Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery

Mija Ruth Lee; Gyusung Isaiah Lee

doi:10.3802/jgo.2017.28.e70

Journal List > J Gynecol Oncol > v.28(5) > 1148298

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee and Lee: Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery

Original Article

J Gynecol Oncol 2017;28(5):e70.

Published online: 4 September 2017

DOI: https://doi.org/10.3802/jgo.2017.28.e70

Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery

Mija Ruth Lee, Gyusung Isaiah Lee

Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

Correspondence to Mija Ruth Lee Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street Blalock 603, Baltimore, MD 21287, USA. E-mail: mijalee71@gmail.com

Received 20 April 2017 Revised 2 June 2017 Accepted 7 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved.

Methods

The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS).

Results

There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ² test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (p<0.05). Gynecologists who felt highly confident about managing ergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (p<0.05). In minimizing their symptoms, surgeons changed ergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (p<0.05). The most common robotic system components to be improved for better ergonomics were microphone/speaker, pedal design, and finger clutch.

Conclusion

More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery.

Keywords: Robotic Surgical Procedures, Human Engineering, Surveys and Questionnaires, Medically Unexplained Symptoms, Gynecology

References

1. Schreuder HW, Verheijen RH. Robotic surgery. BJOG. 2009; 116:198–213.

2. Seideman CA, Bagrodia A, Gahan J, Cadeddu JA. Robotic-assisted pyeloplasty: recent developments in efficacy, outcomes, and new techniques. Curr Urol Rep. 2013; 14:37–40.

3. Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting–the learning curve and beyond: initial 200 cases. J Urol. 2005; 174:269–72.

4. Martino MA, Berger EA, McFetridge JT, Shubella J, Gosciniak G, Wejkszner T, et al. A comparison of quality outcome measures in patients having a hysterectomy for benign disease: robotic vs. non-robotic approaches. J Minim Invasive Gynecol. 2014; 21:389–93.

5. Wilson EB. The evolution of robotic general surgery. Scand J Surg. 2009; 98:125–9.

6. Seco M, Cao C, Modi P, Bannon PG, Wilson MK, Vallely MP, et al. Systematic review of robotic minimally invasive mitral valve surgery. Ann Cardiothorac Surg. 2013; 2:704–16.

7. Griffin L, Feinglass J, Garrett A, Henson A, Cohen L, Chaudhari A, et al. Postoperative outcomes after robotic versus abdominal myomectomy. JSLS. 2013; 17:407–13.

8. Liu H, Lu D, Wang L, Shi G, Song H, Clarke J. Robotic surgery for benign gynaecological disease. Cochrane Database Syst Rev. 2012. CD008978.

9. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009. CD003677.

10. Advincula AP, Wang K. Evolving role and current state of robotics in minimally invasive gynecologic surgery. J Minim Invasive Gynecol. 2009; 16:291–301.

11. 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; 19:1064–70.

12. Stefanidis D, Hope WW, Scott DJ. Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favored by more surgeons compared with laparoscopy. Surg Endosc 2011;25:2141–6.

13. Stefanidis D, Wang F, Korndorffer JR Jr, Dunne JB, Scott DJ. Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc. 2010; 24:377–82.

14. Berguer R, Smith W. An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res. 2006; 134:87–92.

15. 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; 9:142–7.

16. Klein MI, Warm JS, Riley MA, Matthews G, Doarn C, Donovan JF, et al. Mental workload and stress perceived by novice operators in the laparoscopic and robotic minimally invasive surgical interfaces. J Endourol. 2012; 26:1089–94.

17. 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; 23:1365–71.

18. 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; 28:456–65.

19. Lawson EH, Curet MJ, Sanchez BR, Schuster R, Berguer R. Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Robot Surg. 2007; 1:61–7.

20. Craven R, Franasiak J, Mosaly P, Gehrig PA. Ergonomic deficits in robotic gynecologic oncology surgery: a need for intervention. J Minim Invasive Gynecol. 2013; 20:648–55.

21. Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D. Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg. 2010; 210:306–13.

22. Franasiak J, Ko EM, Kidd J, Secord AA, Bell M, Boggess JF, et al. Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery. Gynecol Oncol. 2012; 126:437–42.

23. McDonald ME, Ramirez PT, Munsell MF, Greer M, Burke WM, Naumann WT, et al. Physician pain and discomfort during minimally invasive gynecologic cancer surgery. Gynecol Oncol. 2014; 134:243–7.

Fig. 1.

Robotic surgery system components for improvement. 3D, three-dimensional.

Fig. 2.

Correlation between physical symptoms and annual robotic case volume.

Fig. 3.

Correlation between physical symptoms and the confidence level in ergonomic setting management and the helpfulness level for better ergonomics.

Fig. 4.

Correlation between the da Vinci robotic system generations and eye fatigue reporting. Standard, first generation; S, second generation; Si, third generation.

Table 1.

Survey instrument

Categories	Questions
Demographics	1. What is your age?
	2. What is your height?
	3. What is your gender?
	4. What is your specialty?
	5. What is the total number of cases you perform per month as a primary surgeon (performing 50% or more of the procedure)?
	6. What is the percentage for each type of surgery?
	7. How many years have you been practicing robotic surgery?
Robotic systems	8. Which robotic system do you primarily use for your practice?
	9. What type of features does your chair for robotic surgery have? (Please check all that apply.)
	10. How often do you adjust the ergonomic settings of the surgeon's console?
Ergonomics	11. How confident do you feel that your ergonomic settings are set for the best ergonomics?
	12. Do you have your ergonomic settings stored at the surgeon's console?
	13. How helpful are the ergonomic features of the surgeon's console for reducing your physical strain?
	14. Have you experienced any difficulty in microphone/speaker communication with your OR staff when you are sitting at the surgeon's console?
	15. Which robotic system components would need more improvement for better ergonomics? (Please check all that apply.)
	16. Do you take off your shoes when operating pedals of the surgeon's console?
Physical symptoms	17. Have you ever had any physical discomfort or symptoms you would specifically attribute to your robotic operating?
	18. If you answered yes to question 17, which of the following apply?
	19. When do these symptoms bother you?
	20. How have you attempted to minimize these problems?

OR, operating room.

Table 2.

Discomforting body parts and reported rate

Body parts	Frequency (%)
Finger	134 (85.9)
Neck	112 (71.8)
Upper back	86 (55.1)
Lower back	65 (41.7)
Shoulder	57 (36.5)
Wrist	58 (37.2)
Eye	43 (27.6)

TOOLS

Similar articles