Development of an arm support system to improve ergonomics in laparoscopic surgery: study design and provisional results

Abstract

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.

Differential analysis of muscle fatigue induced elbow and wrist tremor in controlled laparoscopic manoeuvring

“…The subjects were provided with sufficient amount of tool manipulation period in order to get familiarised with the experimental set up before they actually start the experiment. This also helps to reduce the cognitive load for the assigned laparoscopic experimental manipulative task for the experiment effectively resulting lesser action tremor …”

“…All the subjects were instructed to hold the tool with a palmer grasp without the sustained grip. Initial tool manipulation angle was fixed within 45° to 30° to create a similar scenario of RAMIS under this controlled experimental situation . Before starting the actual experimental task, all the subjects were provided with sufficient amount of time to become familiar with the experimental setup.…”

“…LTM is generated by the coordinated movement of the elbow and wrist joints . In the case of the robot‐assisted surgical manipulation and the manual laparoscopic tool manipulation with elbow rest, elbow and wrist become the two prime joints to contribute the surgeons' hand tremor. Joint movements are produced by coherent activation of the associated muscles.…”

Ergonomics in Laparoscopic Surgery

“…Apart from laparoscopic surgical instruments, other support devices have been developed to improve the ergonomic conditions during surgery. This is the case of operating chairs [58] or arm supports [59], whose main objective is to improve the surgeon's ergonomic posture during surgery. A novel portable ergonomic simulator for training of basic laparoscopic skills was also presented by Xiao et al [60].…”

Housing design and testing of a surgical robot developed for orthopaedic surgery

“…The housing should be compact and meet the general requirements for safety, mobility and operability, at the same time ensuring that the robot that is working in the operating room fulfills the mechanical, electrical, and sterilization requirements [15] , [16] , [17] . In addition, the design should allow the active–passive robot arm to operate properly at the same time; a well-considered ergonomic design would improve the interaction among the surgeons, nurses and patient [18] .…”