Karim Md Rezaul, Kim Sola, Islam Rafiza, Kong Amos, Patel Bijendra
Department of Surgery, The Royal London Hospital, London, GBR.
Department of Surgical Science, Barts Cancer Institute, Queen Mary University of London, London, GBR.
Cureus. 2024 Dec 20;16(12):e76107. doi: 10.7759/cureus.76107. eCollection 2024 Dec.
Laparoscopic surgery has now become the gold standard in managing most surgical cases. Despite its advantages, working hours and in-theatre training restrictions have prompted trainees to explore alternatives like virtual reality (VR) simulations and box training. Furthermore, given the increased frequency of minimally invasive surgery and the prevalence of musculoskeletal issues among surgeons, there's a growing effort to optimize ergonomics. There is currently a lack of focus on ergonomics in training, prompting our study to inspect VR and box training's ergonomic outcomes and their impact on task performance. This systematic review was conducted at Barts Cancer Institute, Queen Mary University, from January 27, 2024, to April 22, 2024. Multiple databases were searched electronically from January 1980 to March 2024, including only articles that utilized electromyography (EMG) or the NASA Task Load Index (NASA-TLX) to measure ergonomics. Two reviewers independently conducted eligibility assessment, data extraction, and risk of bias evaluation, with discrepancies resolved through consensus discussions. Ultimately, 12 studies were selected. EMG results indicated a higher %MVC (maximum voluntary contraction) in box training in poor ergonomic settings and a negative correlation between skills and muscle activity. Both modalities showed a significant decrease in NASA-TLX scores after training on the simulators and when comparing novice and experienced surgeons. Furthermore, a reduction in physical demand and improved task performance was observed, with significant differences found between experts and novices in a VR appendicectomy scenario. This systematic review reveals reduced muscle activity and physical demand among trained individuals in laparoscopic surgery with both box trainers and VR simulators, emphasizing the importance of addressing ergonomic considerations. To advance our understanding of surgical ergonomics, the standardization of measurement methods and higher-quality evidence, particularly through randomized controlled trials, are recommended.
腹腔镜手术现已成为大多数外科病例管理的金标准。尽管它有诸多优点，但工作时长和手术室培训限制促使实习生探索虚拟现实（VR）模拟和箱式训练等替代方案。此外，鉴于微创手术频率增加以及外科医生中肌肉骨骼问题的普遍存在，人们越来越努力优化人体工程学。目前培训中缺乏对人体工程学的关注，促使我们的研究考察VR和箱式训练的人体工程学效果及其对任务表现的影响。本系统评价于2024年1月27日至4月22日在玛丽女王大学巴茨癌症研究所进行。从1980年1月至2024年3月对多个数据库进行了电子检索，仅纳入使用肌电图（EMG）或美国国家航空航天局任务负荷指数（NASA - TLX）来测量人体工程学的文章。两名评审员独立进行资格评估、数据提取和偏倚风险评估，分歧通过共识讨论解决。最终，选取了12项研究。EMG结果表明，在人体工程学环境较差的箱式训练中，%MVC（最大自主收缩）较高，且技能与肌肉活动之间呈负相关。两种方式在模拟器上训练后以及比较新手和经验丰富的外科医生时，NASA - TLX评分均显著降低。此外，观察到体力需求减少且任务表现有所改善，在VR阑尾切除场景中，专家和新手之间存在显著差异。本系统评价揭示，使用箱式训练器和VR模拟器进行腹腔镜手术训练的个体肌肉活动和体力需求均有所减少，强调了考虑人体工程学因素的重要性。为了增进我们对外科人体工程学的理解，建议标准化测量方法并提供更高质量的证据，特别是通过随机对照试验。
