Optimal port locations for endoscopic intracorporeal knotting

Abstract

Port location is crucial for endoscopic manipulations. The aim of the study was to investigate the influence of manipulation, azimuth, and elevation angles of instruments on endoscopic intracorporeal knotting. The standard task was tying a surgeon's knot. Manipulation angles of 30 degrees , 45 degrees , 60 degrees , 75 degrees , and 90 degrees with equal and unequal azimuth angles and elevation angles of 0 degrees , 30 degrees , and 60 degrees were investigated. The endpoints were the execution time and parameters of knot analysis. The execution time was shorter with 60 degrees than with either 90 degrees or 30 degrees manipulation angles (p < 0.0001 and p < 0. 01). Equal azimuth angles resulted in a shorter execution time than wide unequal angles (p < 0.001). A combination of 60 degrees manipulation angle with 60 degrees elevation angle had the shortest execution time (p < 0.001) and highest performance quality score (p < 0.02). A range of 45 degrees -75 degrees manipulation angles with equal azimuth angles is recommended. As the manipulation angle increases, the elevation angle has to increase accordingly.

The effect of laparoscopic instrument working angle on surgeons’ upper extremity workload

“…A l t h o u g h textbooks of laparoscopic surgery describe accepted port locations for specific procedures, variations in patients' habitus, patient positioning, type of instrumentation, and surgeons' body sizes limit the choices for trocar placement. H a n n a et al [5] reported that the c o m b i n a t i o n of a 60 ~ m a n i p u l a t i o n angle and a 60 ~ elevation angle produces the shortest execution time for intracorporeal knot tying in a laboratory model. However, the reality of everyday clinical surgery is a tradeoff between efficient instrument placement for anatomic manipulation of the tissues and the surgeon's comfort and difficulty in operating the instruments.…”

“…Unfortunately, as a result, the surgeon often experiences the musculoskeletal problems associated with poor ergonomics after several hours of surgery. Although the surgeon's comfort is not the primary focus of the operations, the data reported by Hanna et al indicate that inefficient working postures directly affect his or her work efficiency [5]. It is also well known that the incidence of work-related musculoskeletal injury is directly proportional to workplace hazards such as excessive muscle loading [3].…”

Ergonomic principles of task alignment, visual display, and direction of execution of laparoscopic bowel suturing

“…The optical axis, port locations, and intra/extracorporeal instrument length ratio were set up to maximize the optimal ergonomic setup [2][3][4]. The vision system consisted of a 30°e ndoscope 10 mm in diameter coupled to a single chip camera (endovision 9050-PB, Karl Storz) and a high-resolution monitor (Model PVM-1443MD, Sony, Tokyo).…”

Comparison of orthodox versus off-optical axis endoscopic manipulations

“…The ports for the telescope and the needle drivers were inserted into the trainer as described by Hanna et al [4] and Emam et al [2]. Illumination of the operative ®eld was kept the same throughout the experiments.…”