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Laparoscopy Versus Robotics: Ergonomics—Does It Matter?

  • Theodoros Tokas
  • Ali Serdar Gözen
  • Jan Klein
  • Alexandra Tschada
  • Thomas Frede
  • Dogu Teber
  • Jens Rassweiler
Chapter

Abstract

Laparoscopy offers significant benefits to the patients, mainly due to its minimally invasive nature. Nevertheless, it is also characterized by significant ergonomic limitations which make it tedious for the surgeon. Robotic surgery seems to offer a valid solution to this problem but is also accompanied by several important ergonomic handicaps. In this chapter, we want to focus on the ergonomic problems of laparoscopy, in comparison to the da Vinci system, based on the current literature and personal long-term experience with both techniques. Additionally, we present different solutions to the ergonomic predicaments that one may encounter during a complex procedure, and future perspectives that could aid in the creation of ergonomically designed operating theatres for minimally invasive procedures.

Keywords

Laparoscopy Ergonomics Robotic surgery da Vinci Surgeon posture Laparoscopic instruments 

Notes

Acknowledgement

The authors would specially like to thank Nikos Vatsitsis for preparing the graphics of this chapter.

References

  1. 1.
    Vereczkel A, Bubb H, Feussner H. Laparoscopic surgery and ergonomics: it’s time to think of ourselves as well. Surg Endosc. 2003;17(10):1680–2.  https://doi.org/10.1007/s00464-003-9020-1.CrossRefPubMedGoogle Scholar
  2. 2.
    Hemal AK, Srinivas M, Charles AR. Ergonomic problems associated with laparoscopy. J Endourol. 2001;15(5):499–503.  https://doi.org/10.1089/089277901750299294.CrossRefPubMedGoogle Scholar
  3. 3.
    Wauben LS, van Veelen MA, Gossot D, Goossens RH. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc. 2006;20(8):1268–74.  https://doi.org/10.1007/s00464-005-0647-y.CrossRefPubMedGoogle Scholar
  4. 4.
    Berguer R, Forkey DL, Smith WD. Ergonomic problems associated with laparoscopic surgery. Surg Endosc. 1999;13(5):466–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Deinhardt. Manipulators and integrated OR systems - requirements and solutions. Minim Invasive Ther Allied Technol. 2003;12(6):284–92.  https://doi.org/10.1080/13645700310018515.CrossRefPubMedGoogle Scholar
  6. 6.
    Stone R, McCloy R. Ergonomics in medicine and surgery. BMJ. 2004;328(7448):1115–8.  https://doi.org/10.1136/bmj.328.7448.1115.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Koneczny S, Matern U. Instruments for the evaluation of ergonomics in surgery. Minim Invasive Ther Allied Technol. 2004;13(3):167–77.  https://doi.org/10.1080/13645700410033652.CrossRefPubMedGoogle Scholar
  8. 8.
    van Veelen MA, Kazemier G, Koopman J, Goossens RH, Meijer DW. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech A. 2002;12(1):47–52.  https://doi.org/10.1089/109264202753486920.CrossRefPubMedGoogle Scholar
  9. 9.
    Matern U, Koneczny S. Safety, hazards and ergonomics in the operating room. Surg Endosc. 2007;21(11):1965–9.  https://doi.org/10.1007/s00464-007-9396-4.CrossRefPubMedGoogle Scholar
  10. 10.
    Binder J, Kramer W. Robotically—assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Rassweiler J, Frede T, Seemann O, Stock C, Sentker L. Telesurgical laparoscopic radical prostatectomy. Initial experience. Eur Urol. 2001;40(1):75–83.  https://doi.org/10.1159/000049752.CrossRefPubMedGoogle Scholar
  12. 12.
    Rassweiler J, Binder J, Frede T. Robotic and telesurgery: will they change our future? Curr Opin Urol. 2001;11(3):309–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Hemal AK, Menon M. Robotics in urology. Curr Opin Urol. 2004;14(2):89–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Binder J, Brautigam R, Jonas D, Bentas W. Robotic surgery in urology: fact or fantasy? BJU Int. 2004;94(8):1183–7.  https://doi.org/10.1046/j.1464-410x.2004.05130.x.CrossRefPubMedGoogle Scholar
  15. 15.
    Dasgupta P, Jones A, Gill IS. Robotic urological surgery: a perspective. BJU Int. 2005;95(1):20–3.  https://doi.org/10.1111/j.1464-410X.2005.05241.x.CrossRefPubMedGoogle Scholar
  16. 16.
    Rassweiler J, Hruza M, Teber D, Su LM. Laparoscopic and robotic assisted radical prostatectomy—critical analysis of the results. Eur Urol. 2006;49(4):612–24.  https://doi.org/10.1016/j.eururo.2005.12.054.CrossRefPubMedGoogle Scholar
  17. 17.
    Lux MM, Marshall M, Erturk E, Joseph JV. Ergonomic evaluation and guidelines for use of the daVinci robot system. J Endourol. 2010;24(3):371–5.  https://doi.org/10.1089/end.2009.0197.CrossRefPubMedGoogle Scholar
  18. 18.
    Reyes DA, Tang B, Cuschieri A. Minimal access surgery (MAS)-related surgeon morbidity syndromes. Surg Endosc. 2006;20(1):1–13.  https://doi.org/10.1007/s00464-005-0315-2.CrossRefPubMedGoogle Scholar
  19. 19.
    van der Schatte Olivier RH, Van’t Hullenaar CD, Ruurda JP, Broeders IA. Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc. 2009;23(6):1365–71.  https://doi.org/10.1007/s00464-008-0184-6.CrossRefPubMedGoogle Scholar
  20. 20.
    van Det MJ, Meijerink WJ, Hoff C, van Veelen MA, Pierie JP. Ergonomic assessment of neck posture in the minimally invasive surgery suite during laparoscopic cholecystectomy. Surg Endosc. 2008;22(11):2421–7.  https://doi.org/10.1007/s00464-008-0042-6.CrossRefPubMedGoogle Scholar
  21. 21.
    Mitre AI, Duarte RJ, Arap MA, Coelho RF, Lopes RI, Trigo-Rocha F, Srougi M. Ergonomic aspects related to surgeon position in laparoscopic radical prostatectomy. J Endourol. 2009;23(2):259–62.  https://doi.org/10.1089/end.2008.0434.CrossRefPubMedGoogle Scholar
  22. 22.
    Gofrit ON, Mikahail AA, Zorn KC, Zagaja GP, Steinberg GD, Shalhav AL. Surgeons’ perceptions and injuries during and after urologic laparoscopic surgery. Urology. 2008;71(3):404–7.  https://doi.org/10.1016/j.urology.2007.07.077.CrossRefPubMedGoogle Scholar
  23. 23.
    Johnston WK 3rd, Hollenbeck BK, Wolf JS Jr. Comparison of neuromuscular injuries to the surgeon during hand-assisted and standard laparoscopic urologic surgery. J Endourol. 2005;19(3):377–81.  https://doi.org/10.1089/end.2005.19.377.CrossRefPubMedGoogle Scholar
  24. 24.
    Wolf JS Jr, Marcovich R, Gill IS, Sung GT, Kavoussi LR, Clayman RV, McDougall EM, Shalhav A, Dunn MD, Afane JS, Moore RG, Parra RO, Winfield HN, Sosa RE, Chen RN, Moran ME, Nakada SY, Hamilton BD, Albala DM, Koleski F, Das S, Adams JB, Polascik TJ. Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery. Urology. 2000;55(6):831–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Lee G, Lee T, Dexter D, Godinez C, Meenaghan N, Catania R, Park A. Ergonomic risk associated with assisting in minimally invasive surgery. Surg Endosc. 2009;23(1):182–8.  https://doi.org/10.1007/s00464-008-0141-4.CrossRefPubMedGoogle Scholar
  26. 26.
    Matern U, Waller P. Instruments for minimally invasive surgery: principles of ergonomic handles. Surg Endosc. 1999;13(2):174–82.CrossRefPubMedGoogle Scholar
  27. 27.
    Vereczkei A, Feussner H, Negele T, Fritzsche F, Seitz T, Bubb H, Horvath OP. Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy. Surg Endosc. 2004;18(7):1118–22.  https://doi.org/10.1007/s00464-003-9157-y.CrossRefPubMedGoogle Scholar
  28. 28.
    van Det MJ, Meijerink WJ, Hoff C, Totte ER, Pierie JP. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc. 2009;23(6):1279–85.  https://doi.org/10.1007/s00464-008-0148-x.CrossRefPubMedGoogle Scholar
  29. 29.
    Matern U. Ergonomic deficiencies in the operating room: examples from minimally invasive surgery. Work. 2009;33(2):165–8.  https://doi.org/10.3233/wor-2009-0862.CrossRefPubMedGoogle Scholar
  30. 30.
    Breedveld P, Stassen HG, Meijer DW, Jakimowicz JJ. Manipulation in laparoscopic surgery: overview of impeding effects and supporting aids. J Laparoendosc Adv Surg Tech A. 1999;9(6):469–80.CrossRefPubMedGoogle Scholar
  31. 31.
    Uhrich ML, Underwood RA, Standeven JW, Soper NJ, Engsberg JR. Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery. Surg Endosc. 2002;16(4):635–9.  https://doi.org/10.1007/s00464-001-8151-5.CrossRefPubMedGoogle Scholar
  32. 32.
    Hanna GB, Shimi SM, Cuschieri A. Task performance in endoscopic surgery is influenced by location of the image display. Ann Surg. 1998;227(4):481–4.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Schurr MO, Kunert W, Arezzo A, Buess G. The role and future of endoscopic imaging systems. Endoscopy. 1999;31(7):557–62.  https://doi.org/10.1055/s-1999-52.CrossRefPubMedGoogle Scholar
  34. 34.
    Pietrabissa A, Scarcello E, Carobbi A, Mosca F. Three-dimensional versus two-dimensional video system for the trained endoscopic surgeon and the beginner. Endosc Surg Allied Technol. 1994;2(6):315–7.PubMedGoogle Scholar
  35. 35.
    McDougall EM, Soble JJ, Wolf JS Jr, Nakada SY, Elashry OM, Clayman RV. Comparison of three-dimensional and two-dimensional laparoscopic video systems. J Endourol. 1996;10(4):371–4.CrossRefPubMedGoogle Scholar
  36. 36.
    van Veelen, Jakimowicz, Kazemier. Improved physical ergonomics of laparoscopic surgery. Minim Invasive Ther Allied Technol. 2004;13(3):161–6. doi: https://doi.org/10.1080/13645700410033193.
  37. 37.
    Frede T, Hammady A, Klein J, Teber D, Inaki N, Waseda M, Buess G, Rassweiler J. The radius surgical system—a new device for complex minimally invasive procedures in urology? Eur Urol. 2007;51(4):1015–22.; discussion 1022.  https://doi.org/10.1016/j.eururo.2006.11.046.CrossRefPubMedGoogle Scholar
  38. 38.
    Frede T, Stock C, Renner C, Budair Z, Abdel-Salam Y, Rassweiler J. Geometry of laparoscopic suturing and knotting techniques. J Endourol. 1999;13(3):191–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Frede T, Stock C, Rassweiler JJ, Alken P. Retroperitoneoscopic and laparoscopic suturing: tips and strategies for improving efficiency. J Endourol. 2000;14(10):905–13. discussion 913-904.CrossRefPubMedGoogle Scholar
  40. 40.
    Schurr MO, Buess GF, Wieth F, Saile HJ, Botsch M. Ergonomic surgeon's chair for use during minimally invasive surgery. Surg Laparosc Endosc Percutan Tech. 1999;9(4):244–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Albayrak A, van Veelen MA, Prins JF, Snijders CJ, de Ridder H, Kazemier G. A newly designed ergonomic body support for surgeons. Surg Endosc. 2007;21(10):1835–40.  https://doi.org/10.1007/s00464-007-9249-1.CrossRefPubMedGoogle Scholar
  42. 42.
    Rassweiler JJ, Goezen AS, Jalal AA, Schulze M, Pansadoro V, Pini G, Kim F, Turner C. A new platform improving the ergonomics of laparoscopic surgery: initial clinical evaluation of the prototype. Eur Urol. 2012;61(1):226–9.  https://doi.org/10.1016/j.eururo.2011.09.018.CrossRefPubMedGoogle Scholar
  43. 43.
    Gozen AS, Tokas T, Tschada A, Jalal A, Klein J, Rassweiler J. Direct comparison of the different conventional laparoscopic positions with the ethos surgical platform in a laparoscopic pelvic surgery simulation setting. J Endourol. 2015;29(1):95–9.  https://doi.org/10.1089/end.2014.0051.CrossRefPubMedGoogle Scholar
  44. 44.
    Tokas T, Gözen AS, Tschada A, Rassweiler J. PD18-11 a laparoscopic combination with comparable ergonomic results to robotic surgery, tested in an experimental laparoscopic radical prostatectomy setting. J Urol. 193(4):e390. doi:10.1016/jjuro201502.696.Google Scholar
  45. 45.
    Berguer R, Smith W. An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res. 2006;134(1):87–92.  https://doi.org/10.1016/j.jss.2005.10.003.CrossRefPubMedGoogle Scholar
  46. 46.
    Lee EC, Rafiq A, Merrell R, Ackerman R, Dennerlein JT. Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems. Surg Endosc. 2005;19(8):1064–70.  https://doi.org/10.1007/s00464-004-8213-6.CrossRefPubMedGoogle Scholar
  47. 47.
    Bagrodia A, Raman JD. Ergonomics considerations of radical prostatectomy: physician perspective of open, laparoscopic, and robot-assisted techniques. J Endourol. 2009;23(4):627–33.  https://doi.org/10.1089/end.2008.0556.CrossRefPubMedGoogle Scholar
  48. 48.
    Chandra V, Nehra D, Parent R, Woo R, Reyes R, Hernandez-Boussard T, Dutta S. A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery. 2010;147(6):830–9.  https://doi.org/10.1016/j.surg.2009.11.002.CrossRefPubMedGoogle Scholar
  49. 49.
    Hubert N, Gilles M, Desbrosses K, Meyer JP, Felblinger J, Hubert J. Ergonomic assessment of the surgeon’s physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot. 2013;9(2):142–7.  https://doi.org/10.1002/rcs.1489.CrossRefPubMedGoogle Scholar
  50. 50.
    Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR. Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc. 2014;28(2):456–65.  https://doi.org/10.1007/s00464-013-3213-z.CrossRefPubMedGoogle Scholar
  51. 51.
    Tse MA, Masters RS, McManus AM, Lo CY, Patil NG. Trunk muscle training, posture fatigue, and performance in laparoscopic surgery. J Endourol. 2008;22(5):1053–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Kenngott HG, Muller-Stich BP, Reiter MA, Rassweiler J, Gutt CN. Robotic suturing: technique and benefit in advanced laparoscopic surgery. Minim Invasive Ther Allied Technol. 2008;17(3):160–7.  https://doi.org/10.1080/13645700802103381.CrossRefPubMedGoogle Scholar
  53. 53.
    Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009;55(5):1037–63.  https://doi.org/10.1016/j.eururo.2009.01.036.CrossRefPubMedGoogle Scholar
  54. 54.
    Rassweiler J, Klein J, Teber D, Schulze M, Frede T. Mechanical simulators for training for laparoscopic surgery in urology. J Endourol. 2007;21(3):252–62.  https://doi.org/10.1089/end.2007.9983.CrossRefPubMedGoogle Scholar
  55. 55.
    Baumhauer M, Feuerstein M, Meinzer HP, Rassweiler J. Navigation in endoscopic soft tissue surgery: perspectives and limitations. J Endourol. 2008;22(4):751–66.  https://doi.org/10.1089/end.2007.9827.CrossRefPubMedGoogle Scholar
  56. 56.
    Stolzenburg JU, Truss MC, Do M, Rabenalt R, Pfeiffer H, Dunzinger M, Aedtner B, Stief CG, Jonas U, Dorschner W. Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE)—technical improvements and development of a nerve-sparing, potency-preserving approach. World J Urol. 2003;21(3):147–52.  https://doi.org/10.1007/s00345-003-0351-2.CrossRefPubMedGoogle Scholar
  57. 57.
    Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol. 2000;163(6):1643–9.CrossRefPubMedGoogle Scholar
  58. 58.
    Lee DH, Choi J, Park JW, Bach DJ, Song SJ, Kim YH, Jo Y, Sun K. An implementation of sensor-based force feedback in a compact laparoscopic surgery robot. ASAIO J. 2009;55(1):83–5.  https://doi.org/10.1097/MAT.0b013e31819018e7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Theodoros Tokas
    • 1
  • Ali Serdar Gözen
    • 2
  • Jan Klein
    • 3
  • Alexandra Tschada
    • 4
  • Thomas Frede
    • 5
  • Dogu Teber
    • 6
  • Jens Rassweiler
    • 2
  1. 1.Department of Urology and AndrologyGeneral Hospital Hall i.THall in TirolAustria
  2. 2.Department of UrologySLK-Kliniken HeilbronnHeilbronnGermany
  3. 3.Department of Urology and Pediatric UrologyUniversity Hospital UlmUlmGermany
  4. 4.Department of UrologySLK-Kliniken HeilbronnHeilbronnGermany
  5. 5.Department of UrologyHelios-KlinikMüllheimGermany
  6. 6.Department of UrologyUniversity Hospital of HeidelbergHeidelbergGermany

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