Ergonomics in minimal access surgery
•
9 j'aime•1,099 vues
ergonomics is very vital for all laparoscopic surgeons.
Recommandé
Contenu connexe
Tendances
Tendances (20)
Similaire à Ergonomics in minimal access surgery
Similaire à Ergonomics in minimal access surgery (20)
Plus de Yamal Patel
Dernier
Dernier (20)
Ergonomics in minimal access surgery
- 1. Dr. Yamal Patel Kenya. ERGONOMICS AND LAPAROSCOPIC SURGERY
- 3. principles In line visualization of target Triangulation of instruments Conflict of instruments needs to be minimized Patient positioning Table height Tactile limitation 2D view Port positioning Ergonomic principles
- 4. Laparoscopic Surgery provides patients with less painful surgery but is more demanding for the surgeon CONCEPT OF ERGONOMICS PROBLEMS AT LAPAROSCOPY ASSESSMENT OF DAMAGE MANAGEMENT OF THE PROBLEM
- 5. WHAT IS Ergonomics… • ERGON= Work • NOMOS= Natural laws or arrangement • Ergonomics - science of best suiting the worker to his/her job • The study of the psychological & physical interaction between the user (surgeon, assistant & nurse) & their tools.
- 7. Why Ergonomics ➢ Prevent you from being injured ➢ Optimize Your Productivity ➢ Increase Your Comfort at home and at Play hard Way The easy Way
- 9. HISTORY 18th Century- Doctors noticed that workers who required to maintain body positions for long periods developed musculoskeletal problems In the last 20 yrs- Research has clearly established a connection between certain jobs and repetitive stress injuries or musculoskeletal injuries. Park et al- J. AM Coll Surg 2010 - physical strain at laparoscopy >87%
- 12. Visual Axis and Motor Axis - same
- 14. Table Height 0.49 x - Roughly At the level of the waist
- 15. Vital angles • Angle between trunk and arm - <15 degrees • Angle between forearm and hand axis - <15 degrees • Monitor height – 15 degrees gaze down view • Distance from monitor – 5 x the diagonal size of the screen - gives full view on macula - e.g which seats are the best for a movie?
- 16. Manipulation angle BETWEEN TWO WORKING INSTRUMENTS 60-90 DEGREES TRY EATING OR WRITING WITH DIFFERENT ANGLES AND SEE
- 17. Azimuth angle - Angle between instrument and the telescope - Usually 2 azimuth angles make up the manipulation angle
- 19. Elevation angle - Angle between patients body and the inst rument - ~ 30-60 degrees - Try keeping half instrument in and half out i.e 18cm from the organ – elevation angle becomes 30 - E.g eating with spoon, cooking on pan etc
- 20. Elevation Angle
- 22. Dueling sword or scissoring 1. When ports too close – this effect 2. Also called chopstick effect 3. Keep ports minimal 8 -10 cm apart to avoid this
- 23. Mirror movement • ! Never work against the camera
- 25. Effects of not being ergonomic Surgeon :- Fatigue Stress Physical Injury Patient : Poor surgery outcome more likely
- 26. Why Surgeon Injuries? • Head is fixed on monitor- immobile for long periods • Shoulders (esp left)- statically flexed for long esp in short surgeons and those with large waist circumference or pregnant • Legs- One is fixed & static, during long procedure lactic acid build up. The other leg moves between the pedals. • Position of table • Open Surgery - At surgeon’s elbow level • Laparoscopic Sx- Table much lower to allow elbow almost 90 degrees or more.
- 27. Laparoscopic Layout OPERATING TABLE WITH PATIENT Foot Pedals
- 28. • Static Work- Musculoskeletal effort required to HOLD a certain position, even a comfortable one. • Force- amount of tension one would generate e.g. tilting your head forward or backward from a neutral, vertical position quadruples the amount of force acting on your lower neck vertebrae.
- 29. EFFECTS OF POOR ERGONOMICS CTD- Cumulative trauma disorder RSI- Repetitive Strain Injuries MSD- Musculoskeletal disorders
- 31. Types of Surgeon Injuries • Neck Pain- Spondylosis • Burning eyes- Stress exhaustion • Cervical spondylitis & backache • “ Chicken Wing scapula” • U/L-Carpal tunnel syndrome, tenosynovitis, hand finger joint pain, hand muscle injury • Leg pain, cramps, joint stiffness • Backache and stiffness- due to static posture
- 32. Problems with viewing at laparoscopy Surgeon stands looking at a 2D/3D monitor 3-8 feet away, which affects neck+back posture. Axis of surgery is below axis of vision Loss of peripheral vision- dangerous
- 33. Laparoscopic issues with instruments DESIGNER/ MANUFACTURER BRICK WALL USER Gap of Communication
- 34. Issues with laparoscopic instruments Long instruments, passed through narrow ports in fixed positions Decreased mechanical efficiency, movement about a fulcrum on the body wall (port) Surgeon needs to squeeze harder, bend the wrists more, hold arms higher Hand and Shoulder fatigue
- 35. Long instruments ➢ Long handles • Poor at transmitting force • A ratio of only 1.3 from handle to the tip as compared to 3:1 with open surgery instruments therefore surgeon has to work 6 times harder for same effect ➢ Restricted movements • Only 4 namely in/out, rotation, angulation, side to side and u p/down
- 36. ➢ Only one standard size • One fits all??? • Try same size glove for everybody??? ➢ Handles • Pistol grip- allows more natural position • In line handle need more pronation • Opposite movements- length of instrum ent inside decides the arc of movement
- 37. • Ability to achieve ideal posture and PRO PER ergonomy is determined by: ➢Height of Operating table ➢Position of visual display (monitor) ➢Foot pedal location ➢Selection of hand instruments
- 38. How to solve these problems • Exercise • Nutrition • Relaxation • Maintain ideal procedure • Prevention: • Warm up and stretches before activities that are repetitive, static or prolonged. • Breaks and stretches from any sustained position every 20-30 mins. • Respect painful positions and stop painful activity. • Recognize early signs of inflammation process & treat early-Physician treat thyself.
- 40. Maintain neutral position Erect position of back and neck with relaxed shoulders Equipment and monitor directly in front of you Upper arms close to body, with elbows 90-120 degrees flexed
- 41. Ideal Angles
- 42. Visual angle to monitor 15-40 degrees below line of sight/eye level. Monitor mounted on flexible beams Instrument handles at or below elbow height (after instruments inserted into the ports) Foot pedals near foot and aligned in the same direction as the instruments, towards the principal monitor Exercises to relax during the surgery:-
- 43. Ergonomics
- 44. • To IMPROVE ERGONOMICS i. Allows surgeon to keep both arms at sides of body ii. Avoids pressure points on hands iii. Allows surgeon to apply pressure using gun-type ha ndle iv. Enable surgeon to keep both wrists in neutral (unbe nt) position v. Allows fine manipulation with a precision grip • “Palming“ an instrument (removing the thumb from the ring & placing the palm on the handle) reduces amount of wrist flexion • Increases surgeons power when grasping tissue for a long time
- 46. Ideal relax ed positio n Waist line table Gaze down view Straight line / coaxial Triangulation Straight head, in the axis of the trunkwithout rotation or extension of cervical spine Shoulders in relaxed or neutral position Arms alongside the body Elbows bent 70-90 degrees Forearms horizontal or slightly descended direction. Hands pronated Hands and fingers lightly grip the handpiece
- 47. TEAM PERFORMANCE • Surgeon • Anaesthesiologist • Operating Room Nurses • Biomedical Engineer • Each hospital/ Ambulatory centre should create a dedicated laparoscopy team, which should train together and understand equipment & instruments together.
- 48. Surgeons Stance
- 49. 3 pillars of a great lap surgeon Ergonomics Task analysis engineering
- 50. engineering 1. Camera 2. Insufflator 3. Electrosurgery 4. Monitor 5. Scopes 6. Hysteromatt 7. Connections to record 8. Video – editing/ movie making
- 51. Task analysis Sequential steps of procedural and executional process. Break each procedure into sub-procedures E.g hysterectomy – almost 91 executional substeps •Access •Exposure of adnexae •Upper pedicles •Ant/ post leaf •Uv fold •Uterines •Post wall- uterosacrals •Colpotomy •Suturing •Safety checks
- 52. Future Google glass vision Apple virtual reality Better and motorized handles
- 53. Take Home • Prepare well for every case • Keep physically fit • Tailor make your surroundings and settings to suit you. • You have one life with one body - use it well