Steinhilber Benjamin, Seibt Robert, Reiff Florian, Rieger Monika A, Kraemer Bernhard, Rothmund Ralf
Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany.
Department of Gyneacological and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany.
Surg Endosc. 2016 Jan;30(1):78-88. doi: 10.1007/s00464-015-4164-3. Epub 2015 Apr 1.
To investigate the effect of a pistol grip laparoscopic instrument with a rotatable handle piece (rot-HP) on biomechanical stress and precision as well as a possible interaction between the instrument and working height (WH).
Biomechanical stress induced by laparoscopic surgery (LS) is associated with work-related upper limb musculoskeletal disorders in surgeons. Ergonomic handle designs of laparoscopic instruments may reduce the risk of musculoskeletal disorders.
Without LS experience, 57 healthy subjects (30 women; 27 men, median age: 26) were observed while performing a laparoscopic exercise. Subjects had to pick up coloured pins and place them into a colour-coded wooden set-up inside a pelvitrainer. The exercise was performed at two WHs using the rot-HP and a standard laparoscopic (fixed) handle piece in randomized sequence. Biomechanical stress was monitored via surface electromyography (sEMG) on fife muscles from the upper limb and shoulder region. Further, the wrist angle (palmar and dorsi flexion) and posture of the dominant upper arm were recorded. Precision was assessed using the number of validly placed pins and process time.
sEMG parameters and upper arm postures indicated no differences in biomechanical stress related to either laparoscopic handle piece. The higher WH was associated with higher trapezius and deltoid activity and elevated arm postures (p < 0.05). Neutral wrist positions were more frequent using the rot-HP, and the lower WH resulted in slightly more neutral wrist positions. Precision was similar during all experimental conditions.
The rot-HP did not decrease biomechanical stress in the shoulder or lower arm muscles. However, wrist angle position may be optimized without affecting precision. Long-term effects of the rot-HP on preventing complaints of the upper extremity should be evaluated. Low WH is recommended to reduce biomechanical stress in the shoulder during laparoscopic surgery.
研究一种带有可旋转手柄部件（rot-HP）的手枪式握把腹腔镜器械对生物力学应力和精准度的影响，以及该器械与工作高度（WH）之间可能存在的相互作用。
腹腔镜手术（LS）所引发的生物力学应力与外科医生工作相关的上肢肌肉骨骼疾病有关。腹腔镜器械的人体工程学手柄设计可能会降低肌肉骨骼疾病的风险。
在57名无腹腔镜手术经验的健康受试者（30名女性；27名男性，中位年龄：26岁）进行腹腔镜练习时对其进行观察。受试者必须拿起彩色别针并将其放入骨盆训练器内按颜色编码的木制装置中。该练习使用rot-HP和标准腹腔镜（固定）手柄部件，以随机顺序在两个工作高度下进行。通过表面肌电图（sEMG）监测上肢和肩部区域五块肌肉的生物力学应力。此外，记录手腕角度（掌屈和背屈）以及优势上臂的姿势。使用正确放置的别针数量和操作时间来评估精准度。
sEMG参数和上臂姿势表明，与任何一种腹腔镜手柄部件相关的生物力学应力均无差异。较高的工作高度与斜方肌和三角肌的活动增加以及手臂姿势升高有关（p < 0.05）。使用rot-HP时，手腕更常处于中立位置，较低的工作高度导致手腕中立位置略多。在所有实验条件下，精准度相似。
rot-HP并未降低肩部或下臂肌肉的生物力学应力。然而，在不影响精准度的情况下，手腕角度位置可能会得到优化。rot-HP对预防上肢不适的长期影响应予以评估。建议在腹腔镜手术期间采用较低的工作高度以降低肩部的生物力学应力。
