Division of General Surgery, Department of Surgery, School of Medicine, University of Maryland, 22 South Greene Street, Room S4B14, Baltimore, MD 21201, USA.
Surg Endosc. 2011 May;25(5):1585-93. doi: 10.1007/s00464-010-1443-x. Epub 2010 Nov 3.
Research confirms that surgeons experience physical symptoms due to the unfavorable ergonomics of laparoscopy. The physical effects of performing Natural Orifice Transluminal Endoscopic Surgery (NOTES)-potentially the next evolutionary surgical step-are only now being quantitatively and systematically assessed. This study investigates NOTES- and laparoscopy-related physical workloads through biomechanical analyses.
Fourteen surgeons with varying laparoscopic experience were recruited. Each participant completed ring transfer and triangle transfer tasks using two surgical platforms: laparoscopy and NOTES. Motion capture and electromyography (EMG) systems recorded biomechanical data for quantitative physical workload assessment. The normalized cumulative muscular workload (NCMW) and mean muscular workload (MMW) were obtained from EMG data. Then normalized performance time (NPT) was compared between the two surgical platforms. The overall NCMW was considerably greater when participants performed tasks using the NOTES platform (1315.8±116.9%) compared with traditional laparoscopy (153.9±18.8%).
Performing NOTES required eight to nine times higher muscular workload (NCMW: NOTES 1315.8%, laparoscopy 153.9%, p<0.05) when compared with traditional laparoscopy. This result was shown to be caused by the following: (1) six to eight times longer NPT with NOTES (p<0.05) and (2) higher average activation levels shown in regard to biceps, extensor digitorum communis, and thenar compartment (p<0.05), the muscles responsible for specific joint movements to hold and operate the scope.
This study demonstrated that performing NOTES is significantly more challenging for surgeons than laparoscopy. The greater amount of muscular exertion required is linked to higher ergonomic risks. Based on the depth and strength of our results, we propose that an alternative NOTES platform be designed, one that overcomes the awkward operational mechanism of the dual-working-channel flexible endoscope.
研究证实，由于腹腔镜检查的不利人体工程学，外科医生会出现身体症状。进行经自然腔道内镜外科手术（NOTES）的物理影响——可能是下一个进化的手术步骤——现在才被定量和系统地评估。本研究通过生物力学分析调查 NOTES 和腹腔镜相关的体力工作负荷。
招募了 14 名具有不同腹腔镜经验的外科医生。每位参与者使用两种手术平台（腹腔镜和NOTES）完成了指环转移和三角转移任务。运动捕捉和肌电图（EMG）系统记录了生物力学数据，用于定量体力工作负荷评估。从 EMG 数据中获得归一化累积肌肉工作量（NCMW）和平均肌肉工作量（MMW）。然后比较了两种手术平台之间的归一化操作时间（NPT）。与传统腹腔镜相比，参与者使用 NOTES 平台执行任务时的整体 NCMW 要高得多（1315.8±116.9%）。
与传统腹腔镜相比，执行 NOTES 时需要高 8 至 9 倍的肌肉工作量（NCMW：NOTES 1315.8%，腹腔镜 153.9%，p<0.05）。这一结果是由以下原因造成的：（1）使用 NOTES 时 NPT 长 6 至 8 倍（p<0.05），（2）特定关节运动中负责握持和操作内窥镜的二头肌、伸指总肌和鱼际肌的平均激活水平较高（p<0.05）。
本研究表明，与腹腔镜相比，执行 NOTES 对外科医生来说具有更大的挑战性。需要更大的肌肉用力与更高的人体工程学风险相关。基于我们研究结果的深度和强度，我们建议设计一种替代的 NOTES 平台，克服双工作通道柔性内窥镜的尴尬操作机制。
