手持和机器人辅助摄像控制中的工效学：一项随机对照试验。
Ergonomics in handheld and robot-assisted camera control: a randomized controlled trial.
机构信息
Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.
Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
出版信息
Surg Endosc. 2019 Dec;33(12):3919-3925. doi: 10.1007/s00464-019-06678-1. Epub 2019 Feb 11.
BACKGROUND
Laparoscopic surgery potentially increases the physical burden to operating theater personnel and can cause physical discomfort. This study aims to evaluate if a robotic camera holder (AutoLap™ system) can improve ergonomics for the surgeon and the camera assistant during laparoscopic procedures.
METHODS
A total of thirty cases were included and randomized (15 AutoLap™, 15 control). Five types of surgery were included: right hemicolectomy, fundoplication, sigmoid resection, rectopexy, and low anterior resection. The posture of the surgeon and assistant was photographed during predefined steps of the procedure. MATLAB was used to calculate angles relevant for the RULA score. The RULA score is a validated method to evaluate body posture, force and repetition of the upper extremities. Two investigators assessed the RULA score independently. Three subjective questionnaires (SMEQ, NASA TLX, and LED) were used to assess mental and physical discomfort.
RESULTS
No differences in patient characteristics were observed. Sixteen fundoplications, seven right hemicolectomies, five sigmoid resections, one rectopexy, and one low anterior resection were included. The mean RULA score of the surgeon was comparable in both groups, 2.58 (AutoLap™) versus 2.72 (control). The mean RULA score of the assistant was significantly different in both groups, with 2.55 (AutoLap™) versus 3.70 (control) (p = 0.001). The inter-observer variability (ICC) was excellent with 0.93 (surgeon) and 0.97 (assistant). The questionnaires showed a significant difference in physical discomfort for the assistant. The LED and SMEQ score were significantly lower in the robotic group. The NASA TLX demonstrated a significant reduction in scores in all domains when using robotics with the exception of the mental domain.
CONCLUSION
Use of the AutoLap™ system shows improvement in ergonomics and posture of the first assistant, and ergonomics of the surgeon are not affected. Furthermore, the subjective work load is significantly reduced by using a robotic camera holder.
TRIAL REGISTRATION NUMBER
NCT0339960, https://clinicaltrials.gov/ct2/show/study/NCT03339960?term=autolap&rank=5 .
背景
腹腔镜手术可能会增加手术室人员的体力负担，并导致身体不适。本研究旨在评估机器人摄像器固定架（AutoLap™系统）是否可以改善腹腔镜手术中外科医生和摄像助手的人体工程学。
方法
共纳入 30 例患者，并进行随机分组（15 例 AutoLap™，15 例对照组）。纳入 5 种手术类型：右半结肠切除术、胃底折叠术、乙状结肠切除术、直肠固定术和低位前切除术。在手术的预定步骤中拍摄外科医生和助手的姿势照片。使用 MATLAB 计算与 RULA 评分相关的角度。RULA 评分是一种经过验证的方法，可用于评估上肢的姿势、力量和重复度。两名研究人员独立评估 RULA 评分。使用三个主观问卷（SMEQ、NASA TLX 和 LED）评估精神和身体不适。
结果
患者特征无差异。纳入 16 例胃底折叠术、7 例右半结肠切除术、5 例乙状结肠切除术、1 例直肠固定术和 1 例低位前切除术。两组外科医生的平均 RULA 评分相当，分别为 2.58（AutoLap™）和 2.72（对照组）。两组助手的平均 RULA 评分差异显著，分别为 2.55（AutoLap™）和 3.70（对照组）（p=0.001）。观察者间变异系数（ICC）为 0.93（外科医生）和 0.97（助手），极好。问卷显示助手的身体不适有显著差异。机器人组的 LED 和 SMEQ 评分明显较低。NASA TLX 显示除精神领域外，使用机器人时所有领域的评分均显著降低。
结论
使用 AutoLap™系统可改善第一助手的人体工程学和姿势，且外科医生的人体工程学不受影响。此外，使用机器人摄像器固定架可显著降低主观工作负荷。
试验注册号
NCT0339960，https://clinicaltrials.gov/ct2/show/study/NCT03339960?term=autolap&rank=5。
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