Shanglei Liu, MD, Daniel Hemming, Jonathan C DeLong, MD, Domingo Montalvo, MD, Toshiaki Suzuki, MD, Jessica Reynolds, MD, Ran B Luo, MD, Garth R Jacobsen, MD, Bryan J Sandler, MD, Santiago Horgan, MD. UCSD Healthcare Systems
Introduction: The widespread adoption of laparoscopic surgery has put new physical demands on the surgeon leading to increased musculoskeletal disorders and injuries. Back, shoulder, and neck pains are among the most common complaints experienced by laparoscopic surgeons. Here we evaluate the feasibility and efficacy of a non-intrusive passive support exoskeleton worn by surgeons under the sterile gown (see image below) to reduce pain and fatigue.
Methods and Procedures: This is a prospective randomized crossover trial approved by the Internal Review Board (IRB). The study involves 3 phases of testing. In each phase, general surgery residents and attendings were randomized to wearing the surgical exoskeleton at the beginning or at the crossover point. The first phase tests for surgeon manual dexterity wearing the device using the Minnesota Dexterity test, the Purdue Pegboard test, and the Fundamentals of Laparoscopic Surgery (FLS) modules. The second phase tests the effect of the device on shoulder pain and fatigue while operating the laparoscopic camera. And the third phase rates surgeon experience in the operating room between case-matched operating days. Pre-existing musculoskeletal disorders were evaluated with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Pain is evaluated using a modified Cornell Musculoskeletal Discomfort Questionnaire (CMDQ)
Results: A total of 18 surgical attendings and residents participated. Everyone had the similar completion times for dexterity tasks and FLS regardless of wearing the exosuit (P value 0.15-0.84). Exosuit subjects had a significant higher rate of completing camera test compared to those without (9 vs 3, p<0.02). Exosuit surgeons experienced significantly less arm pain after 10 minutes (3.25 vs 6.85 p=0.005) and fatigue at all time points (See graph).
After matched operative days, the increase in total pain score at the end of the day was 25% lower in the device group (1±1.41 vs 4±2.55, P=0.074). The most common site of complaint of pain was neck followed by lower back than shoulder in both groups.
Conclusion: Our initial experience shows reduction of surgeon pain and fatigue after laparoscopic surgery when wearing the surgical exosuit. The device is non-intrusive to surgeon operative skills or manual dexterity and can be used in the operating room safely.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79935
Program Number: S117
Presentation Session: MIS – Cool Stuff
Presentation Type: Podium