Objective ergonomic risk assessment of wrist and spine with motion analysis technique during simulated laparoscopic cholecystectomy in experienced and novice surgeons

Abstract

INTRODUCTION:There is a rise in prevalence of work-related musculoskeletal disorders in surgeons performing laparoscopic surgeries due to lack of ergonomic considerations to the minimal access surgical environment. The objective of this study was to assess the physical ergonomics in experienced and novice surgeons during a simulated laparoscopic cholecystectomy.METHODOLOGY:Thirty-two surgeons participated in this study and were distributed in two groups (experienced and novices) based on the inclusion criteria. Both groups were screened for the spinal and wrist movements on the orientation sensor-based, motion analysis device while performing a simulated laparoscopic cholecystectomy. Simultaneous video recording was used to estimate the other joint positions. The RULA (Rapid Upper Limb Assessment) ergonomic risk scores were estimated with the acquired data.RESULTS:We found that surgeons in both novice and experienced groups scored a high on the RULA. Limited awareness of the influence of monitor position on the postural risk caused surgeons to adopt non-neutral range cervical postures. The thoracolumbar spine is subjected to static postural demand. Awkward wrist postures were adopted during the surgery by both groups. There was no statistically significant difference in the RULA scores between the novice and experienced, but some differences in maximum joint excursions between them as detected on the motion analysis system.CONCLUSION:Both experienced and novice surgeons adopted poor spinal and wrist ergonomics during simulated cholecystectomy. We concluded that the physical ergonomic risk is medium as estimated by the RULA scoring method, during this minimally invasive surgical procedure, demanding implementation of change in the ergonomic practices.

A systematic review of interventions to prevent work-related musculoskeletal disorders in ENT surgeons

“…41 This scoring system has been used successfully in a number of other studies looking at surgical ergonomics outside of otolaryngology, including laparoscopic, plastic and dental surgery. [42][43][44][45] Differences in the measurement of Rapid Upper Limb Assessment scores made comparison between studies difficult. For instance, Govil et al (2018) used an observer in the room at the time of procedure whereas Smith et al (2015) measure data from static photography taken at the end of each simulated test session.…”

Colecistectomía Laparoscópica: comparación de TécnicaAmericana vs Técnica Modificada en relación a elementos deconfort del cirujano

“…El confort del cirujano durante el acto quirúrgico estudiado, es de gran importancia para su adecuada práctica, así lo demostraron Rodriguez-Zamacona et al, en México (5) , y Dabholkar et. al en India (8), pues contribuye a un mejor desempeño, disminuyendo los riesgos físicos asociados a la realización de la colecistectomía laparoscópica, concordando con el presente estudio donde se encuentra una mejor percepción de confort durante el acto quirúrgico con la técnica modificada, mejorando su desempeño.…”

“…En la India, Dabholkar et al, 2017 demostraron que tanto los cirujanos experimentados como los novatos adoptaron una mala postura de la columna y la muñeca durante la colecistectomía simulada; el riesgo ergonómico físico fue estimado por el método de puntuación RULA (evaluación rápida de miembros superiores) durante este procedimiento quirúrgico mínimamente invasivo, concluyendo en necesidad de implementar prácticas ergonómicas en estos procedimientos (8) .…”

Musculoskeletal Risks: RULA Bibliometric Review

“…They showed that there was a risk regarding the postures the surgeons developed [197]. In some cases, they combined these studies with the use of new technologies.…”