Galleano Raffaele, Carter Fiona, Brown Stuart, Frank Timothy, Cuschieri Alfred
University of Dundee, Dundee, UK.
Ann Surg. 2006 Mar;243(3):329-33. doi: 10.1097/01.sla.0000201481.08336.dc.
The study sought to determine whether the support provided by armrests influenced task quality, task efficiency, and surgeon comfort during laparoscopic surgery.
Complex laparoscopic surgery requires precise movements, and usually long execution times and an uncomfortable stance. Discomfort in the shoulders, back, and neck is an established complaint among laparoscopic surgeons and is related to the unnatural postures adopted during laparoscopic interventions. Discomfort, and the associated fatigue, is a contributory factor in the execution of errors.
Nineteen subjects completed a bimanual simulated laparoscopic task both with and without the aid of bilateral armrests. The task was completed in both an ideal unstressed posture and an uncomfortable, stressed elevated posture that more closely represents real laparoscopic operating conditions. Task duration was prolonged sufficiently to precipitate muscular fatigue. The participants also completed a visual analogue scale instrument on level of discomfort symptoms experienced in every part of the upper limbs and vertebral spine. Execution errors (task quality) and completion times (task efficiency) were recorded automatically by the laparoscopic simulator.
Error rates and discomfort measures were significantly improved when the armrests were used, but there was no significant change in task completion time.
The use of armrests in simulated laparoscopic surgery brings measurable comfort and task performance benefits, which could transfer to actual surgical procedures.
本研究旨在确定扶手提供的支撑是否会影响腹腔镜手术期间的任务质量、任务效率和外科医生的舒适度。
复杂的腹腔镜手术需要精确的动作，通常执行时间长且姿势不舒服。肩部、背部和颈部不适是腹腔镜外科医生中公认的问题，并且与腹腔镜手术期间采用的不自然姿势有关。不适以及相关的疲劳是导致错误发生的一个因素。
19名受试者在有双侧扶手和没有双侧扶手的辅助下完成了一项双手模拟腹腔镜任务。该任务在理想的无压力姿势和更接近实际腹腔镜手术条件的不舒服、有压力的抬高姿势下完成。任务持续时间延长到足以引发肌肉疲劳。参与者还完成了一份视觉模拟量表，评估上肢和脊柱各部位的不适症状程度。腹腔镜模拟器自动记录执行错误（任务质量）和完成时间（任务效率）。
使用扶手时，错误率和不适指标有显著改善，但任务完成时间没有显著变化。
在模拟腹腔镜手术中使用扶手可带来可测量的舒适度提升和任务表现改善，这可能会转化到实际手术操作中。
