Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks

M Susan Hallbeck; Bethany R Lowndes; Bernadette McCrory; Melissa M Morrow; Kenton R Kaufman; Chad A LaGrange

doi:10.1016/j.apergo.2017.02.003

Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks

Appl Ergon. 2017 Jul:62:118-130. doi: 10.1016/j.apergo.2017.02.003. Epub 2017 Mar 1.

Authors

M Susan Hallbeck¹, Bethany R Lowndes², Bernadette McCrory³, Melissa M Morrow⁴, Kenton R Kaufman⁵, Chad A LaGrange⁶

Affiliations

¹ Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Surgery, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA. Electronic address: [email protected].
² Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA.
³ Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
⁴ Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA.
⁵ Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
⁶ Department of Surgery, Division of Urology, University of Nebraska Medical Center, Omaha, NE 68198, USA.

PMID: 28411722
DOI: 10.1016/j.apergo.2017.02.003

Abstract

While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.

Keywords: LESS; surgical instrument; workload.

MeSH terms

Adult
Biomechanical Phenomena
Computer Simulation
Endoscopy / instrumentation*
Ergonomics*
Female
Forearm / physiopathology
Humans
Laparoscopy / instrumentation*
Male
Middle Aged
Movement
Musculoskeletal Pain / etiology
Occupational Health
Posture
Rotation
Shoulder / physiopathology
Task Performance and Analysis
Upper Extremity / physiopathology*
Workload*
Wrist / physiopathology