Matern Ulrich
Managing Director, Experimental-OR and Ergonomics, University Hospital of Tuebingen, Ernst-Simon-Strasse 16, 72072 Tuebingen, Germany.
Work. 2009;33(2):165-8. doi: 10.3233/WOR-2009-0862.
The importance of minimally invasive surgery (MIS) has constantly increased in the last 20 years. Laparoscopic removal of the gallbladder has become the gold standard with advantages for patients. However, in laparoscopy, the surgeon loses direct contact with the surgical site. Rather than seeing the entire surgical field including adjacent organs, the surgeon's vision is restricted by an optic and camera system. Pictures of the surgical site in the abdomen are presented on a monitor. Hand eye coordination is decreasing because the operating team is not able to position the monitor at an ergonomically preferable position given that operation tables, constructed for open surgery where surgeons use short instruments, are too high for laparoscopic procedures where surgeons use long-shafted instruments. Additionally the degrees of freedom for camera movements and the instruments are limited, tactile feedback given in open surgery is lost. The typical design of instrument handles leads to pressure areas and nerve lesions. All these aspects force the surgeon into unnatural and uncomfortable body postures that can affect the outcome of the operation. An ideal posture for laparoscopic surgeons is described and ergonomic requirements for an optimal height of operation tables, monitor positions and man-machine interfaces are discussed.
在过去20年里，微创手术（MIS）的重要性不断提高。腹腔镜胆囊切除术已成为金标准，对患者具有诸多优势。然而，在腹腔镜手术中，外科医生与手术部位失去了直接接触。外科医生的视野并非看到包括相邻器官在内的整个手术区域，而是受光学和摄像系统的限制。腹部手术部位的图像显示在监视器上。由于手术台是为开放手术构建的（外科医生在开放手术中使用短器械），对于使用长柄器械的腹腔镜手术来说太高了，手术团队无法将监视器放置在符合人体工程学的理想位置，因此手眼协调能力正在下降。此外，摄像头和器械的活动自由度有限，开放手术中所具有的触觉反馈也丧失了。器械手柄的典型设计会导致压力区域和神经损伤。所有这些因素迫使外科医生采取不自然且不舒服的身体姿势，这可能会影响手术结果。本文描述了腹腔镜外科医生的理想姿势，并讨论了手术台最佳高度、监视器位置和人机界面的人体工程学要求。
