principles of Ergonomics for the benefit of laparoscopic surgeon

1. Understanding Ergonomics
&
Its Importance In Laparoscopic Surgery
Dr.S.Easwaramoorthy
MS FRCS(Eng) FRCS (Glas) FRCS (Edin)
Head of Dept of Minimal Access Surgery
Examiner, RCS of Edinburgh
Executive Member, South Zone IAGES
FIAGES Board member

2. 2 D Image
No depth Perception
No tactile feedback
Counter-intuitive
Limited movements
Magnification

3. Open Surgeon Vs Lap Surgeon
How do they differ?!
Open Surgeon
• Fast
• Hand is as good as eyes
• Dissection precedes
• Ergonomics: Optional
Laparoscopic Surgeon
• Slow and steady
• Stop when you don’t see
• Haemostasis precedes
• Ergonomics: Vital

4. To be an efficient Surgeon…
• Equipments
• Environment
Concentrate on

5. Ergonomics
• Straight Line principle
• Triangulation
• Manipulation angle
• Elevation angle
• Low lying table
• Gaze down view

6. Straight Line Principle
Surgeon
Pathology
Monitor

7. Visual Axis and Motor Axis

8. Co Axial alignment

9. Base Ball Diamond Concept
& Triangulation
Monitor
S
C
R
L
P

10. Manipulation angle
Azimuth Angle
Manipulation Angle
30-45 degree
60-90 degree

11. Elevation angle

12. Ideal angles!
1. Manipulatation angle: 60 degree
2. Azimuth angle: Equal/30 degree each
3. Elevation angle: 60 degree

13. SILS
Experience
Energy Sources
Equipments
Co axial instruments
Endo eye laparoscope
Spider system
SILS Ports

14. 360 degree rotation/Roticulation
Endo eye

15. Ergonomics with SILS
Spider System
Intra abdominal Triangulation!

16. Ergonomics of Hand Instruments
• Tip
– Range of movements
• Conventional Vs Robotic instrument: 4: 7

17. Da Vinci Robot
Wrist like action
PrecisionPrecision

18. Ergonomics of Hand Instruments
• Tip
– Range of movements
• Conventional Vs Robotic instrument
• Length of the shaft

19. Fulcrum Effect of Hand Instruments
1: 1

20. Ergonomics of Port Placement

21. Ergonomics of Hand Instruments
• Tip
– Range of movements
• Conventional Vs Robotic instrument
– Force transmission
• Length of the shaft
• Handle design

22. Ergonomic handles…

23. Surgeon’s Stance
Ideal relaxed stature Tiring

24. Ideal Relaxed Position
-straight head, in the axis of the trunk,
without rotation or extension of the cervical spine;
- shoulders in a relaxed and neutral position;
- arms alongside the body
- elbows bent to 70 to 90 degrees
- forearms in an horizontal or slightly descending axis-
-hands pronated (physiological resting position);
- hands and fingers lightly grip the handles/handpiece
•Waist line table
•Gaze down view of monitor
•Straight line principle
•Triangulation