occupational ergonomic hazards of minimal access surgery george piligian, md, mph with assistance of...
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Occupational Ergonomic Hazards of Minimal Access
Surgery
George Piligian, MD, MPHWith Assistance Of Jae Lim and Andrew Yoon
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Surgery The practice of treating disease or
illness through manual or operative means
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Current Categorization of Surgical Performance
Methods Open Surgery Minimally Invasive Surgery
- Laparoscopy- NOTES- Robot Assisted
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Open Surgery “Surgeons
traditionally require the 'eyes of a hawk' and the 'hands of a lady' when embarking on open surgical procedures”*
*O. Elhage, D. Murphy, B. Challacombe, A. Shortland, P. Dasgupta, 2007, Ergonomics in minimally invasive surgery, International Journal of Clinical Practice, v.61(2), p.186-188
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Minimally Invasive Surgery: Laparoscopy
Surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures
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Minimally Invasive Surgery: Laparoscopy
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Minimally Invasive Surgery: NOTES
Natural Orifice Transluminal Endoscopic Surgery
A new technique that uses natural orifices (e.g., the mouth) as access points and employs both endoscopic and laparoscopic methods with the endoscope as the main platform
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Minimally Invasive Surgery: NOTES
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Minimally Invasive Surgery: Robot Assisted
Surgery that involves the use of a robot under the direction and guidance of a surgeon*
*http://www.surgeryencyclopedia.com/Pa-St/Robot-Assisted-Surgery.html
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Minimally Invasive Surgery: Robot Assisted
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Ergonomics The concept of designing the working
environment to fit the worker*
Physicians are starting to take these factors into account when determining an operative approach**
**Aditya Bagrodia, Jay D. Raman, 2009, Ergonomics Considerations of Radical Prostatectomy: Physician Perspective of Open, Laparoscopic, and Robot-Assisted Techniques, Journal of Endourology, v.23(4), p. 627-633
*Nicholas Stylopoulos, MD, David Rattner, MD, 2003, Robotics and ergonomics, Surgical Clinics of North America, v.83(6), p. 1331-1337
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Ergonomics of Open Surgery
Lacerations from Instrument Infection Overuse Syndrome*
Posture - forward flexed back and neck to lean over the operating field**
**Aditya Bagrodia, Jay D. Raman, 2009, Ergonomics Considerations of Radical Prostatectomy: Physician Perspective of Open, Laparoscopic, and Robot-Assisted Techniques, Journal of Endourology, v.23(4), p. 627-633
*Berguer R., 1999, Surgery and ergonomics, Archives of Surgery, v.134(9), p. 1011-1016.
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Ergonomics of Laparoscopy
Increased Time/Fatigue Length of instruments
- Increased Tremor- Only about 4 Degrees of Freedom compared to human hands that provide 36 DOF and mechanical redundancy
Spatial disorientation/ instrument movement- Fulcrum Effect
Greater force required to grip instruments Only one size of instruments often
available
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Ergonomics of Laparoscopy
Increased Time/Fatigue*
Reduced ability to sense tissue characteristics Surgical Fatigue Syndrome
- A four hour performance “wall” that is manifested by mental exhaustion, irritability, impaired surgical judgment, and reduced manual dexterity
Visual fatigue - long term effect is unknown
Possibly significant cardiovascular stress
*D. A. G. Reyes, B. Tang, A. Cuschieri, 2006, Minimal access surgery (MAS)-related surgeon morbidity syndromes, Surgical Endoscopy, v.20(1), p. 1-13
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Ergonomics of Laparoscopy
Posture*
Overhead or side placement of monitor- Ideal placement is to the front, near the hands
There is an increase in the amount of equipment, which leads to a need to maneuver around them
Stiff upright with little movement- Less opportunity to shift weight
Requires raised arms placed in awkward positions for extended periods of time
*D. A. G. Reyes, B. Tang, A. Cuschieri, 2006, Minimal access surgery (MAS)-related surgeon morbidity syndromes, Surgical Endoscopy, v.20(1), p. 1-13
Berguer R., 1999, Surgery and ergonomics, Archives of Surgery, v.134(9), p. 1011-1016
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Ergonomics Of NOTES No tactile response Visual fatigue Constant holding of the endoscope
induces fatigue Endoscopy can lead to
musculoskeletal pain in fingers, wrists and shoulders*
Young Hye Byun, Jun Haeng Lee, Moon Kyung Park, 2008, Procedure-related musculoskeletal
symptoms in gastrointestinal endoscopists in Korea, World J Gastroenterol, v.14(27)
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Ergonomics Of Robotic Assisted Surgery
Effects of flexed neck, fixed seated position are unclear*
Fatigue from the use of polarizing head gear in some models**
Provides no tactile response High cost of production and
maintenance*Aditya Bagrodia, Jay D. Raman, 2009, Ergonomics Considerations of Radical Prostatectomy: Physician Perspective of Open, Laparoscopic, and Robot-Assisted Techniques, Journal of Endourology, v.23(4), p. 627-633
**D. A. G. Reyes, B. Tang, A. Cuschieri, 2006, Minimal access surgery (MAS)-related surgeon morbidity syndromes, Surgical Endoscopy, v.20(1), p. 1-13
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Prostatectomy: A Case Study*
Prostatectomy is a relatively difficult open surgical procedure as regards ergonomics of the surgeon
For open prostate surgery, 50% of physicians reported pain, with neck pain being the most common, followed by back pain.
In comparison, for general open surgery, 30% of surgeons report pain, with pain being more common in the shoulders and lower back than the neck
*Aditya Bagrodia, Jay D. Raman, 2009, Ergonomics Considerations of Radical Prostatectomy: Physician Perspective of Open, Laparoscopic, and Robot-Assisted Techniques, Journal of Endourology, v.23(4), p. 627-633
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Prostatectomy: A Case Study
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Prostatectomy: A Case Study
106 Urologists were surveyed Chronic neck/back pain present in
43% of urologists surveyed Neck/back pain was experienced in
50%, 56%, and 23% of surgeons after open, laparoscopic and robot assisted prostatectomy, respectively
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Recommendations For The Future
Shared surgical care and rest breaks to help avoid Surgical Fatigue Syndrome
Exoskeletal Support*
*D. A. G. Reyes, B. Tang, A. Cuschieri, 2006, Minimal access surgery (MAS)-related surgeon morbidity syndromes, Surgical Endoscopy, v.20(1), p. 1-13
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The Ever Changing Future A New Endoscopic Microcapsule
Robot using Beetle Inspired Microfibrillar Adhesives*
* Proceedings of the 2005 IEEE/ASME International Conference on Advanced Intelligent MechatronicsMonterey, California, USA, 24-28 July, 2005
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The Ever Changing Future Nanobots Operated by Clinician Engineers or
Surgeons?