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Franco-González IT, Minor-Martínez A, Ordorica-Flores RM, Sossa-Azuela JH, Pérez-Escamirosa F. Objective psychomotor laparoscopic skills evaluation using a low-cost wearable device based on accelerometry: construct and concurrent validity study. Surg Endosc 2023; 37:3280-3290. [PMID: 36890413 DOI: 10.1007/s00464-023-09953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Motion analysis of surgical maneuvers provides useful quantitative information for the objective evaluation of the surgeons. However, surgical simulation laboratories for laparoscopic training do not usually integrate devices that help quantify the level of skills of the surgeons due to their limited resources and the high costs of new technologies. The purpose of this study is to present the construct and concurrent validity of a low-cost motion tracking system, based on a wireless triaxial accelerometer, employed to objectively evaluate psychomotor skills of surgeons during laparoscopic training. METHODS An accelerometry system, a wireless three-axis accelerometer with appearance of wristwatch, was placed on the dominant hand of the surgeons to register the motion during the laparoscopy practice with the EndoViS simulator, which simultaneously recorded the motion of the laparoscopic needle driver. This study included the participation of 30 surgeons (6 experts, 14 intermediates and 10 novices) who performed the task of intracorporeal knot-tying suture. Using 11 motion analysis parameters (MAPs), the performance of each participant was assessed. Subsequently, the scores of the three groups of surgeons were statistically analyzed. In addition, a validity study was conducted comparing the metrics between the accelerometry-tracking system and the EndoViS hybrid simulator. RESULTS Construct validity was achieved for 8 of the 11 metrics examined with the accelerometry system. Concurrent validity demonstrated that there is a strong correlation between the results of the accelerometry system and the EndoViS simulator in 9 of 11 parameters, showing reliability of the accelerometry system as an objective evaluation method. CONCLUSION The accelerometry system was successfully validated. This method is potentially useful to complement the objective evaluation of surgeons during laparoscopic practice in training environments such as box-trainers and simulators.
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Affiliation(s)
- Iván Tlacaélel Franco-González
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación Y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, México
| | - Arturo Minor-Martínez
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación Y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, México.
| | - Ricardo Manuel Ordorica-Flores
- Departamento de Cirugía Endoscópica, Hospital Infantil de México Federico Gómez, Calle Dr. Márquez No. 162, Cuauhtémoc, Doctores, 06720, Ciudad de México, México
| | - Juan Humberto Sossa-Azuela
- Centro de Investigación en Computación, Instituto Politécnico Nacional, Av. Juan de Dios Bátiz S/N, Esq. Miguel Othón de Mendizábal, Col. Nueva Industrial Vallejo, 07738, Ciudad de México, México
| | - Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas Y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Circuito Exterior S/N, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, México
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Merbah J, Caré BR, Gorce P, Gadea F, Prince F. A New Approach to Quantifying Muscular Fatigue Using Wearable EMG Sensors during Surgery: An Ergonomic Case Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:1686. [PMID: 36772729 PMCID: PMC9919042 DOI: 10.3390/s23031686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Surgeons are exposed to musculoskeletal loads that are comparable to those of industrial workers. These stresses are harmful for the joints and muscles and can lead to musculoskeletal disorders (MSD) and working incapacity for surgeons. In this paper, we propose a novel ergonomic and visualization approach to assess muscular fatigue during surgical procedures. (2) Methods: The activity of eight muscles from the shoulder girdle and the cervical/lumbar spines were evaluated using position and electromyographic wearable sensors while a surgeon performed an arthroscopic rotator-cuff surgery on a patient. The time and frequency-domain variables of the root-mean-square amplitude and mean power frequency, respectively, were calculated from an electromyographic signal. (3) Results: The entire surgical procedure lasted 73 min and was divided into 10 sub-phases associated with specific level of muscular activity and fatigue. Most of the muscles showed activity above 60%, while the middle trapezius muscles were almost constantly activated (>20%) throughout the surgical procedure. (4) Conclusion: Wearable sensors can be used during surgical procedure to assess fatigue. Periods of low-to-high activity and fatigue can be evaluated and visualized during surgery. Micro-breaks throughout surgical procedures are suggested to avoid fatigue and to prevent the risk of developing MSD.
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Affiliation(s)
- Johan Merbah
- International Institute of Biomechanics and Occupational Ergonomics, 83400 Hyères, France
| | | | - Philippe Gorce
- International Institute of Biomechanics and Occupational Ergonomics, 83400 Hyères, France
- International Institute of Biomechanics and Occupational Ergonomics, Université de Toulon, STAPS, CS60584, 83041 Toulon, France
| | - François Gadea
- International Institute of Biomechanics and Occupational Ergonomics, 83400 Hyères, France
| | - François Prince
- International Institute of Biomechanics and Occupational Ergonomics, 83400 Hyères, France
- Département de Chirurgie, Faculté de Médecine, Université de Montréal, Montréal, QC H3C 3J7, Canada
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:916-923. [PMID: 36175710 DOI: 10.1245/s10434-022-12548-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard laparoscopy (SL) is responsible for musculoskeletal disorders in surgeons because of poor ergonomic positions, which could be reduced by robot-assisted laparoscopy (RAL) owing to the surgeons' seated position. One of the aims of the ROBOGYN-1004 study (NCT01247779) was to evaluate surgeons' workloads during real-time procedures of gynecological oncological surgery. METHODS Patients with gynecological cancer eligible for minimally invasive surgery were recruited from 13 French centers between December 2010 and December 2015. Physical workload was evaluated using the Borg scale every hour over the surgery duration and the perception of workload evaluated using NASA-TLX at the end of surgery. RESULTS A total of 369 patients were recruited, of whom 176 underwent RAL and 193 underwent SL (per-protocol analysis). Posture during SL was significantly more challenging for all body parts except the back. There was an increase in discomfort over time (up to 4 h) for the hands and arms, neck, and legs in SL compared with RAL. Perceived physical activity and abilities were rated higher in SL than in RAL (p < 0.01), whereas perceived personal performance was higher in SL (p < 0.01). Perceived physical effort during surgery was lower in RAL than in SL. CONCLUSIONS RAL improves the perception of physical workload. Compared with SL, the perceived effort is lower in RAL regardless of the complexity of the surgery.
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Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France
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4
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The relationship between visual impairments and activity of the neck/shoulder muscles among surgeons during simulated surgical tasks. Surg Endosc 2022; 36:5326-5338. [PMID: 34997342 DOI: 10.1007/s00464-021-08913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Minimally Invasive Surgery (MIS) has an impact on surgeons' musculoskeletal and visual systems. However, the relationship between visual symptoms and musculoskeletal problems is not well understood. AIM OF THE STUDY This study used surface electromyography (sEMG) to examine changes in fatigue of the neck/shoulder muscles among surgeons with visual impairments when performing simulated surgical tasks in 2D and 3D viewing modes. DESIGN Cross-sectional laboratory study. METHODS Changes in median frequency (MDF, an indicator of muscle fatigue) were examined in 17 experienced gynaecologists. Four simulated surgical laparoscopy tasks were performed in 2D and 3D viewing modes. The MDF of three neck/shoulder muscles (cervical erector spinae, [CES], upper trapezii [UT], and anterior deltoids [AD]) were examined bilaterally. Visual parameters (accommodation, convergence, and stereoacuity) were measured prior to commencement. RESULTS There was a downward shift of MDF from simple to more complex tasks for the right and left CES and AD muscles but not the UT, which was consistent for surgeons with mild accommodation/convergence impairment and/or good stereoacuity. There were significant differences in the level of muscle fatigue of the neck/shoulder muscles according to the severity of visual impairment, muscle side, task and surgical performance level. CONCLUSIONS The results show a relationship between the degree of visual impairments and muscle fatigue of the neck/shoulder muscles among MIS surgeons. These findings have important implications in understanding the concurrence of musculoskeletal problems and visual symptoms.
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Gautier B, Tugal H, Tang B, Nabi G, Erden MS. Real-Time 3D Tracking of Laparoscopy Training Instruments for Assessment and Feedback. Front Robot AI 2021; 8:751741. [PMID: 34805292 PMCID: PMC8600079 DOI: 10.3389/frobt.2021.751741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Assessment of minimally invasive surgical skills is a non-trivial task, usually requiring the presence and time of expert observers, including subjectivity and requiring special and expensive equipment and software. Although there are virtual simulators that provide self-assessment features, they are limited as the trainee loses the immediate feedback from realistic physical interaction. The physical training boxes, on the other hand, preserve the immediate physical feedback, but lack the automated self-assessment facilities. This study develops an algorithm for real-time tracking of laparoscopy instruments in the video cues of a standard physical laparoscopy training box with a single fisheye camera. The developed visual tracking algorithm recovers the 3D positions of the laparoscopic instrument tips, to which simple colored tapes (markers) are attached. With such system, the extracted instrument trajectories can be digitally processed, and automated self-assessment feedback can be provided. In this way, both the physical interaction feedback would be preserved and the need for the observance of an expert would be overcome. Real-time instrument tracking with a suitable assessment criterion would constitute a significant step towards provision of real-time (immediate) feedback to correct trainee actions and show them how the action should be performed. This study is a step towards achieving this with a low cost, automated, and widely applicable laparoscopy training and assessment system using a standard physical training box equipped with a fisheye camera.
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Affiliation(s)
| | - Harun Tugal
- Heriot-Watt University, Scotland, United Kingdom
| | - Benjie Tang
- University of Dundee and Ninewells Hospital, Dundee, United Kingdom
| | - Ghulam Nabi
- University of Dundee and Ninewells Hospital, Dundee, United Kingdom
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Mietzsch S, Bergholz R, Boettcher J, Klippgen L, Wenskus J, Reinshagen K, Boettcher M. Classical but Not Rap Music Significantly Improves Transferability and Long-Term Acquisition of Laparoscopic Suturing Skills: A Randomized Controlled Trial. Eur J Pediatr Surg 2020; 30:541-547. [PMID: 31910451 DOI: 10.1055/s-0039-3401798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Acoustic distractions have been shown to increase the level of stress and workload in the operating room (OR). Noise significantly reduces surgical performance, but experienced surgeons are able to reduce the acoustic perception of their surroundings to maintain a high level of performance in complex surgical tasks. However, music has been shown to improve learning and performance of complex motor skills. The aim of this study was to evaluate the influence of music on transferability and long-term acquisition of laparoscopic suturing skills. MATERIALS AND METHODS To evaluate the effects of music on training, subjects were asked to perform four surgeon's square knots on a bowel model within 30 minutes-prior and post 3 hours of hands-on training. To examine long-term skills, the same students were asked to perform a comparable, but more complex, task (four slip knots in a model of esophageal atresia) 6 months post initial training, as a follow-up measurement. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality (Muresan scale), and laparoscopic performance (Munz checklist) were assessed. RESULTS Twenty-four students were included in the study; after simple randomization, 16 were trained while exposed to music (eight to Bach and eight to Bushido) and eight with traditional methods. Seven were lost due to follow-up. Both groups had comparable baseline characteristics and significantly improved after training, in all parameters assessed in this study. Subjects that trained with classical music were superior in terms of speed (p = 0.006), knot quality (p = 0.014), and procedural performance (p = 0.034) compared with controls. CONCLUSION Music during acquisition of complex motor skills, like laparoscopic suturing and knot tying, is superior to traditional training. Especially music considered nondisturbing significantly improved speed, knot quality, and performance. Thus, incorporation of pleasant music into surgical skills training and the OR should be considered.
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Affiliation(s)
- Stefan Mietzsch
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Bergholz
- Department of General, Visceral and Thoracic Surgery, Section of Pediatric Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Johannes Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lea Klippgen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Wenskus
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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González AG, Barrios-Muriel J, Romero-Sánchez F, Salgado DR, Alonso FJ. Ergonomic assessment of a new hand tool design for laparoscopic surgery based on surgeons' muscular activity. APPLIED ERGONOMICS 2020; 88:103161. [PMID: 32678779 DOI: 10.1016/j.apergo.2020.103161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Laparoscopic surgery techniques are customarily used in non-invasive procedures. That said traditional surgical instruments and devices used by surgeons suffer from certain ergonomic deficiencies that may lead to physical complaints in upper limbs and back and general discomfort that may, in turn, affect the surgeon's skills during surgery. A novel design of the laparoscopic gripper handle is presented and compared with one of the most used instruments in this field in an attempt to overcome this problem. The assessment of the ergonomic feature of the novel design was performed by using time-frequency analysis of the surface electromyography (sEMG) signal during dynamic activities. Singular Spectrum Analysis (SSA) was used to decompose the sEMG signal and extract the median frequency of each muscle to assess muscle fatigue. The results reveal that using the proposed ergonomic grip reduces the mean values of the muscle activity during each of the proposed tasks. The novel design also improves the ease of use in laparoscopic surgery as it minimises high-pressure contact areas, reduces large amplitude movements and promotes a neutral position of the hand, wrist and forearm. Furthermore, the SSA method for time-frequency analysis provides a powerful tool to analyse a prescribed activity in ergonomic terms. The proposed methodology to assess muscle activity during surgery activities may be useful in the selection of surgical instruments when programming extended procedures, as it provides an additional selection criterion based on the surgeon's biomechanics and the proposed activity.
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Affiliation(s)
- A G González
- Department of Mechanical Engineering, Energy an Materials, University of Extremadura, C/ Sta. Teresa de Jornet 38, 06800, Mérida, Spain
| | - J Barrios-Muriel
- Department of Mechanical Engineering, Energy an Materials, University of Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - F Romero-Sánchez
- Department of Mechanical Engineering, Energy an Materials, University of Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain.
| | - D R Salgado
- Department of Mechanical Engineering, Energy an Materials, University of Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - F J Alonso
- Department of Mechanical Engineering, Energy an Materials, University of Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain
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Rodrigues Armijo P, Huang CK, Carlson T, Oleynikov D, Siu KC. Ergonomics Analysis for Subjective and Objective Fatigue Between Laparoscopic and Robotic Surgical Skills Practice Among Surgeons. Surg Innov 2019; 27:81-87. [PMID: 31771411 DOI: 10.1177/1553350619887861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction. Our aim was to determine how self-reported and objectively measured fatigue of upper limb differ between laparoscopic and robotic surgical training environments. Methods. Surgeons at the 2016 SAGES Conference Learning Center and at our institution were enrolled. Two standardized surgical tasks (peg transfer [PT] and needle passing [NP]) were performed twice in each surgical skills practical environments: (1) laparoscopic training-box environment (Fundamentals of Laparoscopic Surgery [FLS]) and (2) Mimic dV-trainer (MIMIC). Muscle activation of upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis, and extensor digitorum were recorded using surface electromyography (EMG; Trigno, Delsys, Inc, Natick, MA). Subjective fatigue was self-reported using Piper Fatigue Scale-12. Analysis was done using SPSS v25.0, α = .05. Results. Demographics were similar between FLS (N = 14) and MIMIC (N = 12). For PT, MIMIC had a significant increase in EMGRMS of UT (P < .001) and AD (P < .001). Conversely, FLS led to significant decreased muscle fatigue in UT (P = .015). For NP, MIMIC had a significant increase in EMGRMS for UT (P = .034) and AD (P = .031), but FLS induced more muscle fatigue for AD (P = .004). There was significant decrease in self-reported fatigue after performing FLS tasks (P = .030) but not after MIMIC (P = .663). Conclusion. Our results showed that practice with MIMIC resulted in greater activation of shoulder muscles, while FLS caused more significant muscle fatigue in the same muscles. This could be due to ergonomic disadvantages and nonoptimal ergonomic settings. Further studies are needed to understand the optimal ergonomics and its impact on fatigue and muscle activation during use of both the FLS and MIMIC training systems.
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Affiliation(s)
| | - Chun-Kai Huang
- University of Nebraska Medical Center, Omaha, NE, USA.,University of Kansas Medical Center, Kansas City, KS, USA
| | - Tyson Carlson
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ka-Chun Siu
- University of Nebraska Medical Center, Omaha, NE, USA
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Ergonomics of minimally invasive surgery: an analysis of muscle effort and fatigue in the operating room between laparoscopic and robotic surgery. Surg Endosc 2018; 33:2323-2331. [DOI: 10.1007/s00464-018-6515-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
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10
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A systematic review on fatigue analysis in triceps brachii using surface electromyography. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lee G, Lee T, Dexter D, Klein R, Park A. Methodological Infrastructure in Surgical Ergonomics: A Review of Tasks, Models, and Measurement Systems. Surg Innov 2016; 14:153-67. [DOI: 10.1177/1553350607307956] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Though in its infancy, the discipline of surgical ergonomics is increasingly valued. Still, little has been written regarding this field's tasks, models, and measurement systems. These 3 critical experimental components are crucial in objectively and accurately assessing joint and postural control as exhibited by expert laparoscopic surgeons. Such assessments will establish characteristic patterns important for surgical training. In addition, risk factors associated with both minimally invasive surgical instruments and the operating room environment can be identified and minimized. Our review focuses on evidence-based experimental ergonomic studies undertaken in the field of laparoscopic surgery. Publications were located through PubMed and other database and library searches. This article describes tasks, models, and measurement systems and considers their specific applications and the types of data obtainable with the use of each. Advantages and limitations, especially those of measurement systems, are compared and discussed. Future trends and directions believed necessary for optimal investigation and results are also addressed.
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Affiliation(s)
- Gyusung Lee
- Department of Surgery, University of Maryland, Baltimore
| | - Tommy Lee
- Department of Surgery, University of Maryland, Baltimore
| | - David Dexter
- Department of Surgery, University of Maryland, Baltimore
| | - Rosemary Klein
- Department of Surgery, University of Maryland, Baltimore
| | - Adrian Park
- Department of Surgery, University of Maryland, Baltimore,
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Suh IH, LaGrange CA, Oleynikov D, Siu KC. Evaluating Robotic Surgical Skills Performance Under Distractive Environment Using Objective and Subjective Measures. Surg Innov 2015. [DOI: 10.1177/1553350615596637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures. Methods. Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMGfmed) and the EMG envelope (EMGenv) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman’s correlations were conducted to compare objective and subjective measures. Results. Significant distraction effect was found for all objective kinematics measures ( P < .05). There were significant distraction effects for EMG measures (EMGenv, P < .004; EMGfmed, P = .031). Significant distraction effects were also found for subjective measurements. Conclusions. Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education.
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Affiliation(s)
- Irene H. Suh
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Ka-Chun Siu
- University of Nebraska Medical Center, Omaha, NE, USA
- University of Nebraska at Omaha, Omaha, NE, USA
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13
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Haworth JL, Harbourne RT, Vallabhajosula S, Stergiou N. Center of pressure and the projection of the time-course of sitting skill acquisition. Gait Posture 2013; 38:806-11. [PMID: 23602446 DOI: 10.1016/j.gaitpost.2013.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 02/09/2013] [Accepted: 03/27/2013] [Indexed: 02/02/2023]
Abstract
A normal time-course for the acquisition of sitting is essential. A delay in sitting may affect other developmental milestones, resulting in deficiencies in overall skill. Therefore, our aim was to identify variables whose measures at the very beginning of sitting would allow for the projection of the evolution of the sitting skill. Center of pressure data were collected from the postural sway of twenty-six typically developing infants while sitting on a force platform with a beginning ability to sit upright. Spatial, temporal and frequency variables of postural sway were obtained from both the medial/lateral and anterior/posterior directions of sway. Discriminant function analysis was conducted to identify potential predictors of the duration between onset and fully independent sitting. Gender (p=0.025), median frequency (p=0.006), and correlation dimension (p=0.002) were identified to be predictive of grouping with 73.1% correct classification of the participating infants into short, mid, and long delay groups. In conclusion, measures taken at the earliest stage of sitting may allow the projection of the time-course to achieve independent sitting for typical infants. This approach may be useful for monitoring typical development.
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Affiliation(s)
- Joshua L Haworth
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA; College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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14
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Ergonomic analysis of muscle activity in the forearm and back muscles during laparoscopic surgery: influence of previous experience and performed task. Surg Laparosc Endosc Percutan Tech 2013; 23:203-7. [PMID: 23579519 DOI: 10.1097/sle.0b013e3182827f30] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The first aim of this study is to analyze the muscle activity in back and forearm muscles in surgeons during laparoscopic dissection and suturing maneuvers. The second aim is to determine the influence of the surgeons' previous experience in laparoscopic surgery. METHODS A total of 30 laparoscopic surgeons were divided in 3 groups: novice suturing, novice dissecting, and experts suturing. Electromyography data were collected from the trapezius, forearm flexors, and forearm extensors muscles, during the proposed tasks on physical simulator. RESULTS Muscle activity was significantly lower in the expert group. Moreover, muscle activity in the trapezius was significantly higher during the completion of intracorporeal suturing when compared with that during dissection. CONCLUSIONS Results obtained in this study show that the surgeons with a higher degree of laparoscopic experience exhibit a lower level of muscle activity when compared with the novice surgeons. Moreover, in accordance to our results, laparoscopic suturing involves a higher degree of muscle effort than during laparoscopic dissection.
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15
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Freschi C, Ferrari V, Melfi F, Ferrari M, Mosca F, Cuschieri A. Technical review of the da Vinci surgical telemanipulator. Int J Med Robot 2012; 9:396-406. [DOI: 10.1002/rcs.1468] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/09/2022]
Affiliation(s)
- C. Freschi
- EndoCAS Centre; Università di Pisa; Italy
| | - V. Ferrari
- EndoCAS Centre; Università di Pisa; Italy
| | - F. Melfi
- Dipartimento Cardio Toracico e Vascolare; Università di Pisa; Italy
| | - M. Ferrari
- EndoCAS Centre; Università di Pisa; Italy
| | - F. Mosca
- EndoCAS Centre; Università di Pisa; Italy
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16
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Music meets surgery: two sides to the art of “healing”. Surg Endosc 2012; 27:719-23. [DOI: 10.1007/s00464-012-2525-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 07/24/2012] [Indexed: 12/25/2022]
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17
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Retention of fundamental surgical skills learned in robot-assisted surgery. J Robot Surg 2011; 6:301-9. [DOI: 10.1007/s11701-011-0312-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
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18
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Suh I, Mukherjee M, Oleynikov D, Siu KC. Training program for fundamental surgical skill in robotic laparoscopic surgery. Int J Med Robot 2011; 7:327-33. [PMID: 21688381 DOI: 10.1002/rcs.402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although the use of robotic laparoscopic surgery has increased in popularity, training protocols for gaining proficiency in robotic surgical skills are not well established. The purpose of this study was to examine a fundamental training program that provides an effective approach to evaluate and improve robotic surgical skills performance using the da Vinci(™) Surgical System. METHODS Fifteen medical students without any robotic surgical experience were recruited. Participants went through a 4-day training program for developing fundamental robotic surgical skills and received a retention test 1 day after the completion of training. Data analysis included time to task completion, average speed, total distance traveled and movement curvature of the instrument tips, and muscle activities of the participants' forearms. Surgical performance was graded by the modified Objective Structured Assessment of Technical Skills for robotic laparoscopic surgery. Finally, participants evaluated their own performance after each session through questionnaires. RESULTS Significant training effects were shown for the time to task completion (p < 0.001), average speed (p < 0.01), and movement curvature (p < 0.05) for the test conditions. Significant learning effects were also found for EMG activation (p < 0.05). Participants reported more mastery, familiarity, and self-confidence and less difficulty in performing fundamental tasks with the surgical robot in both post-testing and retention sessions. CONCLUSIONS Our 4-day training program comprising of a series of training tasks from fundamental to surgical skill levels was effective in improving surgical skills. Further studies are required to verify these findings with a longer period of retention.
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Affiliation(s)
- Irene Suh
- University of Nebraska Medical Center, College of Public Health; University of Nebraska Medical Center, Center for Advanced Surgical Technology
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19
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Wurdeman SR, Huisinga JM, Filipi M, Stergiou N. Multiple sclerosis affects the frequency content in the vertical ground reaction forces during walking. Clin Biomech (Bristol, Avon) 2011; 26:207-12. [PMID: 21035929 PMCID: PMC3034792 DOI: 10.1016/j.clinbiomech.2010.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple sclerosis is a progressive neurological disease that results in a high incident of gait disturbance. Exploring the frequency content of the ground reaction forces generated during walking may provide additional insights to gait in patients with multiple sclerosis that could lead to specific tools for differential diagnosis. The purpose of this study was to investigate differences in the frequency content of these forces in an effort to contribute to improved clinical management of this disease. METHODS Eighteen patients and eighteen healthy controls walked across a 10 meter long walkway. The anterior-posterior and vertical ground reaction forces generated during the stance phase of gait were evaluated in the frequency domain using fast Fourier transformation. T-tests were utilized for comparison of median frequency, the 99.5% frequency, and the frequency bandwidth between patients and healthy controls and also for comparisons between patients with mild and moderate severity. FINDINGS Patients with multiple sclerosis had significantly lower 99.5% frequency (P=0.006) and median frequency (P<0.001) in the vertical ground reaction force. No differences were found in the anterior-posterior reaction force frequency content. There were no differences between patients with mild and moderate severity. INTERPRETATION The lower frequency content suggests lesser vertical oscillation of the center of gravity. Lack of differences between severities may suggest presence of differences prior to currently established diagnosis timelines. Analysis of the frequency content may potentially serve to provide earlier diagnostic assessment of this debilitating disease.
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Affiliation(s)
- Shane R. Wurdeman
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA,College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jessie M. Huisinga
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA
| | - Mary Filipi
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nicholas Stergiou
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA,College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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20
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Siu KC, Suh IH, Mukherjee M, Oleynikov D, Stergiou N. The Effect of Music on Robot-Assisted Laparoscopic Surgical Performance. Surg Innov 2010; 17:306-11. [DOI: 10.1177/1553350610381087] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Music is often played in the operating room to increase the surgeon’s concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion ( P = .005) and total travel distance ( P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency ( P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.
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Affiliation(s)
- Ka-Chun Siu
- University of Nebraska Medical Center, Omaha, NE, USA, University of Nebraska at Omaha, Omaha, NE, USA,
| | - Irene H. Suh
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Nick Stergiou
- University of Nebraska Medical Center, Omaha, NE, USA, University of Nebraska at Omaha, Omaha, NE, USA
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21
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The impact of environmental noise on robot-assisted laparoscopic surgical performance. Surgery 2010; 147:107-13. [DOI: 10.1016/j.surg.2009.08.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 08/27/2009] [Indexed: 11/24/2022]
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22
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Robotic Fourth-Arm Enucleation of an Esophageal Leiomyoma and Review of Literature. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009; 4:354-7. [DOI: 10.1097/imi.0b013e3181c46218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Esophageal leiomyomas are resected in symptomatic and/or malignancy-suspicious cases. Traditionally, they have been removed by laparotomy or thoracotomy and more recently by thoracoscopy and laparoscopy. Mucosal injury is reported as high as 7% of cases but may be higher in unreported general practice. Robotic technology seems to offer advantages. We describe a robotic approach that seems to minimize mobilization of the esophagus, potentially decreasing the likelihood of mucosal injury and postoperative recovery time. We review the literature to evaluate the reports of mucosal injury with the open, minimally invasive, and robotic techniques and describe our own method. To improve efficiency, we use a four-arm technique.
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23
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Kernstine KH, Emily S, Falabella A, Ramirez NA, Anderson CA, Beblawi I. Robotic Fourth-Arm Enucleation of an Esophageal Leiomyoma and Review of Literature. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kemp H. Kernstine
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - S. Emily
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Andres Falabella
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Natalie A. Ramirez
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Casandra A. Anderson
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Ihab Beblawi
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
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Judkins TN, Oleynikov D, Stergiou N. Electromyographic response is altered during robotic surgical training with augmented feedback. J Biomech 2009; 42:71-6. [DOI: 10.1016/j.jbiomech.2008.09.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 09/30/2008] [Accepted: 09/30/2008] [Indexed: 11/28/2022]
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Validated robotic laparoscopic surgical training in a virtual-reality environment. Surg Endosc 2008; 23:66-73. [PMID: 18401648 DOI: 10.1007/s00464-008-9894-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 02/04/2008] [Accepted: 02/25/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND A robotic virtual-reality (VR) simulator has been developed to improve robot-assisted training for laparoscopic surgery and to enhance surgical performance in laparoscopic skills. The simulated VR training environment provides an effective approach to evaluate and improve surgical performance. This study presents our findings of the VR training environment for robotic laparoscopy. METHODS Eight volunteers performed two inanimate tasks in both the VR and the actual training environment. The tasks were bimanual carrying (BC) and needle passing (NP). For the BC task, the volunteers simultaneously transferred two plastic pieces in opposite directions five times consecutively. The same volunteers passed a surgical needle through six pairs of holes in the NP task. Both tasks require significant bimanual coordination that mimics actual laparoscopic skills. Data analysis included time to task completion, speed and distance traveled of the instrument tip, as well as range of motion of the subject's wrist and elbow of the right arm. Electromyography of the right wrist flexor and extensor were also analyzed. Paired t-tests and Pearson's r were used to explore the differences and correlations between the two environments. RESULTS There were no significant differences between the actual and the simulated VR environment with respect to the BC task, while there were significant differences in almost all dependent parameters for the NP task. Moderate to high correlations for most dependent parameters were revealed for both tasks. CONCLUSIONS Our data shows that the VR environment adequately simulated the BC task. The significant differences found for the NP task may be attributed to an oversimplification in the VR environment. However, they do point to the need for improvements in the complexity of our VR simulation. Further research work is needed to develop effective and reliable VR environments for robotic laparoscopic training.
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