Berguer R, Rab G T, Abu-Ghaida H, Alarcon A, Chung J
Department of Surgery University of California Davis, 4301 X Street, Sacramento, CA 95817, USA.
Surg Endosc. 1997 Feb;11(2):139-42. doi: 10.1007/s004649900316.
There is increasing recognition of surgeons' physical fatigue in the new ergonomic environment of laparoscopic surgery. The purpose of this study was to determine what the differences are in the movement of the surgeon's axial skeleton between laparoscopic and open operations.
Surgeons' body positions were recorded on videotape during four laparoscopic (LAP) and six open (OP) operations. The percent of time the head and back were in a normal, bent, or twisted position as well as the number of changes in head and back position were tabulated using a computer program. A separate laboratory study was performed on four surgeons "walking" a 0.5-inch polyethylene tubing forward and backward using laparoscopic and open techniques. The movements of the surgeons' head, trunk, and pelvis were measured using a three-camera kinematic system (Kin). The center of pressure was recorded using a floor-mounted forceplate (Fp).
In the operating room surgeons' head and back positions were more often straight in laparoscopic procedures and more often bent in open operations. The number of changes in back position per minute were significantly decreased when the laparoscopic-only part of surgery was analyzed. In the laboratory the subjects' head position was significantly (p = 0.02) more upright and the anteroposterior (AP) and rotational range of motion of the head was significantly reduced during laparoscopy. Subjects' CP was more anterior and there was a significant reduction in the AP range of motion of the CP during laparoscopy.
Our study suggests that surgeons exhibit decreased mobility of the head and back and less anteroposterior weight shifting during laparoscopic manipulations despite a more upright posture. This more restricted posture during laparoscopic surgery may induce fatigue by limiting the natural changes in body posture that occur during open surgery.
在腹腔镜手术这种新的人体工程学环境中，外科医生的身体疲劳问题日益受到关注。本研究的目的是确定腹腔镜手术和开放手术中外科医生轴向骨骼运动的差异。
在4例腹腔镜手术（LAP）和6例开放手术（OP）过程中，用录像带记录外科医生的身体位置。使用计算机程序将头部和背部处于正常、弯曲或扭转位置的时间百分比以及头部和背部位置的变化次数制成表格。对4名外科医生分别进行一项单独的实验室研究，他们使用腹腔镜技术和开放技术向前和向后“推送”一根0.5英寸的聚乙烯管。使用三摄像头运动学系统（Kin）测量外科医生头部、躯干和骨盆的运动。使用安装在地面的测力板（Fp）记录压力中心。
在手术室中，腹腔镜手术过程中外科医生的头部和背部位置更常保持挺直，而开放手术中则更常弯曲。当仅分析手术的腹腔镜部分时，每分钟背部位置的变化次数显著减少。在实验室中，腹腔镜检查期间受试者的头部位置明显更直立（p = 0.02），头部的前后（AP）和旋转运动范围显著减小。受试者的压力中心更靠前，并且在腹腔镜检查期间压力中心的AP运动范围显著减小。
我们的研究表明，尽管腹腔镜操作时姿势更挺直，但外科医生在腹腔镜操作过程中头部和背部的活动度降低，前后重量转移减少。腹腔镜手术中这种更受限的姿势可能会限制开放手术中自然发生的身体姿势变化，从而导致疲劳。
