Ergonomics in Endourology: Measurement of Force for Deflection in Contemporary Ureteroscopes

Urologist's Fatigue and Discomfort in Different Body Regions After Performing Flexible Ureteroscopy

OBJECTIVE

To assess self-reported surgeon fatigue and discomfort in different body regions after performing flexible ureteroscopy.

METHODS

An anonymous survey was designed and distributed among urologists and trainees in four hospitals. Participants rated their discomfort in different body and hand regions as well as overall fatigue before and immediately after each flexible ureteroscopy procedure they performed.

RESULTS

The final working sample size was 45 unique surgeons (26 female and 19 male) completing 58 procedures. Respondents were 38.2 ± 14.7 years of age. Forty-two percent of respondents were male, 75% were right-hand dominant, and 25% reported existing musculoskeletal disorder. Urologists' overall fatigue score significantly increased after ureteroscopy, but females had a significantly larger increase (female β: 1.74, P <.001; male β: 0.78, P = .017). Women experienced higher discomfort in neck, upper back, right shoulder, and right elbow than men. Across different hand regions, increased post-procedural discomfort was reported mostly in the thenar area (41.8%), followed by the hypothenar area (28.5%) and thumb area (27.9%).

DISCUSSION

Urologists experience significant increase in overall fatigue and discomfort across most body and hand regions. Women seem to be disproportionally affected. Additional studies are needed to determine the causality of these findings and explore potential interventions aimed at reducing procedure-related discomfort among all urologists, especially women.

Ergonomics in Urology: Current Landscape and Future Directions

Optimal ergonomics are essential to improving clinical performance and longevity among urologists, as poor ergonomics can contribute to work-related injury and physician burnout. While a majority of urologists experience muscular injury throughout their career, women and trainees are disproportionately affected. These disparities are exacerbated by the lack of formal ergonomics education within urologic training programs. This review provides an overview of practical approaches to optimize ergonomics across working environments for urologists and trainees. We highlight intraoperative techniques and novel devices which have been shown to reduce work-related injury, and we identify knowledge gaps to guide future areas of ergonomic research.

Safety enhanced surgical robot for flexible ureteroscopy based on force feedback

BACKGROUND

Although some robotic systems have been developed to improve conventional flexible ureteroscopy (FURS), a widely used intervention in urology, these robots rarely have a comprehensive force feedback function which is important for master-slave controlled surgical robots.

METHODS

Here, we design and fabricate a novel FURS robot with a comprehensive force feedback function. Moreover, to realize better force feedback, a neural network-based method is also demonstrated to estimate the interactive forces between the flexible ureteroscope and the environment.

RESULTS

We show that when teleoperating the flexible ureteroscope with our robot, the operator can accurately feel the obstruction if the interactive axial force or torque exceeds 1.2 N or 15.6 mN·m respectively. For bending movement, augmented force feedback greatly improves the accuracy of the operator's perception of obstruction.

CONCLUSIONS

The developed robotic system with force feedback is expected to improve the safety of robot-assisted FURS.

Ergonomics in the OR: Electromyographic Evaluation of Common Muscle Groups Used During Simulated Flexible Ureteroscopy - a Pilot Study

OBJECTIVE

To assess the effects of different surgeon positions and ureteroscope types on muscle activation as measured by surface electromyography (sEMG) during simulated ureteroscopy in an endourology box-trainer model and kidney phantom.

METHODS

For this exploratory study, sEMG was used to quantify muscle activation of three endourology fellows during various ureteroscopic tasks. Electrodes were placed on the ureteroscope-holding side of the following muscles: thenar, forearm flexor, forearm extensor, biceps, triceps, deltoid, and trapezius. Subjects wore fitted lead aprons in an operating room and used a cystoscopy table with surgical drapes and an endoscopic video tower. Trials were completed with a disposable and reusable ureteroscope, both in the standing and sitting positions. Each subject performed an identical set of tasks in a phantom silicone kidney and ureteroscopy box trainer to recreate the procedural components of basketing, navigating a renal collecting system, and dusting. Raw EMG data for each task was processed and normalized as a percent of each subject's maximum voluntary contraction to allow comparison.

RESULTS

The forearm extensor was the most heavily utilized muscle. The trapezius and deltoid muscles were activated more during sitting whereas the forearm flexors had increased activity during standing. The heavier reusable ureteroscope had increased forearm extensor activation compared to the disposable ureteroscope.

CONCLUSIONS

Preliminary data show measurable differences in muscle activation based on both surgical posture and type of ureteroscope used. This highlights the need for more extensive EMG studies to identify techniques and equipment to optimize ergonomics and potentially minimize injury during flexible ureteroscopy.