Walczak Dominik A, Pawełczak Dariusz, Piotrowski Piotr, Trzeciak Piotr W, Jędrzejczyk Adam, Pasieka Zbigniew
Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland ; Department of Experimental Surgery, Medical University of Lodz, Lodz, Poland.
Department of Experimental Surgery, Medical University of Lodz, Lodz, Poland.
Wideochir Inne Tech Maloinwazyjne. 2015 Apr;10(1):87-91. doi: 10.5114/wiitm.2014.47434. Epub 2014 Dec 4.
During laparoscopy, the monitor is usually placed near the operating table, at eye level, which significantly affects hand-eye coordination. First, it is impossible for the surgeon to simultaneously observe the operative field and hand movement. Second, the axis of view of the endoscope rarely matches the natural axis of the surgeon's sight: it resembles a direct view into the operative field. Finally, as the arms of the tools act as levers with a fulcrum at the site of the skin incision, the action of the tool handles is a mirror image of the movement of the tool tips seen on the monitor. Studies have shown that a neutral position with the head flexed at 15-45° is the most ergonomically suitable.
To evaluate whether the level of monitor placement exerts an influence on laparoscopic performance.
A group of 52 students of medicine were asked to pass a thread through 9 holes of different sizes, placed at different levels and angles, using a self-made laparoscopic simulator. Each student performed the task four times in two monitor positions: at eye level, and placed on a simulator. The order of monitor placement was randomized.
The task was performed more quickly when the monitor was placed on the simulator and the sight was forced downwards. Lower placement was also found to be more beneficial for students with experience in laparoscopy.
New technologies which place the display on the patient, thus improving the ergonomics of the operation, should be developed.
在腹腔镜手术过程中，监视器通常放置在手术台附近，与眼睛平齐，这会显著影响手眼协调。首先，外科医生无法同时观察手术区域和手部动作。其次，内窥镜的视野轴很少与外科医生的自然视线轴匹配：它类似于直接看向手术区域。最后，由于工具的臂在皮肤切口处充当杠杆，工具手柄的动作是监视器上看到的工具尖端运动的镜像。研究表明，头部弯曲15 - 45°的中立位置在人体工程学上最为合适。
评估监视器放置高度是否会对腹腔镜手术操作产生影响。
让一组52名医学专业学生使用自制的腹腔镜模拟器，将线穿过9个大小不同、位于不同高度和角度的孔。每个学生在两个监视器位置各执行该任务4次：与眼睛平齐，以及放置在模拟器上。监视器放置顺序随机。
当监视器放置在模拟器上且视线被迫向下时，任务完成得更快。还发现较低的放置位置对有腹腔镜手术经验的学生更有益。
应开发将显示器放置在患者身上的新技术，从而改善手术的人体工程学。
