Division of General Surgery, University of Maryland Medical Center, 22 S. Greene Street, Rm S4B14, Baltimore, MD 21201-1595, USA.
Surg Endosc. 2011 Jul;25(7):2168-74. doi: 10.1007/s00464-010-1517-9. Epub 2011 Mar 24.
This study compares surgical techniques and surgeon's standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons' learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist.
Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed.
RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p<0.05). The two-handed technique in the side-standing position required more effort than the one-handed (p<0.05). No difference in operative time or complication rate was demonstrated among the four procedures. The two-handed/between-standing method was chosen as the best procedure to teach and standardize.
Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for the surgeon. Though further investigations should be conducted, adopting the between-standing position deserves serious consideration as it may be the best short-term ergonomic alternative.
本研究比较了腹腔镜胆囊切除术（LC）中的手术技术和外科医生的站立姿势，分别从外科医生的学习、表现和人体工程学角度进行了研究。LC 的表现和培训存在很大的差异。站立姿势（侧站技术与对站技术）和手技（单手与双手）存在差异。
对 32 例在虚拟现实模拟器上进行的 LC 手术进行视频记录和分析。每位受试者进行了四种不同的手术：单手/侧站、单手/对站、双手/侧站和双手/对站。使用 Rapid Upper Limb Assessment（RULA）评估物理人体工程学。使用 National Aeronautics and Space Administration-Task Load Index（NASA-TLX）评估心理工作量。分析虚拟现实（VR）模拟器生成的性能评估和主观调查。
无论单手还是双手，对站技术的 RULA 评分始终较低（表明人体工程学更好），而侧站技术的评分较高（表明人体工程学较差）。总体解剖评分显示侧站对上肢和躯干有不利影响。NASA-TLX 显示侧站位置与高物理需求、高努力和高挫折感之间存在显著关联（p<0.05）。侧站位置的双手技术比单手技术需要更多的努力（p<0.05）。四种手术之间的手术时间或并发症发生率没有差异。双手/对站方法被选为最佳的教学和标准化方法。
腹腔镜胆囊切除术会给外科医生带来身体受伤的风险。由于 LC 目前在美国普遍施行，左侧侧站位置可能会导致物理需求和努力增加，从而导致外科医生的人体工程学条件不佳。尽管还需要进一步的研究，但采用对站位置值得认真考虑，因为它可能是短期最佳的人体工程学替代方案。
