Video display during laparoscopy - where should it be placed?

Abstract

IntroductionDuring laparoscopy, the monitor is usually placed near the operating table, at eye level, which significantly affects hand-eye coordination. First, it is impossible for the surgeon to simultaneously observe the operative field and hand movement. Second, the axis of view of the endoscope rarely matches the natural axis of the surgeon's sight: it resembles a direct view into the operative field. Finally, as the arms of the tools act as levers with a fulcrum at the site of the skin incision, the action of the tool handles is a mirror image of the movement of the tool tips seen on the monitor. Studies have shown that a neutral position with the head flexed at 15–45° is the most ergonomically suitable.AimTo evaluate whether the level of monitor placement exerts an influence on laparoscopic performance.Material and methodsA group of 52 students of medicine were asked to pass a thread through 9 holes of different sizes, placed at different levels and angles, using a self-made laparoscopic simulator. Each student performed the task four times in two monitor positions: at eye level, and placed on a simulator. The order of monitor placement was randomized.ResultsThe task was performed more quickly when the monitor was placed on the simulator and the sight was forced downwards. Lower placement was also found to be more beneficial for students with experience in laparoscopy.ConclusionsNew technologies which place the display on the patient, thus improving the ergonomics of the operation, should be developed.

Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study*

“…In line with these findings, human laparoscopic surgeons exhibited higher EMG activity in the forearm extensor and flexor muscles when laparoscopic grasping forceps were used to open and close a spring loaded alligator clip compared to a pair of hemostats typically used in open surgery . Likewise, muscle activity was greater in the thumb, forearm flexor, and deltoid muscles of surgeons performing a 90‐second simulated knot tying exercise via laparoscopy compared to an open surgery . Conversely, a study of 25 experienced surgeons performing surgical procedures ranging from 30 to 60 minutes reported higher demands on the neck, back, and shoulder muscles when the procedures were done via an open rather than a laparoscopic approach …”

“…The PT task was designed to assess a broad and basic set of laparoscopic psychomotor skills, and the SS task was modified to serve the same purpose. Not surprisingly, the number of pegs transferred and the number of sutures threaded over the course of 3 minutes were greater during open surgery compared to MLS and SLS, and when during MLS compared to SLS.…”

“…Participants had 3 minutes to thread a 3‐0 monofilament absorbable suture (Covidien, Biosyn, Mansfield, Massachusetts) through 8 (1‐1/18”) eyebolts and 4 (1‐9/16”) eyebolts along a standard path outlined on a piece of (15 cm × 4cm) plywood (Figure C). The number of threaded eyebolts were recorded to compare productivity between surgical techniques . Muscle activity was the primary outcome measure evaluated.…”

Esplenectomia No Manejo Do Paciente Traumatizado

“…Nessa técnica, faz-se o uso do laparoscópico, instrumento composto por um cabo de fibra óptica, que permite a visualização de órgãos e demais estruturas internas do corpo por meio de uma microcâmera, que posteriormente transmite as imagens em alta resolução para monitores de vídeo. São pelas imagens obtidas nas câmeras e trazidas até os monitores, que o médico se guiará para conduzir o procedimento (WALCZARK et al, 2015;DOHERTY, 2017).…”

Projected Augmented Reality to Display Medical Information Directly on a Patient’s Skin

“…Typically, the video from the laparoscope video is displayed on a TV screen close to the surgeon (Figure 1a). The problem with this approach is that the surgeon's tool motion viewed in the laparoscope video is decoupled with the natural viewing direction resulting in reduced hand-eye coordination that the surgeon must compensate for with training [2]. The second way to display a laparoscopic video is to use a head-mounted display (HMD) aligned in the same direction as the laparoscope cameras (see Figure 1b).…”