Methodological Infrastructure in Surgical Ergonomics: A Review of Tasks, Models, and Measurement Systems

Though in its infancy, the discipline of surgical ergonomics is increasingly valued. Still, little has been written regarding this field's tasks, models, and measurement systems. These 3 critical experimental components are crucial in objectively and accurately assessing joint and postural control as exhibited by expert laparoscopic surgeons. Such assessments will establish characteristic patterns important for surgical training. In addition, risk factors associated with both minimally invasive surgical instruments and the operating room environment can be identified and minimized. Our review focuses on evidence-based experimental ergonomic studies undertaken in the field of laparoscopic surgery. Publications were located through PubMed and other database and library searches. This article describes tasks, models, and measurement systems and considers their specific applications and the types of data obtainable with the use of each. Advantages and limitations, especially those of measurement systems, are compared and discussed. Future trends and directions believed necessary for optimal investigation and results are also addressed.

[1]  G. Fried,et al.  Development of a model for training and evaluation of laparoscopic skills. , 1998, American journal of surgery.

[2]  A. J. Hodgson,et al.  Automated high-frequency posture sampling for ergonomic assessment of laparoscopic surgery , 2009, Surgical Endoscopy.

[3]  A. Cuschieri,et al.  Computer-controlled endoscopic performance assessment system , 1998, Surgical Endoscopy.

[4]  Patla,et al.  The initiation of gait in young, elderly, and Parkinson's disease subjects. , 1998, Gait & posture.

[5]  A. Leardini,et al.  Gait Analysis, Methodologies and Clinical Applications , 1997 .

[6]  A. Cuschieri,et al.  Ergonomic principles of task alignment, visual display, and direction of execution of laparoscopic bowel suturing , 2002, Surgical Endoscopy And Other Interventional Techniques.

[7]  C. Giebmeyer,et al.  Monitor position in laparoscopic surgery , 2005, Surgical Endoscopy And Other Interventional Techniques.

[8]  Constantinos N Maganaris,et al.  Paradoxical muscle movement in human standing , 2004, The Journal of physiology.

[9]  Steven D Schwaitzberg,et al.  Effects of cognitive distraction on performance of laparoscopic surgical tasks. , 2006, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[10]  K. J. Craik.  Theory of the human operator in control systems; man as an element in a control system. , 1948, British Journal of Psychology General Section.

[11]  A. E. Park,et al.  The effect of using laparoscopic instruments on muscle activation patterns during minimally invasive surgical training procedures , 2003, Surgical Endoscopy And Other Interventional Techniques.

[12]  R Berguer,et al.  Surgery and ergonomics. , 1999, Archives of surgery.

[13]  Alfred Cuschieri,et al.  Differences between Experts and Trainees in the Motion Pattern of the Dominant Upper Limb during Intracorporeal Endoscopic Knotting , 2000, Digestive Surgery.

[14]  J. R. Engsberg,et al.  Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery , 2002, Surgical Endoscopy.

[15]  J. Brøgger,et al.  In-line versus pistol-grip handles in a laparoscopic simulators , 2002, Surgical Endoscopy And Other Interventional Techniques.

[16]  W. D. Smith,et al.  An ergonomic study of the optimum operating table height for laparoscopic surgery , 2002, Surgical Endoscopy And Other Interventional Techniques.

[17]  Alberto Menache,et al.  Understanding Motion Capture for Computer Animation and Video Games , 1999 .

[18]  J R Wilson,et al.  Fundamentals of ergonomics in theory and practice. , 2000, Applied ergonomics.

[19]  D. Kerrigan,et al.  Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. , 2002, Archives of physical medicine and rehabilitation.

[20]  Alfred Cuschieri,et al.  Can Armrests Improve Comfort and Task Performance in Laparoscopic Surgery? , 2006, Annals of surgery.

[21]  A. Darzi,et al.  Motion analysis , 1986 .

[22]  Richard H. M. Goossens,et al.  Assessment of ergonomics in laparoscopic surgery. , 2001, Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy.

[23]  A. Cuschieri,et al.  Minimal access surgery (MAS)-related surgeon morbidity syndromes , 2005, Surgical Endoscopy And Other Interventional Techniques.

[24]  Ergonomic testing of two different types of handles via virtual reality simulation , 2005, Surgical Endoscopy And Other Interventional Techniques.

[25]  Postural instability does not necessarily correlate to poor performance: case in point , 2007, Surgical Endoscopy.

[26]  C. Giebmeyer,et al.  Ergonomic aspects of five different types of laparoscopic instrument handles under dynamic conditions with respect to specific laparoscopic tasks: An electromyographic-based study , 2004, Surgical Endoscopy And Other Interventional Techniques.

[27]  A Cuschieri,et al.  Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. , 2004, Archives of surgery.

[28]  Natalia Dounskaia,et al.  Efficient control of arm movements in advanced age , 2007, Experimental Brain Research.

[29]  A. Cuschieri,et al.  Rocker handle for endoscopic needle drivers , 1999, Surgical Endoscopy.

[30]  A. Darzi,et al.  Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system , 2004, Surgical Endoscopy And Other Interventional Techniques.

[31]  Fernando Bello,et al.  Real-time synchronization of kinematic and video data for the comprehensive assessment of surgical skills. , 2004, Studies in health technology and informatics.

[32]  R. Baxendale,et al.  Fatigue and EMG changes in the masseter and temporalis muscles during sustained contractions. , 1993, Journal of oral rehabilitation.

[33]  J.W. HUBER,et al.  The effects of different viewing conditions on performance in simulated minimal access surgery , 2003, Ergonomics.

[34]  K Moorthy,et al.  Objective evaluation of the effect of noise on the performance of a complex laparoscopic task. , 2004, Surgery.

[35]  R. Riener,et al.  In vivo kinematic measurement during laparoscopic cholecystectomy , 2007, Surgical Endoscopy And Other Interventional Techniques.

[36]  Rajesh Aggarwal,et al.  Synchronized video and motion analysis for the assessment of procedures in the operating theater. , 2005, Archives of surgery.

[37]  Ramon Berguer,et al.  A comparison of the physical effort required for laparoscopic and open surgical techniques. , 2003, Archives of surgery.

[38]  G. Karst,et al.  Center of Pressure Measures during Standing Tasks in Minimally Impaired Persons with Multiple Sclerosis , 2005, Journal of neurologic physical therapy : JNPT.

[39]  R Berguer,et al.  A comparison of forearm and thumb muscle electromyographic responses to the use of laparoscopic instruments with either a finger grasp or a palm grasp. , 1999, Ergonomics.

[40]  R. Berguer,et al.  A comparison of surgeons' posture during laparoscopic and open surgical procedures , 1997, Surgical Endoscopy.

[41]  William J. Kraemer,et al.  Influence of load and stretch shortening cycle on the kinematics, kinetics and muscle activation that occurs during explosive upper-body movements , 1997, European Journal of Applied Physiology and Occupational Physiology.

[42]  T. G. Frank,et al.  Influence of handle design on the surgeon's upper limb movements, muscle recruitment, and fatigue during endoscopic suturing , 2001, Surgical Endoscopy.

[43]  A. Dosis,et al.  Motion tracking systems for assessment of surgical skill , 2007, Surgical Endoscopy.

[44]  A Cuschieri,et al.  Objective assessment of endoscopic knot quality. , 1997, American journal of surgery.

[45]  Christoph Bregler,et al.  Motion capture assisted animation: texturing and synthesis , 2002, ACM Trans. Graph..

[46]  J. Jakimowicz,et al.  Ergonomic problems encountered by the medical team related to products used for minimally invasive surgery , 2003, Surgical Endoscopy And Other Interventional Techniques.

[47]  D. Winter,et al.  Stiffness control of balance in quiet standing. , 1998, Journal of neurophysiology.

[48]  S. Koneczny,et al.  Instruments for the evaluation of ergonomics in surgery , 2004, Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy.

[49]  Warren D. Smith,et al.  Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery , 2001, Surgical Endoscopy.

[50]  A Cuschieri,et al.  Ergonomic evaluation of laparoscopic bowel suturing. , 1998, American journal of surgery.

[51]  D. Ankrum.  On the confusion between static load level and static task. , 2000, Applied ergonomics.

[52]  A. Cuschieri,et al.  Errors enacted during endoscopic surgery--a human reliability analysis. , 1998, Applied ergonomics.

[53]  Warren D. Smith,et al.  Ergonomic problems associated with laparoscopic surgery , 1999, Surgical Endoscopy.

[54]  G. Fried,et al.  Evaluation of laparoscopic skills: a 2-year follow-up during residency training. , 1999, Canadian journal of surgery. Journal canadien de chirurgie.

[55]  A. Cuschieri,et al.  Effect of the angle between the optical axis of the endoscope and the instruments’ plane on monitor image and surgical performance , 2002, Surgical Endoscopy And Other Interventional Techniques.

[56]  R H M Goossens,et al.  Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. , 2002, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[57]  Giuseppe Andreoni,et al.  Method for the analysis of posture and interface pressure of car drivers. , 2002, Applied ergonomics.

[58]  Alfred Cuschieri,et al.  Optimal angle between instrument shaft and handle for laparoscopic bowel suturing. , 2004, Archives of surgery.

[59]  D. Oleynikov,et al.  Robotic surgery and training: electromyographic correlates of robotic laparoscopic training , 2005, Surgical Endoscopy And Other Interventional Techniques.

[60]  N. Stylopoulos,et al.  Simulated laparoscopy using a head-mounted display vs traditional video monitor: an assessment of performance and muscle fatigue , 2005, Surgical Endoscopy And Other Interventional Techniques.

[61]  A. Cuschieri,et al.  Comparison of orthodox versus off-optical axis endoscopic manipulations , 2001, Surgical Endoscopy And Other Interventional Techniques.

[62]  Daniel Gopher,et al.  Workload: An examination of the concept. , 1986 .

[63]  S. Coleman,et al.  A three-dimensional examination of the planar nature of the golf swing , 2005, Journal of sports sciences.

[64]  A. Darzi,et al.  Use of Suturing as a Measure of Technical Competence , 2003, Annals of plastic surgery.

[65]  I. Kant,et al.  A survey of static and dynamic work postures of operating room staff , 1992, International archives of occupational and environmental health.

[66]  G. Franco,et al.  Bernardino Ramazzini's early observations of the link between musculoskeletal disorders and ergonomic factors. , 2004, Applied ergonomics.

[67]  G M Hägg,et al.  Methodologies for evaluating electromyographic field data in ergonomics. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[68]  Alan M. Wood,et al.  Motion analysis , 1986 .

[69]  A. Cuschieri,et al.  Comparison of direct vision and electronic two‐ and three‐dimensional display systems on surgical task efficiency in endoscopic surgery , 1995, The British journal of surgery.

[70]  Monitor height affects surgeons' stress level and performance on minimally invasive surgery tasks. , 2005, Studies in health technology and informatics.

[71]  D. Rempel,et al.  Effect of Four Computer Keyboards in Computer Users with Upper Extremity Musculoskeletal Disorders , 1999, American journal of industrial medicine.

[72]  K. Moorthy,et al.  The benfits of stereoscopic vision in robotic-assisted performance on bench models , 2004, Surgical Endoscopy And Other Interventional Techniques.

[73]  A. Darzi,et al.  Measurement of Surgical Dexterity Using Motion Analysis of Simple Bench Tasks , 2003, World Journal of Surgery.

[74]  A. Darzi,et al.  Dexterity enhancement with robotic surgery , 2004, Surgical Endoscopy And Other Interventional Techniques.

[75]  C. A. Fischer,et al.  Surgeon workload and motion efficiency with robot and human laparoscopic camera control , 2001, Surgical Endoscopy.

[76]  D. Winter,et al.  Balance recovery from medio-lateral perturbations of the upper body during standing , 1999 .

[77]  A. Cuschieri,et al.  Comparison of conventional and gaze-down imaging in laparoscopic task performance , 2003, Surgical Endoscopy.

[78]  Yan Xiao,et al.  Measuring Awkwardness of Workplace Layout: Dispersion of Attentional and Psychomotor Resources within the Anesthesia Workspace , 2004 .

[79]  C. J. Snijders,et al.  Improvement of the laparoscopic needle holder based on new ergonomic guidelines , 2003, Surgical Endoscopy And Other Interventional Techniques.

[80]  Motoki Kouzaki,et al.  Importance of body sway velocity information in controlling ankle extensor activities during quiet stance. , 2003, Journal of neurophysiology.

[81]  James R Korndorffer,et al.  Simulator training for laparoscopic suturing using performance goals translates to the operating room. , 2005, Journal of the American College of Surgeons.

[82]  C. D. De Luca,et al.  Effects of muscle fiber type and size on EMG median frequency and conduction velocity. , 1995, Journal of applied physiology.

[83]  Alfred Cuschieri,et al.  Optimum shadow-casting illumination for endoscopic task performance. , 2004, Archives of surgery.

[84]  William H Gage,et al.  Kinematic and kinetic validity of the inverted pendulum model in quiet standing. , 2004, Gait & posture.

[85]  C. Giebmeyer,et al.  Ergonomic aspects of four different types of laparoscopic instrument handles with respect to elbow angle , 2002, Surgical Endoscopy.

[86]  A. Darzi,et al.  Laboratory-Based Validation of a Novel Suture Technique for Wound Closure , 2002, Annals of plastic surgery.

[87]  U Matern,et al.  MIS instruments. An experimental comparison of various ergonomic handles and their design. , 1999, Surgical endoscopy.

[88]  Warren D Smith,et al.  A simple virtual instrument to monitor surgeons' workload while they perform minimally invasive surgery tasks. , 2004, Studies in health technology and informatics.

[89]  D. L. Forkey,et al.  The effect of laparoscopic instrument working angle on surgeons’ upper extremity workload , 2001, Surgical Endoscopy.

[90]  Changes in postural mechanics associated with different types of minimally invasive surgical training exercises , 2003, Surgical Endoscopy And Other Interventional Techniques.

[91]  G. Fried,et al.  Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. , 2004, Surgery.

[92]  A. Cuschieri,et al.  Influence of the optical axis-to-target view angle on endoscopic task performance , 1999, Surgical Endoscopy.

[93]  P. V. Patil,et al.  Effect of fixation of shoulder and elbow joint movement on the precision of laparoscopic instrument manipulations , 2005, Surgical Endoscopy And Other Interventional Techniques.

[94]  D. Meijer,et al.  Evaluation of the usability of two types of image display systems, during laparoscopy , 2001, Surgical Endoscopy.

[95]  A. Cuschieri,et al.  Task performance in endoscopic surgery is influenced by location of the image display. , 1998, Annals of surgery.

[96]  A. Cuschieri,et al.  Effect of intracorporeal-extracorporeal instrument length ratio on endoscopic task performance and surgeon movements. , 2000, Archives of surgery.

[97]  Gyusung Lee,et al.  Technology Overview: The Gait Analysis Laboratory , 2001 .

[98]  Ara Darzi,et al.  The relationship between motion analysis and surgical technical assessments. , 2002, American journal of surgery.

[99]  A. Cuschieri,et al.  Time–motion analysis of operation theater time use during laparoscopic cholecystectomy by surgical specialist residents , 2004, Surgical Endoscopy And Other Interventional Techniques.

[100]  B Jonsson.  Quantitative electromyographic evaluation of muscular load during work. , 1978, Scandinavian journal of rehabilitation medicine. Supplement.

[101]  William A. Sands,et al.  Biomechanical research in artistic gymnastics: a review , 2006, Sports biomechanics.

[102]  M. Moont,et al.  In-line vs pistol-grip handles in a laparoscopic simulator , 2003, Surgical Endoscopy And Other Interventional Techniques.

[103]  H. Xina,et al.  Laparoscopic surgery , perceptual limitations and force : A review , 2006 .

[104]  G. Fried,et al.  Relationship between objective assessment of technical skills and subjective in-training evaluations in surgical residents. , 2004, Journal of the American College of Surgeons.

[105]  Ara Darzi,et al.  Electromagnetic motion analysis in the assessment of surgical skill: Relationship between time and movement , 2002, ANZ journal of surgery.

[106]  B. Nigg,et al.  The effect of material characteristics of shoe soles on muscle activation and energy aspects during running. , 2003, Journal of biomechanics.