Perceived comfort and tool usability during robot-assisted and traditional laparoscopic surgery: a survey study.

It is known that over half of previously surveyed surgeons performing Robot-Assisted Laparoscopic Surgery (RALS) and three-quarters of those performing Traditional Laparoscopic Surgery (TLS) experience intraoperative pain. This survey study aimed to expand upon the ongoing impact of that pain as well as perceived tool usability associated with TLS and RALS, for which considerably less documentation exists. A survey regarding the presence and impact, either immediate or ongoing, of intraoperative pain and Likert scale questions regarding tool usability was administered to TLS and RALS surgeons on the European Association for Endoscopic Surgery (EAES) mailing list. Prevalence statistics as well as trends based on biological sex and glove size were obtained from the 323 responses. Most respondents were right-handed European males (83-88%) with a medium glove size (55.8%). Moderate or severe shoulder symptoms were experienced by one-third of TLS surgeons. Twenty-one percent of RALS surgeons experienced neck symptoms that impacted their concentration. Small-handed surgeons experienced wrist symptoms significantly more frequently than large-handed surgeons, regardless of modality. RALS was associated with a significantly more optimal back and wrist posture compared to TLS. TLS surgeons reported increased ease with applying and moderating force while operating. These results suggest that intraoperative pain may be severe enough in many cases to interfere with surgeon concentration, negatively impacting patient care. Continuing to understand the relationship between tool usability and comfort is crucial in guaranteeing the health and well-being of both surgeons and patients.

Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis.

INTRODUCTION: Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry. METHODS: PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses. RESULTS: A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools. CONCLUSIONS: The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.

Validation of 3-Space Wireless Inertial Measurement Units Using an Industrial Robot.

Inertial Measurement Units (IMUs) are beneficial for motion tracking as, in contrast to most optical motion capture systems, IMU systems do not require a dedicated lab. However, IMUs are affected by electromagnetic noise and may exhibit drift over time; it is therefore common practice to compare their performance to another system of high accuracy before use. The 3-Space IMUs have only been validated in two previous studies with limited testing protocols. This study utilized an IRB 2600 industrial robot to evaluate the performance of the IMUs for the three sensor fusion methods provided in the 3-Space software. Testing consisted of programmed motion sequences including 360° rotations and linear translations of 800 mm in opposite directions for each axis at three different velocities, as well as static trials. The magnetometer was disabled to assess the accuracy of the IMUs in an environment containing electromagnetic noise. The Root-Mean-Square Error (RMSE) of the sensor orientation ranged between 0.2° and 12.5° across trials; average drift was 0.4°. The performance of the three filters was determined to be comparable. This study demonstrates that the 3-Space sensors may be utilized in an environment containing metal or electromagnetic noise with a RMSE below 10° in most cases.

Delivery of Inhaled Nitric Oxide During MRI to Ventilated Neonates and Infants.

BACKGROUND: Many pediatric and neonatal ICU patients receive nitric oxide (NO), with some also requiring magnetic resonance imaging (MRI) scans. MRI-compatible NO delivery devices are not always available. We describe and bench test a method of delivering NO during MRI using standard equipment in which a NO delivery device was positioned in the MRI control room with the NO blender component connected to oxygen and set to 80 ppm and delivering flow via 12 m of tubing to a MRI-compatible ventilator, set up inside the MRI scanner magnet room. METHODS: For our bench test, the ventilator was set up normally and connected to an infant test lung to simulate several patients of differing weight (ie, 4 kg, 10 kg, 20 kg). The NO blender delivered flows of 2-10 L/min to the ventilator to achieve a range of NO and oxygen concentrations monitored via extended tubing. The measured values were compared to calculated values. RESULTS: A range of NO concentrations (12-41 ppm) and FIO2 values (0.67-0.97) were achieved during the bench testing. The additional flow increased delivered peak inspiratory pressure and PEEP by 1-5 cm H2O. Calculated values were within acceptable ranges and were used to create a lookup table. CONCLUSIONS: In clinical use, this system can safely generate a range of NO flows of 15-42 ppm with an accompanying FIO2 range of 0.34-0.98.

Self-reported prevalence of injury and discomfort experienced by surgeons performing traditional and robot-assisted laparoscopic surgery: a meta-analysis demonstrating the value of RALS for surgeons.

BACKGROUND: The negative impact of traditional laparoscopic surgery (TLS) on surgeons has been well-established. Prevalence rates of discomfort and injury between 73% and 90% are regularly cited to support this, with robot-assisted laparoscopic surgery (RALS) often being presented as the solution. The purpose of this study was to systematically review pain studies of TLS and RALS surgeons, to consider the difference in the reported strain in general and concerning specific sites of the body. METHODS: PubMed, Embase, and Cochrane databases were searched in October 2019. The resulting articles were screened to ensure the full text was available in English, original data were presented, the study contained pain statistics for TLS or RALS, and the study had a long-term rather than an intra-operative focus. Quality was assessed using the SUrvey Reporting GuidelinE (SURGE). Results from studies were analyzed in two stages for TLS and RALS according to each anatomic region. RESULTS: A total of 1354 papers were found, from which 28 papers were chosen for inclusion. The average quality score of the included articles was 14.8. The risk ratio of experiencing symptoms related to TLS in comparison to RALS was 1.29; however, this was not significant. Discomfort was significantly more likely to be experienced in the back, elbows, and wrists/hands for those practicing TLS in comparison with RALS. The regions associated with the highest risk of injury for TLS and RALS were the back and neck, respectively. CONCLUSIONS: There is limited evidence in this study for the possibility that RALS is ergonomically more beneficial for the surgeon in comparison with TLS. Further analysis would be improved with the publication of larger, high-quality, homogenous studies, especially concerning injuries experienced by RALS surgeons, to overcome the limitations of heterogeneity and bias.

Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis.

BACKGROUND: The repetitive and forceful motions used by operating surgeons increase the risk of developing musculoskeletal disorders. Most ergonomists consider the surgical environment to be incredibly harsh for its workers. Traditional Laparoscopic Surgery (TLS) in particular has a number of physical and mental challenges associated with it, and while Robotic-Assisted Laparoscopic Surgery (RALS) provides several features that improve upon TLS, some surgeons have still reported musculoskeletal symptoms they attribute to RALS. In this paper, we endeavored to systematically review muscle activation for both TLS and RALS, to compare the modalities and present the results as a meta-analysis. METHODS: A literature search was conducted using Pubmed, Embase, and Cochrane databases in November 2018 with the following inclusion criteria: full text was available in English, the paper contained original data, EMG was one of the primary measurement techniques, and the paper included EMG data for both TLS and RALS. Results from studies were compared using standardized mean difference analysis. RESULTS: A total of 379 papers were found, and through screening ten were selected for inclusion. Sample populations ranged from 1 to 31 surgeons, and a variety of study designs and metrics were used between studies. The biceps were the only muscle group that consistently and significantly demonstrated lower muscle activation for RALS for all included studies. CONCLUSIONS: The results may support the belief that RALS is ergonomically superior to TLS, shown through generally lower muscle activation scores. However, these results must be interpreted with caution due to the heterogeneity between the studies and multiple potential sources for bias within studies. This analysis would be strengthened with a higher number of homogenous, high-quality studies examining larger sample sizes.