Ergonomics in Laparoscopic Box Training and Virtual Reality (VR) Simulations: A Systematic Review

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Human Factors and Ergonomics

Background:

• Laparoscopic surgery is the standard of care, but training faces restrictions.
• Surgeons experience musculoskeletal issues, necessitating ergonomic optimization.
• Current surgical training lacks focus on ergonomic outcomes.

Purpose of the Study:

• To systematically review the ergonomic outcomes of virtual reality (VR) and box training.
• To assess the impact of these training modalities on surgical task performance.
• To investigate ergonomic considerations in laparoscopic surgical training.

Main Methods:

• Systematic review of studies from January 1980 to March 2024.
• Inclusion criteria: studies using electromyography (EMG) or NASA Task Load Index (NASA-TLX) for ergonomics.
• Data extraction and risk of bias assessment by two independent reviewers.

Main Results:

• Box training showed higher %MVC in poor ergonomic settings; negative skill-muscle activity correlation.
• Both VR and box training significantly decreased NASA-TLX scores.
• Reduced physical demand and improved task performance observed; experts outperformed novices in VR appendicectomy.

Conclusions:

• VR simulators and box trainers reduce muscle activity and physical demand in laparoscopic surgery training.
• Ergonomic considerations are crucial for effective surgical simulation.
• Standardized methods and high-quality evidence (RCTs) are needed to advance surgical ergonomics research.