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Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training
M Susan Hallbeck1, Bethany R Lowndes2, Bernadette McCrory3
1Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Surgery, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA.
Abstract:
While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.