Physical and Mental Workload in Single-Incision Laparoscopic Surgery and Conventional Laparoscopy

Abstract

SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload.

Comparison of Single Port Access Versus Multiple Port Access Systems in Elective Laparoscopy: 98 Dogs (2005–2014)

“…The surgery duration for gastropexy for SPAS was significantly shorter (43 [14] minutes) than MPAS (61 [22] minutes, P ¼.0039]. The surgery duration for ovariectomy for SPAS was significantly shorter (43 [13] minutes) than MPAS (70 [31] minutes, P ¼ 0.0052).…”

“…This can increase the technical difficulty and may require the use of articulated instruments. 6 These difficulties have the potential to increase surgical time and complication rates, 9,[12][13][14] but are not prohibitive for surgeons with prior experience using multiple port access systems (MPAS). 15,16 Multiple port access is the traditional technique used in veterinary medicine for elective and nonelective procedures.…”

Single-incision laparoscopic cholecystectomy with curved versus linear instruments assessed by systematic review and network meta-analysis of randomized trials

“…An association between the type of instruments used in SIL-C and the primary outcome measures (the risks of bile duct injury, The primary and secondary endpoints were focused on operative and perioperative outcomes with potential etiological association with the ergonomics of single-incision laparoscopic surgery. Indeed, anecdotal and published evidence suggests increased physical and mental workload in single-incision surgery [47,48]. 'Sword fighting' between instruments and the optic poses limitations to the exposure of the surgical field and the process of the operative steps, and may result in frustration of the surgical team.…”

Ergonomics in Laparoscopic Surgery

“…Several metrics of muscle activity during the execution of a certain task can be computed by analyzing the EMG signal such as the percentage of the maximal voluntary contraction (MVC) [29], the amplitude probability distribution function (APDF) [30], or the muscle fatigue [6]. EMG has been an extended ergonomic assessment method in laparoscopic surgery to analyze the surgeon's postural muscle activity [5,11], the use of different surgical instruments, and instrument handles [27,31] (Figure 5).…”

“…Working through a single port implies a defective triangulation, even more lack of coordination, external and internal instrument clashing, forced hands approximation with restrained manipulation, narrowing of the operative field, and possible pneumoperitoneum leakage [4]. Therefore, the use of LESS approach leads to a greater physical and mental workload for the surgeons [5,6].…”