Ergonomic assessment of the French and American position for laparoscopic cholecystectomy

Kelvin Kramp, BSc, J.p.e.n. Pierie, Prof, MD, PhD, Marc van Det, MD, PhD, Christiaan Hoff, MD, Eric Totte, MD, PhD. Department of Surgery, Leeuwarden Medical Center, The Netherlands and Post Graduate School of Medicine, University Medical Center Groningen, The Netherlands.

Aims: The cholecystectomy was one of the first surgical procedures to be performed with laparoscopy in the 1980s. Nowadays, there are generally two operation setups to perform a laparoscopic cholecystectomy: the French and the American position. In the French position the patient lies in the lithotomy position, while in the American position the patient lies supine with the left arm in abduction. In order to find an ergonomic difference between the two operation setups the movements in the vertebral column of the surgeon were analyzed in this crossover study.

Methods: The posture of the surgeon’s vertebral column was recorded intraoperatively using an electromagnetic motion tracking system with three sensors attached to the head and to the trunk at the level of Th1 and S1. A three-dimensional posture analysis of the cervical and thoracolumbar spine was conducted on 4 surgeons performing a laparoscopic cholecystectomy in the French and in the American position. The body angles that were assessed consisted of: flexion/extension of the cervical and the thoracolumbar spine, axial rotation of the cervical and thoracolumbar spine, lateroflexion of the cervical and thoracolumbar spine and the orientation of the head in the sagittal plane. For each body angle, the mean, the time percentage within an ergonomic acceptable range and the relative frequencies were calculated and compared.

Results: No statistical differences were observed in the mean body angles and time percentages within an acceptable range between the French and the American position. The relative frequencies of the body angles might indicate a trend towards slight cervical flexion in the American position and slight thoracolumbar flexion in the French position.

Conclusion: In a modern dedicated minimally invasive surgery suite, there were no significant differences in body posture of the neck and trunk and orientation of the head between the French and American position.

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