Gofrit Ofer N, Mikahail Albert A, Zorn Kevin C, Zagaja Gregory P, Steinberg Gary D, Shalhav Arieh L
Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois 60637, USA.
Urology. 2008 Mar;71(3):404-7. doi: 10.1016/j.urology.2007.07.077.
The biomechanical and mental strains placed on the surgeon while performing laparoscopic procedures are significantly higher compared with open surgical techniques. We undertook this study to assess the prevalence of surgeons' deleterious perceptions or injuries related to laparoscopic urologic surgery.
Members of endourological society were mailed a questionnaire evaluating their laparoscopic experience, total number of standard laparoscopic surgeries (SLS), hand-assisted laparoscopic surgeries (HALS), and robotic-assisted laparoscopic surgeries (RALS) they performed. The subjects reported any neuromuscular or arthritic injuries sustained during laparoscopic surgery, and graded the degree of pain, numbness, and fatigue they experienced.
A total of 73 urologists completed the questionnaires. The average responder was 44 years old, had completed a median of 117 procedures, and was performing 3 laparoscopic surgeries per week. Neuromuscular or arthritic symptoms during surgery were reported by 22 responders (30%), the most common was finger paresthesia (18%). At the conclusion of HALS, 45% of the surgeons suffered from hand and wrist numbness and 37% reported pain in these areas. A significant association was observed between the risk of sustaining injury during surgery and the total number of laparoscopic procedures performed by the responder (P = 0.016). RALS was the procedure least associated with injuries, and HALS the most.
The laparoscopic operating theater is a hostile ergonomic environment. Surgeons' awareness of the common injuries associated with laparoscopic surgery and careful equipment adjustments before surgery are mandatory to minimize injury. Future improvements in instrument design according to ergonomic principles are highly warranted.
与开放手术技术相比，外科医生在进行腹腔镜手术时所承受的生物力学和精神压力明显更高。我们开展这项研究以评估外科医生与腹腔镜泌尿外科手术相关的有害认知或损伤的发生率。
向腔内泌尿外科协会成员邮寄一份问卷，评估他们的腹腔镜手术经验、所进行的标准腹腔镜手术（SLS）、手辅助腹腔镜手术（HALS）和机器人辅助腹腔镜手术（RALS）的总数。受试者报告在腹腔镜手术期间遭受的任何神经肌肉或关节炎损伤，并对他们所经历的疼痛、麻木和疲劳程度进行评分。
共有73名泌尿外科医生完成了问卷。应答者的平均年龄为44岁，完成的手术中位数为117例，每周进行3例腹腔镜手术。22名应答者（30%）报告了手术期间的神经肌肉或关节炎症状，最常见的是手指感觉异常（18%）。在手辅助腹腔镜手术结束时，45%的外科医生手部和腕部出现麻木，37%报告这些部位疼痛。观察到手术期间受伤风险与应答者进行的腹腔镜手术总数之间存在显著关联（P = 0.016）。机器人辅助腹腔镜手术与损伤关联最小，手辅助腹腔镜手术关联最大。
腹腔镜手术室是一个不利于人体工程学的环境。外科医生必须了解与腹腔镜手术相关的常见损伤，并在手术前仔细调整设备，以尽量减少损伤。根据人体工程学原理对器械设计进行未来改进非常有必要。
