Skip to main content
SpringerLink
Log in

The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic surgery presents multiple ergonomic difficulties for the surgeon, requiring awkward body postures and prolonged static muscle loading that increases risk of musculoskeletal strain and injury. This prospective study quantitatively measures the biomechanical movements of surgeons during laparoscopic procedures to determine at-risk movements from prolonged static muscle loading and repetitive motions that may lead to injury.

Methods

A total of 150 video recordings of 18 surgeons, standing at the patient’s left, were captured from three fixed camera positions during live gynecological laparoscopic surgery. Postoperative processing quantified surgeon movements at the neck, shoulders and elbows using computer software to measure extreme joint angles and time spent within defined joint angle ranges.

Results

Surgeons spent a median of 98 % (range 77–100 %) of surgical time with their neck rotated at 21° (range 0°–52°). The non-dominant arm was subjected to more extreme positions for significantly longer periods of time compared to the dominant, with shoulder flexion at 45°–90° for 35 vs. 0 % (p < 0.001) and elbow flexion at >120° for 31 vs. 0 % (p < 0.001) of total surgical time. Procedures involving power morcellation required significantly greater number of instrument insertion/removals—119 (range 56–182) compared with 12 (range 2–122) when morcellation was not used (p < 0.001). Shorter surgeons maintained significantly greater degrees of neck rotation when viewing the monitor (p < 0.003) and surgeons with shorter arm lengths spent longer in extreme positions with their non-dominant shoulder at >90° (p = 0.04) and elbow at >120° (p < 0.001) compared with taller surgeons. No significant correlations were found between BMI or surgical experience and more extreme joint positions.

Conclusions

Four primary areas have been identified where surgeons are consistently demonstrating movements that increase their risk of harm: (1) extended periods of neck rotation; (2) asymmetrical loading between the dominant and non-dominant shoulders; (3) power morcellation and frequent insertions/removals of laparoscopic instruments resulting in repetitions of the most extreme shoulder positions and (4) a negative correlation between height and percentage time spent in more extreme positions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Van Det MJ, Meijerink WJ, Hoff C, Totte ER, Pierie JP (2009) Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 23:1279–1285

    Article  PubMed  Google Scholar 

  2. Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC (2009) Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil 19:175–184

    Article  PubMed  Google Scholar 

  3. Albayrak A, Van Veelen MA, Prins JF, Snijders CJ, De Ridder H, Kazemier G (2007) A newly designed ergonomic body support for surgeons. Surg Endosc 21:1835–1840

    Article  CAS  PubMed  Google Scholar 

  4. Berguer R (1998) Surgical technology and the ergonomics of laparoscopic instruments. Surg Endosc 12:458–462

    Article  CAS  PubMed  Google Scholar 

  5. Reddy PP, Reddy TP, Roig-Francoli J, Cone L, Sivan B, Defoor WR, Gaitonde K, Noh PH (2011) The impact of the alexander technique on improving posture and surgical ergonomics during minimally invasive surgery: pilot study. J Urol 186:1658–1662

    Article  PubMed  Google Scholar 

  6. Berguer R, Forkey DL, Smith WD (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13:466–468

    Article  CAS  PubMed  Google Scholar 

  7. Wauben LSGL, Veelen MA, Gossot D, Goossens RHM (2006) Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc Other Interv Techn 20:1268–1274

    Article  CAS  Google Scholar 

  8. Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D (2010) Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg 210:306–313

    Article  PubMed  Google Scholar 

  9. Miller K, Benden M, Pickens A, Shipp E, Zheng Q (2012) Ergonomics principles associated with laparoscopic surgeon injury/illness. Hum Factors 54:1087–1092

    Article  PubMed  Google Scholar 

  10. Cass GK, Vyas S, Akande V (2014) Prolonged laparoscopic surgery is associated with an increased risk of vertebral disc prolapse. J Obstet Gynaecol 34:74–78

    Article  CAS  PubMed  Google Scholar 

  11. Reyes DA, Tang B, Cuschieri A (2006) Minimal access surgery (MAS)-related surgeon morbidity syndromes. Surg Endosc 20:1–13

    Article  CAS  PubMed  Google Scholar 

  12. Aitchison LP, Flint J, Nesbitt-Hawes E, Ledger W, Abbott J (2015) A feasibility study determining surgical ergonomics in a live surgical setting. J Minim Invasive Gynecol 22:626–630

    Article  PubMed  Google Scholar 

  13. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum, New Jersey

    Google Scholar 

  14. Mcdonald ME, Ramirez PT, Munsell MF, Greer M, Burke WM, Naumann WT, Frumovitz M (2014) Physician pain and discomfort during minimally invasive gynecologic cancer surgery. Gynecol Oncol 134:243–247

    Article  PubMed  PubMed Central  Google Scholar 

  15. Esposito C, El Ghoneimi A, Yamataka A, Rothenberg S, Bailez M, Ferro M, Gamba P, Castagnetti M, Mattioli G, Delagausie P, Antoniou D, Montupet P, Marte A, Saxena A, Bertozzi M, Philippe P, Varlet F, Lardy H, Caldamone A, Settimi A, Pelizzo G, Becmeur F, Escolino M, De Pascale T, Najmaldin A, Schier F (2013) Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg 48:1750–1756

    Article  PubMed  Google Scholar 

  16. Matern U, Waller P (1999) Instruments for minimally invasive surgery: principles of ergonomic handles. Surg Endosc 13:174–182

    Article  CAS  PubMed  Google Scholar 

  17. Ng JKF, Richardson CA, Parnianpour M, Kippers V (2002) EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls. J Orthop Res 20:112–121

    Article  PubMed  Google Scholar 

  18. Kelsey JL, Githens PB, White AA III, Holford TR, Walter SD, Oconnor T, Ostfeld AM, Weil U, Southwick WO, Calogero JA (1984) An epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc. J Orthop Res 2:61–66

    Article  CAS  PubMed  Google Scholar 

  19. Pope MH, Goh KL, Magnusson ML (2002) Spine ergonomics. Ann Rev Biochem 4:49–68

    CAS  Google Scholar 

  20. Zehetner J, Kaltenbacher A, Wayand W, Shamiyeh A (2006) Screen height as an ergonomic factor in laparoscopic surgery. Surg Endosc Other Interv Techn 20:139–141

    Article  CAS  Google Scholar 

  21. Matern U, Faist M, Kehl K, Giebmeyer C, Buess G (2005) Monitor position in laparoscopic surgery. Surg Endosc Other Interv Techn 19:436–440

    Article  CAS  Google Scholar 

  22. Hanna GB, Shimi SM, Cuschieri A (1998) Task performance in endoscopic surgery is influenced by location of the image display. Ann Surg 227:481–484

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Vereczkei A, Feussner H, Negele T, Fritzsche F, Seitz T, Bubb H, Horvath OP (2004) Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy. Surg Endosc 18:1118–1122

    Article  CAS  PubMed  Google Scholar 

  24. Matern U, Waller P, Giebmeyer C, Ruckauer KD, Farthmann EH (2001) Ergonomics: requirements for adjusting the height of laparoscopic operating tables. JSLS 5:7–12

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Marras WS, Lavender SA, Leurgans SE, Rajulu SL, Allread WG, Fathallah FA, Ferguson SA (1993) The role of dynamic three-dimensional trunk motion in occupationally-related low back disorders: the effects of workplace factors, trunk position, and trunk motion characteristics on risk of injury. Spine 18:617–628

    Article  CAS  PubMed  Google Scholar 

  26. Van Veelen MA, Kazemier G, Koopman J, Goossens RH, Meijer DW (2002) Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech A 12:47–52

    Article  PubMed  Google Scholar 

  27. Wolf JM, Williams AE, Delaronde S, Leger R, Clifton KB, King KB (2013) Relationship of serum relaxin to generalized and trapezial–metacarpal joint laxity. J Hand Surg 38:721–728

    Article  Google Scholar 

  28. Aldabe D, Ribeiro D, Milosavljevic S, Dawn Bussey M (2012) Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J 21:1769–1776

    Article  PubMed  PubMed Central  Google Scholar 

  29. Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J (1997) A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc 11:139–142

    Article  CAS  PubMed  Google Scholar 

  30. Matern U (2009) Ergonomic deficiencies in the operating room: examples from minimally invasive surgery. Work 33:165–168

    PubMed  Google Scholar 

Download references

Acknowledgments

This research was funded in part by an unrestricted educational grant from AGES Society (The Australasian Gynaecological Endoscopy and Surgical Society) through a competitive grant process.

Author information

Authors and Affiliations

  1. University of New South Wales, Sydney, Australia

    Lucy Ping Aitchison, Cathy Kexin Cui, Amy Arnold, Erin Nesbitt-Hawes & Jason Abbott

  2. The Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia

    Amy Arnold, Erin Nesbitt-Hawes & Jason Abbott

  3. Prince of Wales Private Hospital, Sydney, Australia

    Erin Nesbitt-Hawes & Jason Abbott

Authors
  1. Lucy Ping Aitchison
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cathy Kexin Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amy Arnold
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erin Nesbitt-Hawes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason Abbott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason Abbott.

Ethics declarations

Disclosures

Lucy Ping Aitchison, Cathy Kexin Cui, Dr Amy Arnold, Dr Erin Nesbitt-Hawes and Associate Professor Jason Abbott have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aitchison, L.P., Cui, C.K., Arnold, A. et al. The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments. Surg Endosc 30, 5068–5076 (2016). https://doi.org/10.1007/s00464-016-4855-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4855-4

Keywords

Search

Navigation