Fan Yu, Kong Gaiqing, Meng Yisen, Tan Shutao, Wei Kunlin, Zhang Qian, Jin Jie
Urology Department and Institute of Urology, Peking University First Hospital, Peking University, Beijing, 100034, China,
Surg Endosc. 2014 Nov;28(11):3249-56. doi: 10.1007/s00464-014-3598-3. Epub 2014 Jun 14.
Flank position is extensively used in retroperitoneoscopic urological practice. Most surgeons follow the patients' position in open approaches. However, surgical ergonomics of the conventional position in the retroperitoneoscopic surgery is poor. We introduce a modified position and evaluated task performance and surgical ergonomics of both positions with simulated surgical tasks.
Twenty-one novice surgeons were recruited to perform four tasks: bead transfer, ring transfer, continuous suturing, and cutting a circle. The conventional position was simulated by setting an endo-surgical simulator parallel to the long axis of a surgical desk. The modified position was simulated by rotating the simulator 30° with respect to the long axis of the desk. The outcome measurements include task performance measures, kinematic measures for body alignment, surface electromyography, relative loading between feet, and subjective ratings of fatigue.
We observed significant improvements in both task performance and surgical ergonomics parameters under the modified position. For all four tasks, subjects finished tasks faster with higher accuracy (p < 0.005 or < 0.001). For ergonomics part: (1) The angle between the upper body and the head was decreased by 7.4 ± 1.7°; (2) The EMG amplitude collected from shoulders and left lumber was significantly lower (p < 0.05); (3) Relative loading between feet was more balanced (p < 0.001); (4) Manual-action muscles and postural muscles are rated less fatiguing according to the questionnaire (p < 0.05).
Conventional position of patient in retroperitoneoscopic upper urinary tract surgery is associated with poor surgical ergonomics. With a simulated surgery, we demonstrated that our modified position could significantly improve task performance and surgical ergonomics. Further studies are still warranted to validate these benefits for both patients and surgeons.
侧卧位在泌尿外科后腹腔镜手术中广泛应用。大多数外科医生在开放手术中遵循患者的体位。然而，后腹腔镜手术中传统体位的手术人体工程学较差。我们引入了一种改良体位，并通过模拟手术任务评估了两种体位的任务表现和手术人体工程学。
招募21名新手外科医生进行四项任务：珠子转移、环转移、连续缝合和环切。通过将内窥镜手术模拟器设置为与手术台的长轴平行来模拟传统体位。通过将模拟器相对于手术台的长轴旋转30°来模拟改良体位。结果测量包括任务表现测量、身体对齐的运动学测量、表面肌电图、双脚之间的相对负荷以及疲劳的主观评分。
我们观察到改良体位下任务表现和手术人体工程学参数均有显著改善。对于所有四项任务，受试者完成任务更快且准确率更高（p < 0.005或< 0.001）。在人体工程学方面：（1）上半身与头部之间的角度减小了7.4±1.7°；（2）从肩部和左腰部采集的肌电图振幅显著降低（p < 0.05）；（3）双脚之间的相对负荷更加平衡（p < 0.001）；（4）根据问卷，手动动作肌肉和姿势肌肉的疲劳程度较低（p < 0.05）。
后腹腔镜上尿路手术中患者的传统体位与较差的手术人体工程学相关。通过模拟手术，我们证明改良体位可显著改善任务表现和手术人体工程学。仍需进一步研究以验证对患者和外科医生的这些益处。
