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Development of an arm support system to improve ergonomics in laparoscopic surgery: study design and provisional results.

Steinhilber B, Hoffmann S, Karlovic K, Pfeffer S, Maier T, Hallasheh O, Kruck S, Seibt R, Rieger MA, Heidingsfeld M, Feuer R, Sawodny O, Rothmund R, Sievert KD - Surg Endosc (2014)

Bottom Line: In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods.Step 4 and 5 are still in process.The concept of supporting the elbow from below has been found to be the most promising approach.

View Article: PubMed Central - PubMed

Affiliation: Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany, benjamin.steinhilber@med.uni-tuebingen.de.

ABSTRACT

Background: Laparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder-neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operation room settings.

Methods: A systematic approach to develop an ASsyst started in October 2012 consisting of five consecutive steps. In step 1, 14 laparoscopic interventions were observed using subjective and objective measures to determine key indicators for the conception of an ASsyst in LS. In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods. During the third step, prototypes of ASsyst were tested in an experimental setting. Steps 4 and 5 are currently in process and include the final development of the ASsyst using the most promising concept for the evaluation during simulated LS.

Results: Increased levels of physical stress were found in LS. Asymmetric strains were common. Three prototypes of ASsyst emerged from step 1 and 2. These prototypes were a cable construction with a noose for the lower arm, a support from below the elbow and a pneumatic vest supporting the upper arm. The experimental testing of these prototypes demonstrated reduced physical stress when compared to the unsupported environment. The support from below the elbow seemed to be the most practical in terms of implementation in various operation room settings and acceptance by surgeons. Step 4 and 5 are still in process.

Conclusions: Ergonomic problems have been identified in LS that could be addressed by an ASsyst. The concept of supporting the elbow from below has been found to be the most promising approach.

No MeSH data available.


Related in: MedlinePlus

Prototypes of three different concepts of a support system
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Fig5: Prototypes of three different concepts of a support system

Mentions: The results of step 1 confirmed the findings reported in the literature [4, 16, 17] regarding increased musculoskeletal pain and biomechanical stress in the shoulder–neck region. Furthermore several other aspects for ergonomic improvement during LS were observed such as the unergonomic position and placement of the monitor. However, recommendations for enhanced ergonomics monitor positioning were found in the literature [18]. Technical tools to reduce biomechanical stress in the shoulder–neck region are rare and may provide an opportunity to reduce physical stress that cannot be addressed by ergonomic monitor and table positioning only. Three basic concepts for the ASsyst were generated during the expert workshop. Concept A was a support for the entire lower arm that could either be used as a standalone device or construction fixed to the operating table. The second concept (concept B) was a pneumatic vest worn under the surgical work clothes. This vest could include air cushions that inflate on demand and support the upper arm of the surgeon. Concept C was a cable fixed to the ceiling that allows the surgeon to put their lower arm into a noose-like halter. These concepts resulted in three prototypes (Fig. 5).Fig. 5


Development of an arm support system to improve ergonomics in laparoscopic surgery: study design and provisional results.

Steinhilber B, Hoffmann S, Karlovic K, Pfeffer S, Maier T, Hallasheh O, Kruck S, Seibt R, Rieger MA, Heidingsfeld M, Feuer R, Sawodny O, Rothmund R, Sievert KD - Surg Endosc (2014)

Prototypes of three different concepts of a support system
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4541700&req=5

Fig5: Prototypes of three different concepts of a support system
Mentions: The results of step 1 confirmed the findings reported in the literature [4, 16, 17] regarding increased musculoskeletal pain and biomechanical stress in the shoulder–neck region. Furthermore several other aspects for ergonomic improvement during LS were observed such as the unergonomic position and placement of the monitor. However, recommendations for enhanced ergonomics monitor positioning were found in the literature [18]. Technical tools to reduce biomechanical stress in the shoulder–neck region are rare and may provide an opportunity to reduce physical stress that cannot be addressed by ergonomic monitor and table positioning only. Three basic concepts for the ASsyst were generated during the expert workshop. Concept A was a support for the entire lower arm that could either be used as a standalone device or construction fixed to the operating table. The second concept (concept B) was a pneumatic vest worn under the surgical work clothes. This vest could include air cushions that inflate on demand and support the upper arm of the surgeon. Concept C was a cable fixed to the ceiling that allows the surgeon to put their lower arm into a noose-like halter. These concepts resulted in three prototypes (Fig. 5).Fig. 5

Bottom Line: In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods.Step 4 and 5 are still in process.The concept of supporting the elbow from below has been found to be the most promising approach.

View Article: PubMed Central - PubMed

Affiliation: Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany, benjamin.steinhilber@med.uni-tuebingen.de.

ABSTRACT

Background: Laparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder-neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operation room settings.

Methods: A systematic approach to develop an ASsyst started in October 2012 consisting of five consecutive steps. In step 1, 14 laparoscopic interventions were observed using subjective and objective measures to determine key indicators for the conception of an ASsyst in LS. In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods. During the third step, prototypes of ASsyst were tested in an experimental setting. Steps 4 and 5 are currently in process and include the final development of the ASsyst using the most promising concept for the evaluation during simulated LS.

Results: Increased levels of physical stress were found in LS. Asymmetric strains were common. Three prototypes of ASsyst emerged from step 1 and 2. These prototypes were a cable construction with a noose for the lower arm, a support from below the elbow and a pneumatic vest supporting the upper arm. The experimental testing of these prototypes demonstrated reduced physical stress when compared to the unsupported environment. The support from below the elbow seemed to be the most practical in terms of implementation in various operation room settings and acceptance by surgeons. Step 4 and 5 are still in process.

Conclusions: Ergonomic problems have been identified in LS that could be addressed by an ASsyst. The concept of supporting the elbow from below has been found to be the most promising approach.

No MeSH data available.


Related in: MedlinePlus