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Surgical Ergonomics

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Ray King

on 21 July 2013

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Transcript of Surgical Ergonomics

Surgical Ergonomics: Does the Robot Help the Surgeon or Do We Need to Do Laparoscopy Better?

Ergonomics of Laparoscopy and Robotics
Physical Ergonomics
Ray King, MD, PhD & Garth Ballantyne MD, MBA, FACS, FASCRS
Medical College of Georgia & Charlie Norwood VA Medical Center

Definition:
Ergonomics (or human factors) is the scientific discipline concerned with the understanding of the interactions among humans and other elements of a system
International Ergonomics Association
www.iea.com
The relevant topics include:
Working postures
Materials handling
Repetitive movements
Work-related musculoskeletal disorders
Workplace layout
Safety and health

Physical ergonomics is concerned with human anatomical, anthropometric, physiological and biomechanical characteristics as they relate to physical activity. 

International Ergonomics Association
www.iea.com

Cognitive Ergonomics

The relevant topics include:
Mental workload
Decision-making
Skilled performance
Human-computer interaction
Human reliability
Work stress and training
Human-system design.


International Ergonomics Association
www.iea.com

Cognitive ergonomics is concerned with mental processes, such as perception, memory, reasoning, and motor response, as they affect interactions among humans and other elements of a system

Organizational ergonomics is concerned with the optimization of socio-technical systems, including their organizational structures, policies, and processes.

Organizational Ergonomics

The relevant topics include:
Communication
Crew resource management
Work design
Design of working times
Teamwork
Participatory organizational culture
Virtual organizations
Quality management 

International Ergonomics Association
www.iea.com

Inherent Ergonomic Problems:
Physical
Laparoscopic Surgery

Fulcrum Effect of Trocar
Motion Reversal
Motion Amplification
Limited Motion: Only Four (4) Degrees of Freedom)
Loss of Proprioception
Loss of Haptic Feedback
Increased Resistance to Instrument Movement
Poor Posture
Poor Distribution of Weight – e.g. Foot Pedals
Poor Angle of View (Neck Strain)

Cognitive Ergonomics
Decreased Visual Perception

Inherent Ergonomic Problems

Laparoscopic Surgery
2D Imaging
Loss of Peripheral Vision
Decreased Resolution Compared to Human Eye
Altered Angle of View
Loss of Orientation
Loss of Control (Separate Camera Holder)
Increased Stress (Greater Processing Time)

Organizational Ergonomics
Increased Complexity of Operating Room

Inherent Ergonomic Problems
Laparoscopic Surgery
Cluttered Operating Room
Cables Across Floor
Increased Set Up Times
Increased Turn Over Times
Increased Need for Team Work

Poor Physical Ergonomics

Laparoscopic Surgery
N Hubert, M Giles, J Hubert
Nancy, France

Chest
Arm &
Back
Support

International Brazil J Urol 2011; 37(4): 455-460

Location
Of Monitor

Annals of Surgery 1998; 227(4): 481-484

Acta Chir Belg 2006; 106: 662-664

2D vs. 3D Vision

FACILTATES LAPAROSCOPY
NOT CLUTTERED – FEW CABLES
INTEGRATED DIGITAL OPERATING ROOMS
Is ROBOTIC SURGERY the ANSWER?
Robotics?
Tele-Surgery?
* Robotic RYGB surgery may result in less
musculosketal stress to the upper extremities.

*Decreased Physical Stress With Robot

Surg Endosc 2009; 23: 1365 - 1371

MSSD: Mean Square of Successive Distances
(beat to beat variability of heart)
Correlates with changes in Vagal Activity)
PEP: Pre-Ejection Period
(Iso-Volumic Heart Contraction)
Correlates with Beta Adrenergic Activity
HRA: Heart Rate of Activity


*Fewer Task Failures & Increased Task Repetitions With Robot
Surg Endosc 2009; 23: 1365 - 1371

Zeus

Job Strain Index

*Decreased Risk of Upper Extremity Disorder With Robot
Surg Endosc 2005; 19: 1064-1070

Surg Endosc 2005; 19: 1064-1070

Rapid Upper Limb Assessment:
Posture of Neck
Posture of Trunk
Posture of Upper Limb
External Load

*Decreased Risk of Musculosketetal Injury With Robot

*Robot Less Stressful for Complex Tasks
J Surg Research 2006; 134: 87-92

The relevant topics include:
Working postures
Materials handling
Repetitive movements
Work-related musculoskeletaldisorders
Workplace layout
Safety and health

Physical Ergonomics
Laparoscopic vs Robotic Surgery
N Hubert, M Giles, J Hubert
Nancy, France

Improved Physical Ergonomics?

Robotic vs Laparoscopic Surgery
N Hubert, M Giles, J Hubert; Nancy, France

Robotic vs Laparoscopic Surgery
N Hubert, M Giles, J Hubert; Nancy, France

Borg Scale: Higher Score Means Greater Effort

N Hubert, M Giles, J Hubert; Nancy, France

Improved Physical Ergonomics
Robotic vs Laparoscopic Surgery
N Hubert, M Giles, J Hubert; Nancy, France
Full transcript