The emotional and cognitive impact of the unexpected death in the simulation lab / Impacto emocional y cognitivo de la muerte inesperada en el laboratorio de simulación

INTRODUCTION: The impact of animal death on surgeons during training in laparoscopic techniques is unknown. METHODS: Emotions and cognitive load were assessed depending on animal survival. RESULTS: Those exposed to animal death (n=14) had higher levels of sadness (1.3) and anxiety (2.4), and lower levels of happiness (6.1) on a one-to-ten scale, compared to the 56 that were non-exposed (1.0/2.0/7.5). Mean cognitive load was 68.21±12.865 in the exposed and 64.74±14.632 in the non-exposed (p > 0.05). CONCLUSIONS: Emotions and cognitive load among surgeons training in laparoscopic techniques were similar, regardless animal survival after the surgical procedure

INTRODUCCIÓN: Se desconoce el impacto de la muerte animal en los cirujanos durante el entrenamiento en técnicas laparoscópicas. MÉTODOS: Se evaluaron emociones y carga cognitiva dependiendo de la exposición a la muerte del animal. RESULTADOS: Los 14 expuestos tuvieron niveles de tristeza (1,3) y ansiedad (2,4) más altos, y de felicidad más bajos (6,1), que los 56 no expuestos (1,0/2,0/7,5). La carga cognitiva fue 68,21±12,865 en los expuestos y 64,74±14,632 en los no expuestos. (p > 0,05). CONCLUSIONES: Emociones y carga cognitiva de cirujanos durante el entrenamiento en técnicas laparoscópicas fueron similares independientemente de la supervivencia del animal

Ergonomic evaluation and performance of a new handle for laparoscopic tools in surgery.

This paper presents a new handle for instruments used in laparoscopic surgery. This new handle has been designed to provide the best ergonomic and usability features required in this kind of surgical interventions. The main novelty of this handle is that the opening and closing motion of the end-effector is operated with the thumb using a lever located on the top of the handle. This enables the surgeon to reach the patient's organs without adopting extremely awkward postures. In order to demonstrate its advantages, the handle has been tested and compared with another commercial handle in terms of efficiency, effectiveness, and satisfaction. To this end, volunteers have been selected for participation in the experimental evaluation, which comprised two types of surveys: objective and subjective. Electromyography and goniometric studies provide objective parameters for evaluation. Questionnaires are used for the subjective assessment. Outstanding results include the lower level of pain reported by the individuals working with the new handle, as well as the reduction in the hyperflexion of the wrist. Compared with the conventional handle, electromyography reveals that no muscle load is increased when working with the new handle. The results of the subjective survey show that volunteers expressed a significant preference for the new handle, demonstrating an improvement in the ergonomic characteristics.

Using infrared imaging for assessment of muscular activity in the forearm of surgeons in the performance of laparoscopic tasks.

Surgeons working in laparoscopic surgery are subjected to hard working conditions because of the poor ergonomic characteristics of the workplace. The improvement in the working conditions requires the use of reliable techniques for the assessment of muscular activity. In this article infrared imaging is used and compared with electromyography for the evaluation of muscle activity in the performance of laparoscopic surgical tasks. Electromyography has been widely used for the evaluation of the electrical activity produced by the muscles in the performance of surgery. On the contrary, infrared imaging is an innovative technique that has not been sufficiently explored. An experimental evaluation was carried out using a thermography camera and recording the infrared images from volunteers in different tests. Pearson's correlation was obtained between the electromyography and thermographic measurements in two stages: Endurance Stage (best value: ρ = 0.8401 with p < 0.01) and Surgical Task (best value: ρ = 0.8309 with p < 0.01). The article demonstrates that infrared imaging is a valuable technique for the evaluation of muscle activity in laparoscopic surgery, and it can be compared with electromyography. The main advantages of infrared imaging are that it allows remote measurement and provides activity information in the whole area of interest. However, drawbacks such as delayed response of the infrared imaging due to thermal conductivity of the skin should be considered. Electromyography only provides information in the location of the electrodes, but it is a real-time response. For these reasons, the techniques complement each other.

A study of the prevalence of musculoskeletal disorders in surgeons performing minimally invasive surgery.

INTRODUCTION: Minimally invasive surgery (MIS) has shown significant benefits for patients and healthcare systems. However, due to the poor ergonomic adaptation of operating rooms and surgical instruments, most surgeons suffer from pain caused by musculoskeletal disorders (MSDs). METHODS: A descriptive survey on MIS surgeons working in different surgical specialties has been carried out in Hospital Valdecilla (Spain). The aim is to determine the prevalence of MSDs using a personal interview and the standardized Nordic questionnaire. The study determines the prevalence of MSDs in different parts of the body and their relationship with epidemiological and labor variables. A questionnaire was filled out by 129 surgeons. RESULTS: 90% of surgeons reported MSDs. The higher prevalence appears in the most experienced surgeons. The most affected zones are the lower back (54%), neck (51%), upper back (44%), lower extremities (42%), right shoulder (29%) and right hand (28%). CONCLUSIONS: The prevalence of MSDs is higher in MIS surgeons than in any other occupational group. The most vulnerable group is experienced surgeons and there is a potential risk that symptoms will be increased in the future. Muscle strength is revealed as a protective factor against MSDs.

La simulación clínica como herramienta para facilitar el cambio de cultura en las organizaciones de salud: aplicación práctica de la teoría avanzada del aprendizaje / Clinical simulation as a tool to facilitate culture change in healthcare: Practical application of advanced learning theory

RESUMEN Introducción: Las organizaciones sanitarias continúan aumentando su complejidad. La mayoría de efectos adversos son causados por problemas inherentes a los procesos utilizados. Objetivo: Comprender el valor del entrenamiento de equipos con simulación para promover un enfoque orientado al sistema, centrado en el paciente y conducido por equipos interprofesionales. Metodología: Reflexión sobre estrategias de simulación para afrontar cambios organizativos. Resultados: Equipos interprofesionales fueron capaces de proporcionar sedación de modo seguro para procedimientos de colonoscopia, y para promover el diagnóstico precoz y el rápido tratamiento de pacientes con sepsis severa. Conclusión: La simulación clínica proporciona un entorno seguro para reorganizar el cuidado en salud y entrenar profesionales a trabajar en equipo.

ABSTRACT Introduction: Healthcare continues to grow in complexity. Numerous publications have confirmed that most adverse events are caused by inherent problems within the processes being used, which implies that reengineering the systems can reduce the incidence of error. Objective: To understand the value of team education with clinical simulation to promote a systems-oriented, multidisciplinary team-driven, patient-centered approach for optimal patient outcomes. Methodology: We present several simulation-based strategies as an example on how to cope with changes at the organizational level. Results: After simulation based training inter-professional teams were able to safely provide sedation for colonoscopy, and to enhance teamwork for early detection and goal-directed treatment of sepsis in the surgical ward. Conclusion: Clinical simulation provides a safe environment to reorganize care and train professionals to work in teams.

Design and evaluation of a new ergonomic handle for instruments in minimally invasive surgery.

BACKGROUND: Laparoscopic surgery techniques have been demonstrated to provide massive benefits to patients. However, surgeons are subjected to hardworking conditions because of the poor ergonomic design of the instruments. In this article, a new ergonomic handle design is presented. This handle is designed using ergonomic principles, trying to provide both more intuitive manipulation of the instrument and a shape that reduces the high-pressure zones in the contact with the surgeon's hand. MATERIALS AND METHODS: The ergonomic characteristics of the new handle were evaluated using objective and subjective studies. The experimental evaluation was performed using 28 volunteers by means of the comparison of the new handle with the ring-handle (RH) concept in an instrument available on the market. The volunteers' muscle activation and motions of the hand, wrist, and arm were studied while they performed different tasks. The data measured in the experiment include electromyography and goniometry values. RESULTS: The results obtained from the subjective analysis reveal that most volunteers (64%) preferred the new prototype to the RH, reporting less pain and less difficulty to complete the tasks. The results from the objective study reveal that the hyperflexion of the wrist required for the manipulation of the instrument is strongly reduced. CONCLUSIONS: The new ergonomic handle not only provides important ergonomic advantages but also improves the efficiency when completing the tasks. Compared with RH instruments, the new prototype reduced the high-pressure areas and the extreme motions of the wrist.