A Novel Dual-Phase Activation-Dependent Foot-Switch Mechanism for Surgical Energy Devices as an Asset in Early Surgical Training: A Proof of Concept Study.

Introduction. Many processes exist that limit or eliminate the incidence of adverse events in general surgery including the World Health Organization safety checklist. Technology and device advancement has a potentially expanding role in the context of surgical safety. Materials and Methods. A dual controlled accessory electrical diathermy footswitch (Permissive diathermy foot switch device or PDf) device concept was developed in an effort to improve patient safety in theatre and enhance opportunities in training. Electrical diathermy is only activated if the senior supervising surgeon and the novice surgeon simultaneously activate their interconnected footswitches. The activation of the PDf accessory footswitch device allows a senior surgeon to exert control on "initiation" of activation of diathermy devices operated by a novice surgeon (foot on pedal) as well as when desiring to deactivate the device (foot off pedal). Results. A process of designing and prototyping was initiated to define the purpose and the functionality of the PDf device up till the stage of a fully functioning prototype. The PDf device was constructed as a final working and tested prototype in association with the local medical engineering department at the Cumberland Infirmary in Carlisle. The device was on a nonbiological model to determine efficacy and safety and passed its laboratory testing phase and was deemed ready for clinical use. Conclusion. We demonstrated the feasibility and functionality of the PDf device and propose a positive role in surgical training in the context of early surgical training and specific circumstances where more control is needed.

Impact of Obesity on Surgeon Ergonomics in Robotic and Straight-Stick Laparoscopic Surgery.

STUDY OBJECTIVE: Work-related musculoskeletal symptoms (WMSs) are reported to be increasing in surgeons performing minimally invasive procedures. Therefore, we investigated the use of inertial measurement units (IMUs) and electromyography (EMG) sensor recorders to record real-time information on the muscle movement/activity required to perform training exercises in simulated in normal and high body mass index (BMI) models. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Four consultant gynecologic oncology surgeons experienced in complex straight-stick (SS) laparoscopic and robotically assisted (RA) surgery. INTERVENTIONS: Three exercises (hoops onto pegs and wire chase) using SS and RA surgery on 2 abdominal models: normal BMI and high BMI. MEASUREMENTS AND MAIN RESULTS: We measured time to complete exercise and surgeon muscle movement/activity. The time to complete all exercises was significantly lower for RA surgery as compared with SS laparoscopy (p <.05 or better). The movement of the surgeons' core was significantly greater in high BMI SS laparoscopy compared with normal BMI SS laparoscopy for exercises 1 and 2 (p <.001). Muscle usage, as determined by EMG peak, was significantly higher in normal BMI SS laparoscopy and even higher in high BMI SS laparoscopy but was generally flat for all normal and high BMI RA surgery exercises (p <.05 or better). CONCLUSION: Detailed real-time information can be collected through IMUs/EMG sensors. Our results indicate that RA surgery requires less surgeon movements and muscle activity to complete tasks compared with SS laparoscopy, particularly in a high BMI model. The implications of these results are that RA surgery in high BMI patients may therefore have less physical impact on the surgeon compared with SS laparoscopy and may result in lower WMS rates.

Low back pain and some associated factors: is there any difference between genders?

OBJECTIVE: To compare men and women with low back pain and identify the prevalence and some of its associated factors in a population-based sample of adults aged 20 and over a seven day period. METHODS: Cross-sectional study based on a population survey. 600 individuals were interviewed on the following: (1) characteristics of the participants (i.e. demographic, socioeconomic, and labor aspects); (2) physical activity level (IPAQ); (3) musculoskeletal symptoms (Nordic Questionnaire). Descriptive, bivariate, and Poisson regression analyses were performed. RESULTS: Overall prevalence of LBP was 28.8%, being 39.0% in men and 60.9% in women. The measured associated factors in men were age between 36 and 59 years (PR=3.00 [1.31-6.88]) and over 60 (PR=4.52 [2.02-10.12]), smoking (PR=2.47 [1.20-5.11]), fewer years of formal education (0-4 years) (PR=6.37 [2.15-18.62]), and hypertension (PR=2.27 [1.15-4.50]). For women, the associated factors were occupational activities that involved heavy lifting (PR=1.80 [1.03-3.16]), standing posture leaning forward (PR=2.04 [1.20-3.44]), sitting posture leaning forward (PR=2.17 [1.24-3.82]), and sitting at the computer three or more days per week (PR=4.00 [1.44-11.11]). Widowed or divorced participants were more likely to report LBP, in both men (PR=3.06 [1.40-6.66]) and women (PR=2.11 [1.15-3.88]). CONCLUSION: This study reveals high prevalence of low back pain in a seven day period. Older age, low education, hypertension, and smoking were associated with LBP in men. Occupational and ergonomic factors were associated with LBP in women. Marital status was associated with LBP in both genders.

Doenças ocupacionais e princípios ergonômicos voltados à formação de profissionais da Odontologia / Occupational diseases and ergonomic principles aimed at training dentistry professionals

Introdução: a alta demanda diária para desempenhar os serviços, aliada ao descuido com o bem-estar laboral, acaba causando uma má postura na hora dos atendimentos, acarretando problemas osteomusculares, dor e, consequentemente, doenças ocupacionais. Objetivo: avaliar o conhecimento dos acadêmicos nos diferentes semestres do curso de Odontologia de uma instituição de ensino superior situada na cidade de Vitória da Conquista ­ Bahia, acerca dos princípios ergonômicos aplicados à prática clínica, além de investigar sintomas associados às doenças ocupacionais. Metodologia: foram selecionados, de forma aleatória, 186 alunos matriculados nas clínicas da faculdade, os quais foram convidados a responder a dois questionários contendo perguntas relacionadas ao conceito de ergonomia e a doenças ocupacionais na Odontologia. Foi aplicado o teste qui-quadradro de Pearson; nos casos em que a frequência esperada foi menor que cinco (n < 5), foi utilizado o teste exato de Fisher (p<0,05). Resultados: cerca de 69% dos graduandos demonstraram total insciênciasobre a ergonomia, 87% apresentaram pouco conhecimento a respeito das doenças ocupacionais da Odontologia, 75% consideraram insatisfatório o conhecimento sobre ergonomia na faculdade e cerca de 76% queixaram-se de dores osteomusculares em pelo menos um local anatômico do seu corpo. Conclusão: o presente estudo demonstrou o pouco conhecimento dos estudantes Oe odontologia a respeito dessa temática e o possível desenvolvimento de doenças osteomusculares ainda na graduação.

Introduction: The high daily demand to perform the services allied to the carelessness with the job well-being lead to a bad posture at the appointments, causing musculoskeletal problems, pain, and, consequently, occupational diseases. Objective: to evaluate the knowledge of students in the different semesters of the Dentistry course of a Higher Education Institution located in the city of Vitória da Conquista - Bahia, on the ergonomic principles applied to clinical practice, and investigate the symptoms associated with occupational diseases. Methodology: 186 students enrolled in the college clinics were randomly selected and invited to answer two questionnaires, containing questions related to the concept of ergonomics and occupational diseases in dentistry. Pearson's chi-square test was applied; in cases that the expected frequency was less than five (n<5), Fisher´s exact test was used (p<0.05). Results: around 69% of the undergraduates demonstrated total unawareness about ergonomics, 87% had little knowledge about occupational diseases in Dentistry, 75% consider the knowledge about ergonomics in college unsatisfactory, and about 76% complained of musculoskeletal pain in at least one anatomical site of their body. Conclusion: the presente study demonstrated Dentistry students have little knowledge about this theme and the possible development of musculoskeletal diseases while still in the undergraduate course.

Estimating Braking Performance in Osteoarthritis of the Knee or Hip with a Reaction Timer.

OBJECTIVE: To investigate if testing in a brake simulator can be replaced by a simple reaction timer setup imitating the ergonomic conditions of emergency braking when evaluating the ability to drive in patients with musculoskeletal problems of the lower extremities. METHODS: A cross-sectional survey was performed in the Department of Orthopaedic Surgery in our University Hospital from October 2014 until May 2015. Patients attending our department with either osteoarthritis or arthroplasty of the knee or hip were asked to participate in the study if they had a valid driving license. The age limit was from 18 to 85 years. Both women and men were included. Registered demographic data were patient age, height, sex, body weight, and body mass index. Braking performance (brake response time [BRT]) was evaluated in a brake simulator that was embedded into a real car cabin (10 measurements). The values obtained were compared with those registered when simply testing (5 measurements) those patients with a normal reaction timer setup that imitated the sitting position in a car. Kendall's tau correlation coefficient was calculated between the values obtained from the brake simulator with those from the reaction timer setup. RESULTS: Altogether, 137 patients (median age 67 years [range, 24-89 years]) with either osteoarthritis of the knee (n = 55) or hip (n = 82) were tested. Age was comparable in both collectives (P = 0.807). The mean body height was 1.70 m in both groups. Knee patients presented with a higher body weight of approximately 5 kg (P = 0.014) and consequently also had a higher body mass index (P = 0.023). The median BRT in the brake simulator was 628 ms (range, 390-1444 ms) for all subjects: 592 ms (range, 418-1146 ms) in the hip group and 696 ms (range, 390-1444 ms) in the knee group. Measurement values obtained by the reaction timer were significantly (P < 0.001) higher by approximately 15% (SD, 22%) than those measured in the brake simulator. A moderate correlation was found between the reaction timer and the brake simulator, with a Kendall's tau of 0.449 (P < 0.001) for all patients. Interestingly, hip patients showed a higher correlation (τ = 0.471) than knee patients (τ = 0.263). CONCLUSION: Even though the measured correlations do not allow us to make a definite statement concerning braking performance, especially in knee patients, a simple reaction timer test can provide a low-cost first estimate of BRT for patients and their treating physicians. For forensic statements, the brake simulator will, however, remain the gold standard.

Praying Sitting Position for Pineal Region Surgery: An Efficient Variant of a Classic Position in Neurosurgery.

BACKGROUND: The sitting position has lost favor among neurosurgeons partly owing to assumptions of increased complications, such as venous air embolisms and hemodynamic disturbances. Moreover, the surgeon must assume a tiring posture. We describe our protocol for the "praying position" for pineal region surgery; this variant may reduce some of the risks of the sitting position, while providing a more ergonomic surgical position. METHODS: A retrospective review of 56 pineal lesions operated on using the praying position between January 2008 and October 2015 was performed. The praying position is a steeper sitting position with the upper torso and the head bent forward and downward. The patient's head is tilted about 30° making the tentorium almost horizontal, thus providing a good viewing angle. G-suit trousers or elastic bandages around the lower extremities are always used. RESULTS: Complete lesion removal was achieved in 52 cases; subtotal removal was achieved in 4. Venous air embolism associated with persistent hemodynamic changes was nonexistent in this series. When venous air embolism was suspected, an immediate reaction based on good teamwork was imperative. No cervical spine cord injury or peripheral nerve damage was reported. The microsurgical time was <45 minutes in most of the cases. Postoperative pneumocephalus was detected in all patients, but no case required surgical treatment. CONCLUSIONS: A protocolized praying position that includes proper teamwork management may provide a simple, fast, and safe approach for proper placement of the patient for pineal region surgery.

Solving the surgeon ergonomic crisis with surgical exosuit.

INTRODUCTION: The widespread adoption of laparoscopic surgery has put new physical demands on the surgeon leading to increased musculoskeletal disorders and injuries. Shoulder, back, and neck pains are among the most common complaints experienced by laparoscopic surgeons. Here, we evaluate the feasibility and efficacy of a non-intrusive progressive arm support exosuit worn by surgeons under the sterile gown to reduce pain and fatigue during surgery. METHODS AND PROCEDURES: This is a prospective randomized crossover study approved by the Internal Review Board (IRB). The study involves three phases of testing. In each phase, general surgery residents or attendings were randomized to wearing the surgical exosuit at the beginning or at the crossover point. The first phase tests for surgeon manual dexterity wearing the device using the Minnesota Dexterity test, the Purdue Pegboard test, and the Fundamentals of Laparoscopic Surgery (FLS) modules. The second phase tests the effect of the device on shoulder pain and fatigue while operating the laparoscopic camera. The third phase rates surgeon experience in the operating room between case-matched operating days. RESULTS: Twenty subjects were recruited for this study. Surgeons had the similar dexterity scores and FLS times whether or not they wore the exosuit (p value ranges 0.15-0.84). All exosuit surgeons completed 15 min of holding laparoscopic camera compared to three non-exosuit surgeons (p < 0.02). Exosuit surgeons experienced significantly less fatigue at all time periods and arm pain (3.11 vs 5.88, p = 0.019) at 10 min. Surgeons wearing the exosuit during an operation experienced significant decrease in shoulder pain and 85% of surgeons reported some form of pain reduction at the end of the operative day. CONCLUSION: The progressive arm support exosuit can be a minimally intrusive device that laparoscopic surgeons wear to reduce pain and fatigue of surgery without significantly interfering with operative skills or manual dexterity.

The effect of shoulder strap width and load placement on shoulder-backpack interface pressure.

BACKGROUND: Pressure on the shoulder can be a major limiting factor to backpack use and poor design can lead to pain and injury. OBJECTIVE: To evaluate the effect of shoulder strap width and load placement in a backpack on the shoulder and axilla. METHODS: A manikin fitted with a backpack load of 20 kg mass and four different width straps (5, 6, 7, and 8 cm) was used. The load was placed high or low. Interface pressure sensors were placed over the shoulder and chest wall at the axilla. RESULTS: A significant interaction was observed between shoulder strap width and load placement. The positive effect of wide straps on shoulder pressure is greater with high load placement and the benefit of wide straps on axillary pressure is improved with low load placement. Interface pressure decreased significantly from narrow to wide straps. A large difference was noted between interface pressure on high and low load placement with narrow straps; however, as shoulder strap width increased, the difference between the two load placements decreased. CONCLUSION: The least amount of interface pressure was observed with 8 cm shoulder straps and high load placement. These findings should influence design and use of backpacks.

Sources of pain in laparoendoscopic gynecological surgeons: An analysis of ergonomic factors and proposal of an aid to improve comfort.

Minimally invasive surgery (MIS) offers cosmetic benefits to patients; however, surgeons often experience pain during MIS. We administered an ergonomic questionnaire to 176 Korean laparoscopic gynecological surgeons to determine potential sources of pain during surgery. Logistic regression analysis was used to identify factors that had a significant impact on gynecological surgeons' pain. Operating table height at the beginning of surgery and during the operation were significantly associated with neck and shoulder discomfort (P <0.001). The ability to control the operating table height was the single factor most significantly associated with neck (P <0.001) and shoulder discomfort (P <0.001). Discomfort of the hand/digits was significantly associated with the trocar site (P = 0.035). The type of electrocautery activation switch and foot pedal were significantly related to surgeons' foot and leg discomfort (P <0.001). In evaluating the co-occurrence of pain in 4 different sites (neck, shoulder, back, hand/digits), the neck and shoulder were determined to have the highest co-occurrence of pain (Spearman's ρ = 0.64, P <0.001). These results provide guidance for identifying ergonomic solutions to reduce gynecological laparoscopic surgeons' pain. Based on our results, we propose the use of an ergonomic surgical step stool to reduce physical pain related to performing laparoscopic operations.

Initial experience using a robotic-driven laparoscopic needle holder with ergonomic handle: assessment of surgeons' task performance and ergonomics.

PURPOSE: The objective of this study is to assess the surgeons' performance and ergonomics during the use of a robotic-driven needle holder in laparoscopic suturing tasks. METHODS: Six right-handed laparoscopic surgeons with different levels of experience took part in this study. Participants performed a set of three different intracorporeal suturing tasks organized in ten trials during a period of five weeks. Surgeons used both conventional (Conv) and robotic (Rob) laparoscopic needle holders. Precision using the surgical needle, quality of the intracorporeal suturing performance, execution time and leakage pressure for the urethrovesical anastomosis, as well as the ergonomics of the surgeon's hand posture, were analyzed during the first, fifth and last trials. RESULTS: No statistically significant differences in precision and quality of suturing performance were obtained between both groups of instruments. Surgeons required more time using the robotic instrument than using the conventional needle holder to perform the urethrovesical anastomosis, but execution time was significantly reduced after training ([Formula: see text] 0.05). There were no differences in leakage pressure for the anastomoses carried out by both instruments. After training, novice surgeons significantly improved the ergonomics of the wrist ([Formula: see text] 0.05) and index finger (Conv: 36.381[Formula: see text], Rob: 30.389[Formula: see text]; p = 0.024) when using the robotic instrument compared to the conventional needle holder. CONCLUSIONS: Results have shown that, although both instruments offer similar technical performance, the robotic-driven instrument results in better ergonomics for the surgeon's hand posture compared to the use of a conventional laparoscopic needle holder in intracorporeal suturing.

Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery.

OBJECTIVE: To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. METHODS: The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). RESULTS: There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ² test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (p<0.05). Gynecologists who felt highly confident about managing ergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (p<0.05). In minimizing their symptoms, surgeons changed ergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (p<0.05). The most common robotic system components to be improved for better ergonomics were microphone/speaker, pedal design, and finger clutch. CONCLUSION: More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery.

Ergonomic Benefits From a Laparoscopic Instrument With Rotatable Handle Piece Depend on the Area of the Operating Field and Working Height.

Objective To evaluate the effect of a laparoscopic instrument with a 360° rotatable handle piece (rot-HP) on biomechanical stress and precision in different areas of a simulated operating field at two working heights. Background Surgeons performing laparoscopic procedures are exposed to biomechanical stress and have an increased risk of musculoskeletal complaints. Method Fifty-seven healthy subjects (27 men, median age 26) without experience in laparoscopy performed a precision task in four quadrants (A-D) of the operating field using the rot-HP or a common fixed handle piece (fixed-HP) at an individually adjusted lower or higher working height. Biomechanical stress was assessed by surface EMG, wrist joint angles, and arm postures and precision by the number of mistakes. Results Using the rot-HP reduced muscle activity of the biceps brachii and flexor carpi radialis muscle. An interaction of flexor activity and area of the operating field occurred with the lowest activity in Quadrant C. Wrist joint angles were more neutral using the rot-HP, especially when the lower working height was applied and in Quadrants B and C. However, increased wrist dorsal flexion occurred in Quadrant A while using the rot-HP. Arm postures and precision were less affected. Conclusion The rot-HP allows some reductions of stresses in the arm and hand region, whereas the stress in the shoulder neck region is not modified. Application The instrument's position and the working height may have to be considered as mediatory factors when describing the effectiveness of an ergonomic handle design for laparoscopic instruments.

From dV-Trainer to Real Robotic Console: The Limitations of Robotic Skill Training.

OBJECTIVES: To investigate operators' performance quality, mental stress, and ergonomic habits through a training curriculum on robotic simulators. DESIGN: Forty volunteers without robotic surgery experience were recruited to practice 2 exercises on a dV-Trainer (dVT) for 14 hours. The simulator software (M-scorea) provided an automatic evaluation of the overall score for the surgeons' performance. Each participant provided a subjective difficulty score (validity to be proven) for each exercise. Their ergonomic habits were evaluated based on the workspace range and armrest load-validated criteria for evaluating the proficiency of using the armrest. They then repeated the same tasks on a da Vinci Surgical Skill Simulator for a final-level test. Their final scores were compared with their initial scores and the scores of 5 experts on the da Vinci Surgical Skill Simulator. RESULTS: A total of 14 hours of training on the dVT significantly improved the surgeons' performance scores to the expert level with a significantly reduced workload, but their ergonomic score was still far from the expert level. CONCLUSION: Sufficient training on the dVT improves novices' performance, reduces psychological stress, and inculcates better ergonomic habits. Among the evaluated criteria, novices had the most difficulty in achieving expert levels of ergonomic skills. The training benefits of robotic surgery simulators should be determined with quantified variables. The detection of the limitations during robotic training curricula could guide the targeted training and improve the training effect.

Comparison of the BackJoy SitSmart Relief and Spine Buddy LT1 H/C Ergonomic Chair Supports on Short-Term Neck and Back Pain.

OBJECTIVE: The purpose of this study was to perform a needs assessment to determine whether short-term use of BackJoy SitSmart Relief and Spine Buddy LT1 H/C chair supports influences neck, upper back, and lower back pain. METHODS: Forty-eight college students (age, 27.5 ± 6.3 years; height, 1.72 ± 0.08 m; body mass, 78.7 ± 19.8 kg; time seated that day, 4.3 ± 2.8 hours; means ± SD) were recruited for this study. The Nordic Musculoskeletal Questionnaire was used to measure pain for the neck, upper back, and lower back regions. Subjects were randomized to sit in a stationary office chair for a single 12-minute period under 1 of 4 conditions: office chair only (control group), BackJoy SitSmart Relief and chair, freezer-cooled Spine Buddy LT1 H/C and chair, or microwave-heated Spine Buddy LT1 H/C and chair. Participants then completed a posttest Nordic Musculoskeletal Questionnaire. A between-within repeated-measures analysis of variance using the between-subject factor intervention (group) and within-subject factor time (baseline and posttest) was used to analyze study data. RESULTS: The main effect of time across the whole sample was statistically significant for neck (P = .000), upper back (P = .032), and lower back (P = .000) pain; however, there was no statistically significant interaction effect between intervention and time. Thus, as long as participants sat down and rested, symptoms improved similarly across the different groups. CONCLUSIONS: In this preliminary study, short-term and single use of a support product for an office chair had no additive effect on reducing neck and back pain.

Do No Harm, Except to Ourselves? A Survey of Symptoms and Injuries in Oncologic Surgeons and Pilot Study of an Intraoperative Ergonomic Intervention.

BACKGROUND: Occupational symptoms and injuries incurred over a surgical career are under- reported, yet they have an impact on daily surgical practice. We assessed the frequency, consequences, and risk factors for occupational injury in oncologic surgeons and evaluated the feasibility of intraoperative foot mat use to mitigate occupational symptoms. STUDY DESIGN: Oncologic surgeons completed a survey of demographic information and occupational symptoms and injuries. Multivariate logistic regression was used to identify factors associated with occupational symptoms and injuries. A randomized cross-over pilot study of intraoperative foot mat use was conducted. RESULTS: One hundred twenty-seven surgeons completed surveys (response rate: 58%). The most commonly reported symptoms were fatigue, discomfort, stiffness, and back pain. An occupational injury was reported by 27.6% of surgeons. Of those injured, 65.7% received treatment, with 17.4% of those treated requiring surgery for their injury. In multivariate analysis, factors significantly associated with occupational injury were male sex (odds ratio [OR] 3.00, 95% CI 1.08 to 8.38), mean case length of 4 hours or more (OR 2.72, 95% CI 1.08 to 6.87), using a step to operate (OR 3.06, 95% CI 1.02 to 9.15), and neck pain (OR 4.81, 95% CI 1.64 to 14.12). In the foot mat pilot study (n = 20), mat use was associated with discomfort (OR 7.57, 95% CI 1.19 to 48.00), but no significant differences in leg volume change due to mat use were found. CONCLUSIONS: Most oncologic surgeons experience musculoskeletal symptoms from operating. Of the 28% of surgeons with an occupational injury, most required treatment. Intraoperative foot mat use was associated with increased discomfort.

Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair: demonstration of technique and matched-pair analysis.

OBJECTIVES: To present the technique and long-term results of retroperitoneal laparoscopic partial nephrectomy (LPN), focusing on the impact of an ergonomic platform. PATIENTS AND METHODS: Between January 2000 and May 2016, 287 patients (193 men, 94 women) underwent LPN performed by four surgeons. The median (range) patient age was 59 (19-85) years, tumour size 3.1 (1-9) cm and PADUA score 7.3 (6-12). Access was retroperitoneal in 235 cases (82%). Since October 2010, we have used the ETHOS™ chair (ETHOS™ , Seattle, WA, USA) during excision of the tumour in 130 patients (45.3%). A total of 51 tumours (17.7%) were excised without ischaemia and 226 (78.7%) under warm ischaemia, with clamping of the renal artery using an enucleo-resection technique. We suture the resection bed and perform renorrhaphy using a barbed-suture pre-loaded with absorbable LAPRA-TY™ clips (Ethicon, Somerville, NJ, USA). The impact of the ETHOS chair was examined using a matched-pair analysis (66 with ETHOS chair vs 67 without ETHOS chair). RESULTS: The median (range) operating time was 146 (60-325) min, the median (range) estimated blood loss was 99 (10-3 000) mL and the mean (range) warm ischaemia time (WIT) was 17.1 (7-47) min. Histology showed 240 (83.6%) renal cell carcinomas (RCCs) and 46 (15.9%) benign tumours. The cumulative overall disease-free survival rate after a median (range) follow-up of 84 (3-155) months was 100% for 203 pT1 RCCs and local recurrence was observed in one patient (0.4%), who was managed by radical nephrectomy. There were two conversions (0.7%) to open surgery, both to hand-assisted laparoscopy. Perirenal haematoma was observed in 13 patients (4.5%). A total of 20 patients (6.9%) required transfusions (2-11 units). We observed five urine leaks (1.7%) requiring prolonged drainage. The median (range) length of hospital stay was 5 (3-24) days. Three patients developed arteriovenous fistulas, which were successfully occluded by superselective embolization (1.0%). Use of the ETHOS chair resulted in shorter operating time (134.7 vs 168.5 min; P = 0.04), including WIT (13.1 vs 15.9 min; P = 0.01), and a lower complication rate (15 vs 29.8%; P = 0.02). CONCLUSIONS: Laparoscopic partial nephrectomy is technically difficult but oncologically effective. Standardization and simplification of endoscopic suturing using the ETHOS chair significantly improved the outcomes of the surgical procedure.

Participatory organizational intervention for improved use of assistive devices for patient transfer: study protocol for a single-blinded cluster randomized controlled trial.

BACKGROUND: Epidemiological studies have shown that patient transfer is a risk factor for back pain, back injuries and long term sickness absence, whereas consistent use of assistive devices during patient transfer seems to be protective. While classical ergonomic interventions based on education and training in lifting and transferring techniques have not proven to be effective in preventing back pain, participatory ergonomics, that is meant to engage and motivate the involved parties while at the same time making the intervention maximally relevant, may represent a better solution. However, these findings are largely based on uncontrolled studies and thus lack to be confirmed by studies with better study designs. In this article, we present the design of a study which aims to evaluate the effect and process of a participatory organizational intervention for improved use of assistive devices. METHODS: The study was performed as a cluster randomized controlled trial. We recruited 27 departments (clusters) from five hospitals in Denmark to participate in the study. Prior to randomization, interviews, observations and questionnaire answers (baseline questionnaire) were collected to gain knowledge of barriers and potential solutions for better use of assistive devices. In April 2016, the 27 departments were randomly allocated using a random numbers table to a participatory intervention (14 clusters, 324 healthcare workers) or a control group (13 clusters, 318 healthcare workers). The participatory intervention will consist of workshops with leaders and selected healthcare workers of each department. Workshop participants will be asked to discuss the identified barriers, develop solutions for increasing the use of assistive devices and implement them in their department. Use of assistive devices (using digital counters -, primary outcome, and accelerometers and questionnaire - secondary outcome), perceived physical exertion during patient transfer, pain intensity in the lower back, occurrence of work-related back injuries during patient transfer, organizational readiness to change, knowledge on how to perform proper patient transfer, social capital and work ability (secondary outcomes) were assessed at baseline and will also be assessed at 1 year follow-up. Process evaluation will be based on qualitative and quantitative data to assess the implementation, the change process, and the impact of context aspects. DISCUSSION: The study will evaluate the effect and process of a participatory intervention on improving the use of assistive devices for patient transfer among hospital healthcare workers. By using cluster-randomization, as well as process- and effect evaluation based on objective measures we will contribute to the evidence base of a promising intervention approach. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02708550 ). March, 2016.

Comparative Study of Performance in Ultrasonic Tissue Dissection for Sleeve Gastrectomy: Wired versus Cordless.

BACKGROUND: The sleeve gastrectomy is being performed increasingly as a primary procedure for the treatment of morbid obesity. A minimally invasive approach is currently applied to the procedure. The two major steps are dissection and stapling. For dissection, several tools have been developed. The goal of this study was to compare the efficiency and the ergonomics of two ultrasonic devices during the sleeve gastrectomy. MATERIALS AND METHODS: Thirty patients were randomised for the use of a cordless Sonicision™ (Covidien, Mansfield, MA) or a cord-containing HARMONIC ACE®+ (Ethicon Endo-Surgery Inc., Cincinnati, OH) during dissection. Both devices were assessed for objective and subjective measures. RESULTS: There was no significant difference in duration of the procedures. The assembly and installation time of the Sonicision™ were significantly shorter; however, the dismantle time was not. No difference in plume formation or dissection failures was found between the devices. Scrub nurses scored the Sonicision™ significantly clearer and easier in use and more reliable. The surgeons, however, did not find one of the devices easier in use, more reliable or precise, but they did report better manoeuvrability of the Sonicision™. CONCLUSION: In comparison to the wired HARMONIC ACE®+, during sleeve gastrectomy, the cordless Sonicision™ was considered easier to use, faster during assembling and installation, and more reliable with better manoeuvrability. Surgeons scored both devices equally effective. Both ultrasonic devices can be used easily and safely for a sleeve gastrectomy.

Discomfort of seated persons exposed to low frequency lateral and roll oscillation: Effect of backrest height.

Backrests influence the comfort of seated people. With 21 subjects sitting with three backrest heights (no backrest, short backrest, high backrest) discomfort caused by lateral, roll, and fully roll-compensated lateral oscillation was investigated at frequencies between 0.25 and 1.0 Hz. With lateral oscillation, the short backrest reduced discomfort at frequencies less than 0.63 Hz and the high backrest reduced discomfort at frequencies less than 1.0 Hz. With roll oscillation, the high backrest reduced discomfort at frequencies less than 0.63 Hz, but increased discomfort at 1.0 Hz. With fully roll-compensated lateral oscillation, the short backrest reduced discomfort at 0.4 Hz and the high backrest reduced discomfort at 0.5 and 0.63 Hz. As predicted by current standards, a backrest can increase discomfort caused by high frequencies of vibration. However, a backrest can reduce discomfort caused by low frequencies, with the benefit depending on the frequency and direction of oscillation and backrest height.