskeletal pain in the lower back, neck and shoulders. Some studies have analysed the various parameters that influence the surgeon's posture with the aim of proposing solutions to reduce pain and improve the overall surgical ergonomic [16,17,19].…”

Section: Introductionmentioning

confidence: 99%

“…These technologies allow analysing the surgeon's ergonomic dynamics by estimating postural angles and muscle tension [17,18] and by providing information to limit musculoskeletal pain in the lower back, neck and shoulders. Some studies have analysed the various parameters that influence the surgeon's posture with the aim of proposing solutions to reduce pain and improve the overall surgical ergonomic [16,17,19]. These methods are based on data collected using EMGs and/or Inertial Measurement Units (IMU) directly attached to the surgeon's body.…”

Section: Introductionmentioning

confidence: 99%

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“Stand-up straight!”: human pose estimation to evaluate postural skills during orthopedic surgery simulations

et al. 2022

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Purpose: Surgery simulators can be used to learn technical and non-technical skills and, to analyse posture. Ergonomic skill can be automatically detected with a Human Pose Estimation algorithm to help improve the surgeon's work quality. The objective of this study was to analyse the postural behaviour of surgeons and identify expertise-dependent movements. Our hypothesis was that hesitation and the occurrence of surgical instruments interfering with movement (defined as interfering movements) decrease with expertise. Material and Methods: Sixty surgeons with three expertise levels (novice, intermediate, and expert) were recruited. During a training session using an arthroscopic simulator, each participant's movements were videorecorded with an RGB camera. A modified OpenPose algorithm was used to detect the surgeon's joints. The detection frequency of each joint in a specific area was visualized with a heatmap-like approach and used to calculate a mobility score. Results: This analysis allowed quantifying surgical movements. Overall, the mean mobility score was 0.823, 0.816, and 0.820 for novice, intermediate and expert surgeons, respectively. The mobility score alone was not enough to identify postural behaviour differences. A visual analysis of each participants' movements highlighted expertise-dependent interfering movements. Conclusion: Video-recording and analysis of surgeon's movements are a non-invasive approach to obtain quantitative and qualitative ergonomic information in order to provide feedback during training. Our findings suggest that the interfering movements do not decrease with expertise but differ in function of the surgeon's level.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“Stand-up straight!”: human pose estimation to evaluate postural skills during orthopedic surgery simulations

et al. 2022

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Ergonomics of Various Modalities for Ear Surgery

Lin,

Zhou,

Kakeheta

et al. 2024

OTO Open

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ObjectiveEvaluate ergonomic differences of various modalities for performing middle ear surgery.Study DesignObservational study.SettingTwo academic tertiary care centers.MethodsAttending physicians and residents performing middle ear surgery were photographed intraoperatively. Intraoperative photographs were analyzed using the validated Rapid Upper Limb Assessment (RULA) tool to measure musculoskeletal disease (MSD) risk. Descriptive statistics and significance testing were used to characterize and compare ergonomic differences between surgical modalities. Multivariable ordinal regression was performed to assess factors associated with increased MSD risk, as determined by the final RULA score.ResultsMost of our 110 intraoperative photos featured attendings (82.7%) performing combined middle ear surgery and mastoidectomy (60.0%). Body angles and the final RULA score varied significantly among modalities. On subset analysis, microscopic surgery exhibited significantly worse wrist, trunk, and neck angles compared to endoscopic and exoscopic surgery. Exoscopic surgery had significantly lower final RULA scores than both endoscopic and microscopic surgery, indicating significantly lower MSD risk. Microscopic and endoscopic surgery final scores did not vary significantly. In a multivariable ordinal regression of factors associated with increased RULA score, exoscopic surgery had statistically significantly less ergonomic risk relative to microscopic surgery (odds ratio = 0.12, 95% confidence interval = [0.03‐0.43]).ConclusionExoscopic, endoscopic, and microscopic surgery all featured low ergonomic risk, although exoscopic middle ear surgery demonstrated the lowest risk profile among studied surgical modalities. This demonstrates the importance of using each modality in combination with other ergonomic interventions to provide meaningful musculoskeletal benefits.

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