Department of Surgery, Meander Medical Center, Maatweg 3, 3818 TZ, Amersfoort, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Surg Endosc. 2018 May;32(5):2533-2540. doi: 10.1007/s00464-017-5959-1. Epub 2017 Dec 20.
BACKGROUND/AIM: Training in robot-assisted surgery focusses mainly on technical skills and instrument use. Training in optimal ergonomics during robotic surgery is often lacking, while improved ergonomics can be one of the key advantages of robot-assisted surgery. Therefore, the aim of this study was to assess whether a brief explanation on ergonomics of the console can improve body posture and performance.
A comparative study was performed with 26 surgical interns and residents using the da Vinci skills simulator (Intuitive Surgical, Sunnyvale, CA). The intervention group received a compact instruction on ergonomic settings and coaching on clutch usage, while the control group received standard instructions for usage of the system. Participants performed two sets of five exercises. Analysis was performed on ergonomic score (RULA) and performance scores provided by the simulator. Mental and physical load scores (NASA-TLX and LED score) were also registered.
The intervention group performed better in the clutch-oriented exercises, displaying less unnecessary movement and smaller deviation from the neutral position of the hands. The intervention group also scored significantly better on the RULA ergonomic score in both the exercises. No differences in overall performance scores and subjective scores were detected.
The benefits of a brief instruction on ergonomics for novices are clear in this study. A single session of coaching and instruction leads to better ergonomic scores. The control group showed often inadequate ergonomic scores. No significant differences were found regarding physical discomfort, mental task load and overall performance scores.
背景/目的：机器人辅助手术的培训主要侧重于技术技能和器械使用。机器人手术中的最佳人体工程学培训往往缺乏，而改善人体工程学可以是机器人辅助手术的关键优势之一。因此，本研究的目的是评估在控制台进行简短的人体工程学讲解是否可以改善手术者的姿势和表现。
本研究采用达芬奇技能模拟器（Intuitive Surgical，Sunnyvale，CA）对 26 名外科实习医生和住院医师进行了一项比较研究。干预组接受了关于控制台人体工程学设置的简明说明和离合器使用方面的指导，而对照组接受了系统使用的标准说明。参与者完成了两组共 5 个练习。对模拟器提供的人体工程学评分（RULA）和表现评分进行了分析。还记录了精神和身体负荷评分（NASA-TLX 和 LED 评分）。
干预组在离合器导向练习中表现更好，显示出较少的不必要动作和手部偏离中立位置的幅度较小。干预组在两个练习中的 RULA 人体工程学评分也明显更好。在整体表现评分和主观评分方面未发现差异。
本研究清楚地表明，对于新手来说，进行简短的人体工程学讲解是有益的。单次指导和教学可带来更好的人体工程学评分。对照组通常显示出不适当的人体工程学评分。在身体不适、精神任务负荷和整体表现评分方面未发现显著差异。
