Marçon Baptiste, Ngueyon Sime Willy, Guillemin Francis, Hubert Nicolas, Lagrange François, Huselstein Céline, Hubert Jacques
Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, France.
Clinical Epidemiology Center Inserm CIC-EC 1433, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54505, France.
Res Rep Urol. 2019 Sep 27;11:261-268. doi: 10.2147/RRU.S220219. eCollection 2019.
Open surgery is increasingly being replaced by laparoscopic approaches that are more demanding for the surgical team. The physical and mental workload of these approaches have not been quantified.
A multicenter prospective study was performed evaluating the physical and mental stresses of 4 surgical approaches (open surgery [OS], standard laparoscopy [SL], hand-assisted laparoscopy [HAL], and robot-assisted laparoscopy [RAL]) for donor nephrectomy for the surgeon and their assistant. The Borg Scale was used to evaluate exertion in different body parts every 30 mins during surgery and the NASA-TLX score was used to evaluate overall workload.
264 nephrectomies were performed over a 33-month period and 258 questionnaires evaluating these surgeries were obtained. Surgeons experienced less left shoulder and arm exertion and left forearm and hand exertion, but greater lower back exertion, as measured by the Borg scale, with RAL. Leg exertion was significantly greater with OS. Assistant surgeons experienced increased exertion in the back, right shoulder and arm, and right forearm and hand with RAL. NASA Task load index (TLX) surgeon scores showed mental demand was similar for all 4 surgical approaches. Physical demand was lower and overall performance was higher with RAL.
Four different nephrectomy surgical approaches were evaluated in a multicenter setting. Surgeon and assistant scores of physical exertions were generally in the "easy" range but confirmed that robotic surgery is an ergonomic progress compared to other techniques, except for the axial skeleton. Further, it degrades the working conditions for the assistant.
开放手术正越来越多地被对手术团队要求更高的腹腔镜手术方法所取代。这些手术方法的身心工作量尚未得到量化。
进行了一项多中心前瞻性研究，评估4种手术方法（开放手术[OS]、标准腹腔镜手术[SL]、手辅助腹腔镜手术[HAL]和机器人辅助腹腔镜手术[RAL]）在供体肾切除术中医师及其助手的身心压力。在手术过程中，每30分钟使用博格量表评估身体不同部位的劳累程度，并使用美国国家航空航天局任务负荷指数（NASA-TLX）评分来评估总体工作量。
在33个月的时间里共进行了264例肾切除术，并获得了258份评估这些手术的问卷。通过博格量表测量，RAL手术中医师的左肩和手臂、左前臂和手部的劳累程度较低，但下背部的劳累程度较高。OS手术中腿部的劳累程度明显更高。RAL手术中助理医师的背部、右肩和手臂以及右前臂和手部的劳累程度增加。NASA任务负荷指数（TLX）医师评分显示，所有4种手术方法的心理需求相似。RAL手术的体力需求较低，总体表现较高。
在多中心环境中评估了4种不同的肾切除术手术方法。医师和助理的体力消耗评分总体处于“轻松”范围内，但证实与其他技术相比，机器人手术在人体工程学方面取得了进步，除了轴向骨骼部分。此外，它还降低了助手的工作条件。
