Ergonomic port placement in robotic colorectal surgery

Validate robot-assisted total laparoscopic hysterectomy with four equally-spaced ports without an assistant port

To evaluate the usefulness of robot-assisted total laparoscopic hysterectomy with four equally-spaced ports (RA-TLH/4e) without an assistant port. In RA-TLH/4e, four da Vinci ports were placed horizontally at a height of 4 cm above the umbilicus with 8 cm equal spacing. Poor development of the surgical field or difficult forceps manipulations were handled with the endoscope and forceps movement (port-hopping). Patient background, surgical outcomes, complications, port-hopping frequency were compared in three groups: RA-TLH/4e, RA-TLH with four unequally-spaced ports (RA-TLH/4u), and conventional RA-TLH with five ports (RA-TLH/5). There were no significant differences in patient background or surgical outcomes among the three groups except for age, preparation time, and hospital stay, and no cases of laparotomy conversion or serious complications. RA-TLH/4e had fewer port-hoppings than RA-TLH/4u. The minimum abdominal width showed a weak negative correlation with port-hopping frequency in RA-TLH/4u, but not in RA-TLH/4e. RA-TLH/4e allowed for a reduction in personnel and costs compared to RA-TLH/5. The equal placement of four ports allowed sufficient port spacing even for patients with narrow abdominal widths. In addition, the port-hopping technique was able to fully compensate for the lack of an assistant port. RA-TLH/4e is a highly useful technique that not only excels in safety but also reduces costs.

Factors affecting upper limb ergonomics in robotic colorectal surgery

The aim of the study was to examine the factors which may influence suboptimal ergonomic surgeon hand positioning during robotic colorectal surgery (RCS). An observational study of 11 consecutive RCS cases from June 2022 to August 2022 was performed. Continuous video footage of RCS cases was analysed concurrently with video recordings of surgeon's hand positions at the console. The outcome studied was the frequency with which either hand remained in a suboptimal ergonomic position outside the predetermined double box outlines, as marked on the surgeon's video, for >1 min. Situations which resulted in poor upper limb ergonomics were dissection in the peripheral operating field location, left-hand use, use of the stapler, dissection of the main mesenteric blood vessels, and multi-quadrant surgery. Being aware of situations when suboptimal ergonomic positions occur can allow surgeons to consciously compensate by using the clutch or pausing to take a rest break.

What does this paper add to the literature?

The study is important because it is the first to look at factors which may influence poor upper limb ergonomics during non-simulated RCS. By recognizing these factors and compensating for them, it may improve surgeon ergonomics with resultant better performance.

Improving ergonomics for the bedside assistant in robotic colorectal surgery

The aim of the study was to document when significant bedside assistant (BA) and robotic arm collisions occurred during robotic colorectal surgery (RCS). An observational study of 10 consecutive RCS cases, from May 2022 to September 2022, was performed. Situations when there was significant collision between BA arm and robotic arm (to cause inadvertent movement of the assistant instrument) were documented. The assistant port was randomly placed to the right or the left side of the camera port. Situations which led to detrimental BA ergonomics include dissection at the most peripheral working field, proximity of the target (mesenteric vessels), small bowel retraction, placement of the assistant port in the medial position (on the left side of the camera port), during intra-corporeal suturing and robotic stapler use. The robotic console surgeon can predictably identify and avoid situations when injury to the BA may occur.