Understanding Ergonomics &

Its Importance In Laparoscopic Surgery

Dr.S.EaswaramoorthyMS 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 D ImageNo depth PerceptionNo tactile feedback

Counter-intuitiveLimited movements

Magnification

Open Surgeon Vs Lap SurgeonHow 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

To be an efficient Surgeon…

• Equipments• Environment

Concentrate on

Ergonomics• Straight Line principle

• Triangulation

• Manipulation angle

• Elevation angle

• Low lying table

• Gaze down view

Straight Line Principle

Surgeon

PathologyMonitor

Visual Axis and Motor Axis

Co Axial alignment

Base Ball Diamond Concept& Triangulation

Monitor

S

C

R

L

P

Manipulation angle

Azimuth Angle Manipulation Angle

30-45 degree 60-90 degree

Elevation angle

Ideal angles!

1. Manipulatation angle: 60 degree2. Azimuth angle: Equal/30 degree each3. Elevation angle: 60 degree

SILS

ExperienceEnergy SourcesEquipments

Co axial instrumentsEndo eye laparoscopeSpider system

SILS Ports

360 degree rotation/Roticulation

Endo eye

Ergonomics with SILSSpider System

Intra abdominal Triangulation!

Ergonomics of Hand Instruments

• Tip– Range of movements

• Conventional Vs Robotic instrument: 4: 7

Da Vinci Robot

Wrist like action

PrecisionPrecision

Ergonomics of Hand Instruments

• Tip– Range of movements

• Conventional Vs Robotic instrument

• Length of the shaft

Fulcrum Effect of Hand Instruments

1: 1

Ergonomics of Port Placement

Ergonomics of Hand Instruments

• Tip– Range of movements

• Conventional Vs Robotic instrument

– Force transmission

• Length of the shaft

• Handle design

Ergonomic handles…

Surgeon’s Stance

Ideal relaxed stature Tiring

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