Research Article | Open Access
Sang D. Choi, "A Review of the Ergonomic Issues in the Laparoscopic Operating Room", Journal of Healthcare Engineering, vol. 3, Article ID 129817, 18 pages, 2012. https://doi.org/10.1260/2040-2295.3.4.587
A Review of the Ergonomic Issues in the Laparoscopic Operating Room
Abstract
This review paper discusses the ergonomic challenges associated with laparoscopy in the operating room (OR) and summarizes the practical ergonomic solutions. The literature search was conducted in the fields of laparoscopy and applied ergonomics. Findings indicated that laparoscopic OR staff (surgeons, perioperative nurses and technicians) commonly experienced physical and mental ergonomic risks while working in prolonged static and awkward body positions. This study highlighted the need for more ergonomic interventions in OR environment in order to improve the efficiency of laparoscopy. Ergonomic solutions included utilizing adjustable equipment, placing computer peripherals in optimal locations, providing ergonomic instruments, and improving communication. Understanding the job- or task-related ergonomic risks and hazards could help identify intervention requirements to meet the challenges associated with increased dependency on advanced high technology in the OR.
References
- Bureau of Labor Statistics. U. S. Department of Labor, Occupational Outlook Handbook, Career Guide to Industries, 2012-13 edition, 2010, http://www.bls.gov/ooh/about/career-guide-to-industries.htm, Accessed July 30, 2012.
- E. G. Verdaasdonk, L. P. Stassen, M. van der Elst, T. M. Karsten, and J. Dankelman, “Problems with technical equipment during laparoscopic surgery: an observational study,” Surgical Endoscopy, vol. 21, pp. 275–279, 2007. View at: Google Scholar
- G. Szeto, P. Ho, A. Ting, J. Poon, S. Cheng, and R. Tsang, “Work-related musculoskeletal symptoms in surgeons,” Journal of Occupational Rehabilitation, vol. 19, pp. 175–184, 2009. View at: Google Scholar
- J. R. Wilson and N. Corlett, Evaluation of Human Work, Taylor & Francis, Boca Raton, FL, 3rd edition, 2005.
- L. S. Wauben, A. Albayrak, and R. H. M. Goossens, “Ergonomics in the Operating Room – An Overview,” in Ergonomics: Design, Integration, and Implementation, B. N. Brinkerhoff, Ed., pp. 79–118, Nova Science Publishers, NY, 2009. View at: Google Scholar
- National Institute for Occupational Safety and Health, Ergonomic Guidelines For Manual Material Handling, DHHS Publication No. 2007–131, US, Department of Health and Human Services, Washington, DC, 2007.
- R. Berguer, G. Rab, H. Abu-Ghaida, A. Alarcon, and J. Chung, “A comparison of surgeons' posture during laparoscopic and open surgical procedures,” Surgical Endoscopy, vol. 11, pp. 139–142, 1997. View at: Google Scholar
- R. Berguer, “Surgical technology and the ergonomics of laparoscopic instruments,” Surgical Endoscopy, vol. 12, pp. 458–462, 1998. View at: Google Scholar
- S. Koneczny, “The operating room: architectural conditions and potential hazards,” WORK, vol. 33, pp. 145–164, 2009. View at: Google Scholar
- M. A. Van Veelen, E. A. L. Nederlof, R. H. M. Goossens, C. J. Schot, and J. J. Jakimowicz, “Ergonomic problems encountered by the medical team related to products used for minimally invasive surgery,” Surgical Endoscopy, vol. 17, pp. 1077–1081, 2003. View at: Google Scholar
- M. Patkin, “History of ergonomy in surgery,” in New Aspects of High Technology in Medicine, H. P. Bruch, F. Kockerling, R. Bouchard, and C. Schuss-Pass, Eds., pp. 239–46, Monduzzi Editore, Hanover, Germany, 2000. View at: Google Scholar
- R. Berguer, S. Gerber, G. Klipatrick, M. Remler, and D. A. Beckley, “Comparison of forearm and thumb muscle electromyographic responses to the use of laparoscopic instruments with either a finger grasp or a palm grasp,” Ergonomics, vol. 42, pp. 1634–1645, 1999. View at: Google Scholar
- U. Matern and P. Waller, “Instruments for minimally invasive surgery: principles of ergonomic handles,” Surgical Endoscopy, vol. 13, pp. 174–182, 1999. View at: Google Scholar
- G. B. Hanna, S. M. Shimi, and A. Cuschieri, “Task performance in endoscopic surgery is influenced by location of the image display,” Annals of Surgery, vol. 227, pp. 481–484, 1998. View at: Google Scholar
- M. A. Van Veelen, J. J. Jakimowicz, R. H. M. Goossens, D. W. Meijer, and J. B. Bussmann, “Evaluation of the usability of two types of image display systems during laparoscopy,” Surgical Endoscopy, vol. 16, pp. 674–678, 2002. View at: Google Scholar
- R. Berguer, S. Gerber, G. Kilpatrick, and D. Beckley, “An ergonomic comparison of in-line vs pistol-grip handle configuration in a laparoscopic grasper,” Surgical Endoscopy, vol. 12, pp. 805–808, 1998. View at: Google Scholar
- R. Berguer, D. L. Forkey, and W. D. Smith, “Ergonomic problems associated with laparoscopic surgery,” Surgical Endoscopy, vol. 13, no. 5, pp. 466–468, 1999. View at: Google Scholar
- R. H. M. Goossens and M. A. Van Veelen, “Assessment of ergonomics in laparoscopic surgery,” Minimally Invasive Therapy & Allied Technology, vol. 10, pp. 175–179, 2001. View at: Google Scholar
- M. O. Schurr, G. F. Buess, F. Wieth, H. J. Saile, and M. Botsch, “Ergonomic surgeon's chair for use during minimally invasive surgery,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, vol. 9, pp. 244–247, 1999. View at: Google Scholar
- M. A. Van Veelen, D. W. Meijer, R. H. M. Goossens, and C. J. Snijders, “New ergonomic design criteria for handles of laparoscopic dissection forceps,” Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 11, no. 1, pp. 17–26, 2001. View at: Google Scholar
- M. A. Van Veelen, G. Kazemier, J. Koopman, R. H. M. Goossens, and D. W. Meijer, “Assessment of the ergonomically optimal operating surface height for laparoscopic surgery,” Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 12, no. 1, pp. 47–52, 2002. View at: Google Scholar
- A. Albayrak, G. Kazemier, D. W. Meijer, and H. J. Bonjer, “Current state of ergonomics of Dutch hospitals in the endoscopic era,” Minimally Invasive Therapy and Allied Technology, vol. 13, no. 3, pp. 156–160, 2004. View at: Google Scholar
- A. G. Gallagher and C. D. Smith, “Human-factors lessons learned from the minimally invasive surgery revolution,” Seminars in Laparoscopic Surgery, vol. 10, no. 3, pp. 127–139, 2003. View at: Google Scholar
- R. Berguer, “The application of ergonomics in the work environment of general surgeons,” Reviews on Environmental Health, vol. 12, pp. 99–106, 1997. View at: Google Scholar
- H. C. Polk, D. S. Vitale, and M. Qadan, “The very busy urban surgeon: another face of the evermore obvious shortage of general surgeons,” The American College of Surgeons, vol. 209, pp. 144–147, 2009. View at: Google Scholar
- A. Park, G. Lee, F. J. Seagull, N. Meenaghan, and D. Dexter, “Patients benefit while surgeons suffer: An impending epidemic,” The American College of Surgeons, vol. 210, no. 3, pp. 306–313, 2010. View at: Google Scholar
- M. W. Stomberg, S. E. Tronstad, K. Hedberg et al., “Work-related musculoskeletal disorders when performing laparoscopic surgery,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, vol. 20, no. 1, pp. 49–53, 2010. View at: Google Scholar
- B. Loring and E. A. Lemieux, “User research improves laparoscopic instruments,” Ergonomics in Design, vol. 18, pp. 18–23, 2010. View at: Google Scholar
- K. H. Fuchs, “Minimally invasive surgery,” Endoscopy, vol. 34, pp. 154–159, 2002. View at: Google Scholar
- G. Nilsson, S. Larsson, and F. Johnsson, “Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period,” British Journal of Surgery, vol. 87, pp. 873–878, 2000. View at: Google Scholar
- R. Berguer, W. D. Smith, and Y. H. Chung, “Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery,” Surgical Endoscopy, vol. 15, pp. 1204–1207, 2001. View at: Google Scholar
- S. D. Schwaitzberg, C. Godinez, S. M. Kavic et al., “Training and working in high-stakes environments: lessons learned and problems shared by aviators and surgeons,” Surg Innov, vol. 16, no. 2, pp. 187–195, 2009. View at: Google Scholar
- B. Zheng, E. Rieder, M. A. Cassera et al., “Quantifying mental workloads of surgeons performing natural orifice transluminal endoscopic surgery (NOTES) procedures,” Surgical Endoscopy, vol. 26, no. 5, pp. 1352–1358, 2012. View at: Google Scholar
- A. Alarcon and R. A. Berguer, “Comparison of operating room crowding between open and laparoscopic operations,” Surgical Endoscopy, vol. 10, pp. 916–919, 1996. View at: Google Scholar
- T. Coles, D. Meglan, and N. John, “The role of haptics in medical training simulators: A survey of the state of the art,” IEEE Transactions on Haptics, vol. 4, no. 1, pp. 51–66, 2011. View at: Google Scholar
- R. M. Satava, J. C. Bowersox, M. Mack, and T. M. Krummel, “Robotic surgery: state of the art and future trends,” Contemporary Surgery, vol. 57, pp. 489–499, 2001. View at: Google Scholar
- U. Matern, “Ergonomic deficiencies in the operating room: examples from minimally invasive surgery,” WORK: A Journal of Prevention, Assessment, and Rehabilitation, vol. 33, pp. 165–168, 2009. View at: Google Scholar
- U. Matern, G. Kuttler, C. Giebmeyer, P. Waller, and M. Faist, “Ergonomic aspects of five different types of laparoscopic instrument handles under dynamic conditions with respect to specific laparoscopic tasks: an electromyographic-based study,” Surgical Endoscopy, vol. 18, no. 8, pp. 1231–1241, 2004. View at: Google Scholar
- R. Berguer, J. Chen, and W. D. Smith, “A comparison of the physical effort required for laparoscopic and open surgical techniques,” Archives of Surgery, vol. 138, pp. 967–970, 2003. View at: Google Scholar
- T. A. Emam, G. Hanna, and A. Cuschieri, “Ergonomic principles of task alignment, visual display, and direction of execution of laparoscopic bowel suturing,” Surgical Endoscopy, vol. 16, pp. 267–271, 2002. View at: Google Scholar
- F. J. Pérez-Duarte, F. M. Sánchez-Margallo, I. Díaz-Güemes, M. A. Sánchez-Hurtado, M. Lucas-Hernández, and J. Usón Gargallo, “Ergonomics in laparoscopic surgery and its importance in surgical training,” Cir Esp, 2011, June 22. View at: Google Scholar
- P. P. Reddy, T. P. Reddy, J. Roig-Francoli et al., “The Impact of the Alexander technique on improving posture and surgical ergonomics during minimally invasive surgery: pilot study,” The Journal of Urology, vol. 186, no. 4, pp. 1658–1662, 2011. View at: Google Scholar
- G. Szeto, S. Cheng, J. Poon, A. Ting, R. Tsang, and P. Ho, “Surgeons' static posture and movement repetitions in open and laparoscopic surgery,” Journal of Surgical Research, vol. 172, no. 1, pp. e19–e31, 2012. View at: Google Scholar
- Y. Youssef, G. Lee, C. Godinez et al., “Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position,” Surg Endosc, vol. 25, no. 7, pp. 2168–2174, 2011. View at: Google Scholar
- M. A. Van Veelen, J. J. Jakimowicz, and G. Kazemier, “Improved physical ergonomics of laparoscopic surgery,” Minimally Invasive Therapy & Allied Technology, vol. 13, no. 3, pp. 161–166, 2004. View at: Google Scholar
- U. Matern, P. Waller, C. Giebmeyer, K. Ruckauer, and E. Farthmann, “Ergonomics: requirements for adjusting the height of the laparoscopic operating tables,” Journal of the Society of Laparoendoscopic Surgeons, vol. 5, pp. 7–12, 2001. View at: Google Scholar
- R. Berguer, W. D. Smith, and S. Davis, “An ergonomic study of the optimum operating table height for laparoscopic surgery,” Surgical Endoscopy, vol. 16, pp. 416–421, 2002. View at: Google Scholar
- L. Kranenburg and D. Gossot, “Ergonomic problems encountered during video-assisted thoracic surgery,” Minimally Invasive Therapy & Allied Technology, vol. 13, no. 3, pp. 147–155, 2004. View at: Google Scholar
- N. T. Nguyen, H. S. Ho, W. D. Smith et al., “An ergonomic evaluation of surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery,” The American Journal of Surgery, vol. 182, no. 6, pp. 720–724, 2001. View at: Google Scholar
- L. S. Wauben, M. A. Van Veelen, D. Gossot, and R. H. M. Goossens, “Application of ergonomic guidelines during minimally invasive surgery: a questionnaire amongst 284 surgeons,” Surgical Endoscopy, vol. 20, no. 8, pp. 1268–1274, 2006. View at: Google Scholar
- J. Zehetner, A. Kaltenbacher, W. Wayand, and A. Shamiyeh, “Screen height as an ergonomic factor in laparoscopic surgery.,” Surgical Endoscopy, vol. 20, pp. 139–141, 2006. View at: Google Scholar
- National Institute for Occupational Safety and Health, Musculoskeletal Disorders and Workplace Factors, U. S. Department of Health and Human Services, 1997, http://www.cdc.gov/niosh/docs/97-141/, Accessed August 31, 2012.
- U. Matern and S. Koneczny, “Safety, hazards and ergonomics in the operating Room,” Surgical Endoscopy, vol. 21, pp. 1965–1969, 2007. View at: Google Scholar
- J. C. Lotz, “The suffering surgeon,” Surgical Endoscopy, vol. 11:548, 1997. View at: Google Scholar
- T. A. Emam, T. G. Frank, G. B. Hanna, and A. Cuschieri, “Influence of handle design on the surgeon's upper limb movements, muscle recruitment, and fatigue during endoscopic suturing,” Surgical Endoscopy, vol. 15, pp. 667–672, 2001. View at: Google Scholar
- P. V. Patil, G. B. Hanna, T. G. Frank, and A. Cuschieri, “Effect of fixation of shoulder and elbow joint movement on the precision of laparoscopic instrument manipulations,” Surgical Endoscopy, vol. 19, pp. 366–368, 2005. View at: Google Scholar
- M. L. Uhrich, R. A. Underwood, J. W. Standeven, N. J. Soper, and J. R. Engsberg, “Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery,” Surgical Endoscopy, vol. 16, pp. 635–639, 2002. View at: Google Scholar
- N. Y. Mehta, R. S. Haluck, M. I. Frecker, and A. J. Snyder, “Sequence and task analysis of instrument use in common laparoscopic procedures,” Surgical Endoscopy, vol. 16, pp. 280–285, 2002. View at: Google Scholar
- C. J. Lin, H. J. Chen, and Y. C. Lo, “Ergonomic investigation of weight distribution of laparoscopic instruments,” Journal of Laparoendosc Advanced Surgical Technology, vol. 21, no. 5, pp. 411–415, 2011. View at: Google Scholar
- D. A. G. Reyes, B. Tang, and A. Cuschieri, “Minimal access surgery (MAS)-related surgeon morbidity syndromes,” Surgical Endoscopy, vol. 20, pp. 1–13, 2006. View at: Google Scholar
- R. Berguer and A. Hrelijac, “The relationship between hand size and difficulty using surgical instruments: a survey of 726 laparoscopic surgeons,” Surgical Endoscopy, vol. 18, pp. 508–512, 2004. View at: Google Scholar
- W. J. Lee and Y. S. Chae, “Superficial nerve damage of thumb of laparoscopic surgeon,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, vol. 11, pp. 207–208, 2001. View at: Google Scholar
- G. R. Verma, “Pressure sore and digital neuropraxia of the thumb in laparoscopic cholecystectomy,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, vol. 14, pp. 178–179, 2004. View at: Google Scholar
- N. E. Quick, J. C. Gillette, R. Shapiro, G. L. Adrales, D. Gerlach, and A. E. Park, “The effect of using laparoscopic instruments on muscle activation patterns during minimally invasive training procedures,” Surgical Endoscopy, vol. 17, pp. 462–465, 2003. View at: Google Scholar
- M. A. Van Veelen, C. J. Snijders, E. Van Leeuwen, R. H. Goossens, and G. Kazemier, “Improvement of foot pedals used during surgery based on new ergonomic guidelines,” Surgical Endoscopy, vol. 17, no. 7, pp. 1086–1091, 2003. View at: Google Scholar
- K. T. den Boer, J. L. Herder, W. Sjoerdsma, D. W. Meijer, D. J. Gouma, and H. G. Stassen, “Sensitivity of laparoscopic dissectors: what can you feel?” Surgical Endoscopy, vol. 13, no. 9, pp. 869–873, 1999. View at: Google Scholar
- M. A. Van Veelen, D. W. Meijer, I. Uijttewaal, R. H. M. Goossens, C. J. Snijders, and G. Kazemier, “Improvement of the laparoscopic needle holder based on new ergonomic guidelines,” Surgical Endoscopy, vol. 17, pp. 699–703, 2003. View at: Google Scholar
- U. Matern, M. Faist, K. Kehl, C. Giebmeyer, and G. Buess, “Monitor position in laparoscopic surgery,” Surgical Endoscopy, vol. 19, pp. 436–440, 2005. View at: Google Scholar
- A. Sheikhzadeh, C. Gore, J. Zuckerman, and M. Nordin, “Perioperating nurses and technicians' perceptions of ergonomic risk factors in the surgical environment,” Applied Ergonomics, vol. 40, pp. 833–839, 2009. View at: Google Scholar
- A. Gerbrands, A. Albayrak, and G. Kazemier, “Ergonomic evaluation of the work area of the scrub nurse,” Minimally Invasive Therapy & Allied Technology, vol. 13, no. 3, pp. 142–146, 2004. View at: Google Scholar
- Y. S. Chang, Y. H. Wu, C. Y. Hsu, S. H. Tang, L. L. Yang, and S. F. Su, “Impairment of perceptual and motor abilities at the end of a night shift is greater in nurses working fast rotating shifts,” Sleep Medicine, vol. 12, no. 9, pp. 866–869, 2011. View at: Google Scholar
- P. L. Johnston, “Occupational stress in the operating theatre suite: should employers be concerned?” Australian Health Review, vol. 22, pp. 60–80, 1999. View at: Google Scholar
- M. A. Sauter, D. Boyle, D. Wallace et al., “Psychometric evaluation of the Organizational Job Satisfaction Scale,” J. Nurs. Meas., vol. 5, pp. 53–69, 1997. View at: Google Scholar
- N. J. Girard, “Does violence still occur in the OR?” AORN J., vol. 80, pp. 407–408, 2004. View at: Google Scholar
- K. H. E. Kroemer, H. B. Kroemer, and K. E. Kroemer-Elbert, Ergonomics: How to Design for Ease and Efficiency, Prentice Hall, Inc., New Jersey, 2nd edition, 2001.
- S. I. Brown, T. G. Frank, A. Cuschieri, R. Sharpe, and C. Cartwright, “Optimization of the projection screen in a display system for minimal access surgery,” Surgical Endoscopy, vol. 17, pp. 1251–1255, 2003. View at: Google Scholar
- S. I. Brown, C. White, K. Wipat, G. B. Hanna, T. G. Frank, and A. Cuschieri, “Characterizing the, "Gold Standard" image for laparoscopic surgery,” Surgical Endoscopy, vol. 18, pp. 1192–1195, 2004. View at: Google Scholar
- A. Szold, “Seeing is believing: visualization systems in endoscopic surgery (video, HDTV, stereoscopy, and beyond),” Surgical Endoscopy, vol. 19, no. 5, pp. 730–733, 2005. View at: Google Scholar
- M. A. Van Veelen, D. W. Meijer, R. H. M. Goossens, C. J. Snijders, and J. J. Jakimowicz, “Improved usability of a new handle design for laparoscopic dissection forceps,” Surgical Endoscopy, vol. 16, pp. 201–207, 2002. View at: Google Scholar
- R. Lafreniere, R. Berguer, P. Seifert et al., “Preparation of the operating room,” ACS Surgery: Principles and Practice, pp. 1–14, 2003. View at: Google Scholar
- E. Sutton, Y. Youssef, N. Meenaghan et al., “Gaze disruptions experienced by the laparoscopic operating surgeon,” Surg Endosc, vol. 24, no. 6, pp. 1240–1244, 2010. View at: Google Scholar
- R. Franson, F. H. Khabbaz, A. Kapoor, and A. Patriciu, “A system for laparoscopic surgery ergonomics and skills evaluation,” Journal of Endourology, vol. 25, no. 7, pp. 1111–1114, 2011. View at: Google Scholar
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