Review of Surgical Ergonomics Research Associated With Minimally Invasive Surgery

Donald R Peterson, PhD, Tarek Tantawy, BS, Drew R Seils, BS, Angela S Kueck, MD, M Kurt E Roberts, MD. University of Connecticut Health Center, Yale University

INTRODUCTION: The widespread acceptance of minimally invasive surgical procedures has led to an increase in its popularity and demand. The growing number of surgical procedures performed coupled with the high physical demand of the laparoscopic tasks has resulted in a significant rise in occurrence of neuromuscular disorders among surgeons. According to a 1999 SAGES survey, 8% to 12% of 149 surgeons reported frequent pain or numbness in arms, wrists, or hands following laparoscopic surgeries. In 2007, the University of Chicago estimated that 30% of 73 urologists sustain neuromuscular or arthritic injury from laparoscopic surgeries. The prevalence of these conditions has prompted ergonomics researchers to evaluate the environment of the operating room and the instruments involved, particularly those in standard laparoscopy.

METHODS AND PROCEDURES: An extensive review of the published literature was conducted in the PubMed database for articles published between January 1998 and March 2011 using keywords such as surgical ergonomics, minimally invasive surgery, laparoscopic tools, laparoscopic instruments and hand sizing, laparoscopic stapling, laparoscopic trainers, laparoscopic training simulations, hand assisted laparoscopy, laparoscopic handle, hand tool grip, grip forces, grip span, and other various combinations of these keywords. The relevant articles were saved and organized into a database that categorizes them according to their type, objectives, and outcomes, and included literature reviews, clinical observations, surveys, discussions, simulated tasks, and virtual reality simulations for gastrointestinal, urological, hernia repair, and other endoscopic procedures.

RESULTS: Of the 47 relevant publications found, 27 employed qualitative methodologies, such as surveys, visual observations, and literature reviews, for evaluating the ergonomics of the surgical tasks and instruments. Twelve quantitative studies were found and were limited primarily to analyses of upper extremity effort using surface electromyography and, in two cases, opto-electronic motion capture. The eight remaining studies incorporated both qualitative and quantitative methodologies. Four of the 47 studies, three qualitative and one quantitative, were found to specifically address the issues associated with workplace design and equipment distribution, including monitor placement and operating table height. In total, 1,407 surgeons were found to be studied with the results from two of the studies suggesting that at least 85% of surgeons experience discomfort in the shoulders and upper extremities from laparoscopic surgery. It was evident that a significant amount of information has been generated but was limited to suturing and grasping tasks and the related surgical instruments, such as laparoscopic needle drivers and articulating graspers. The review also demonstrated a lack of information regarding other laparoscopic procedures, such as tissue resection and vessel ligation, and other related devices, such as laparoscopic surgical staplers and trocars.

CONCLUSIONS: In order to better understand the pathophysiological risks and injuries (e.g. repetitive strain injuries, carpal tunnel syndrome) associated with laparoscopic surgical instrument use, it is clear from the published literature that comprehensive biomechanical performance measurements are needed. Such measurements would allow for an integrated characterization of the primary biomechanical stressors (e.g., awkward postures, dynamic/static posture ratios, repetition, force, actual stressor durations, etc.) throughout complex and rapid sets of movements as a basis for laparoscopic instrument design.
 

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