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The effect of laparoscopic instrument working angle on surgeons' upper extremity workload
R Berguer1, D L Forkey, W D Smith
1School of Medicine, University of California-Davis and VA Northern California Health Care System, 150 Muir Road (112), Martinez, CA 94553, USA.
Surgical Endoscopy
|July 10, 2001
Summary
Extreme horizontal or vertical instrument angles in laparoscopic surgery increase surgeon muscle workload. Surgeons should optimize trocar placement to minimize awkward hand positions, reducing strain on forearm and shoulder muscles.
Area of Science:
- Surgical Ergonomics
- Musculoskeletal Biomechanics
- Minimally Invasive Surgery
Background:
- Laparoscopic surgery, while patient-friendly, poses ergonomic challenges for surgeons.
- Fixed trocar positions can force surgeons into awkward working angles, increasing physical demand.
Purpose of the Study:
- To investigate the impact of horizontal and vertical instrument working angles on surgeon muscle activity.
- To quantify the workload on thumb, forearm, and shoulder muscles during laparoscopic tasks.
Main Methods:
- Electromyography (EMG) recorded muscle activity from thenar, flexor digitorum superficialis, and deltoid muscles.
- Surgeons performed a standardized task with instruments angled at various horizontal (15-75°) and vertical (15-75°) positions.
- Statistical analysis used ANOVA to determine significance of angle variations.
Main Results:
- Horizontal angulation >45° significantly increased workload in flexor digitorum superficialis and deltoid muscles.
- Vertical angulation >45° also significantly increased deltoid muscle workload.
- Thenar muscle activity was unaffected by instrument working angles.
Conclusions:
- Laparoscopic instrument angulation significantly impacts surgeon musculoskeletal workload.
- Optimizing trocar placement to maintain neutral hand positions is crucial for reducing surgeon strain.
- Minimizing extreme horizontal and vertical angles can mitigate risks of musculoskeletal injury in laparoscopic surgeons.