As more procedures become minimally invasive, surgeons will be subject to greater physical strain as they manipulate tools inside smaller spaces. Frost & Sullivan has found several companies and academic institutions that are using robotics, computer processing, and hand grip designs to create devices that extend the surgeon’s skills while relieving them of the fatigue of repetitive hand movements.
The delicate manipulation of endoscopes, forceps, scalpels, sutures and other surgical tools and instruments can physically stress a surgeon. A review of published resources related to surgeon ergonomics appeared in the January/February 2018 issue of Female Pelvic Medicine & Reconstructive Surgery, the official journal of the American Urogynecologic Society. It found that work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons: rates range from 66% to 94% for open surgery, 73% to 100% for conventional laparoscopy, 54% to 87% for vaginal surgery, and 23% to 80% for robotic-assisted surgery.
Among surgeons’ WMSD risk factors are table and monitor positioning, long-shafted instruments, and poor instrument handle design. The article authors found that WMSDs are underreported to surgeons’ clinical institutions and can pose a risk to patients.
These concerns have driven the development of ergonomic devices that will benefit physicians and patients alike. Frost & Sullivan has found several companies and academic institutions that are using robotics, computer processing, and hand grip designs to create devices that extend the surgeon’s skills while relieving them of the fatigue of repetitive hand movements.
Auris Health (Redwood City, Calif.)
Endoscopy has given surgeons a view inside a patient’s body to better prepare their procedures. Surgeons manipulate dials or levers to move endoscopes through the body so that a tip-mounted camera can capture images. But some areas of the body are inherently difficult to reach.
Auris Health aims to take some of the strain off endoscopic navigation in the lungs with its Monarch platform. This system incorporates an instinctive controller interface that physicians use to precisely navigate a flexible, robotic endoscope to the periphery of the lung with fewer manual movements than conventional navigation would require.
This month, the Taft Center for Clinical Research at El Camino Hospital in California announced that its interventional pulmonology team had viewed the inside of a patient’s lung and obtained a tissue sample during a clinical trial using the Monarch platform—its first successful use in the United States following its Food and Drug Administration (FDA) clearance.
Titan Medical Inc. (Ontario, Canada)
Improved ergonomics is a hallmark of the company’s Single Port Orifice Robotic Technology, or SPORT, surgical system. It consists of an ergonomic surgeon workstation that includes a high-definition, 3-D display of the procedure area and a smaller touch screen that displays patient data, and a master controller and hand controllers with adjustable elbow support on a 90-degree pivot; and a patient cart with a central unit that includes a camera insertion tube and multi-articulated arms that guide graspers, scissors, hooks and dissectors with sterile, replaceable instrument tips. Both main components can be easily wheeled from one operating room to another.
The system is in the preclinical testing phase and has not yet been approved for sale or use. The company hopes that the system’s more compact footprint will be ideal for smaller hospitals and ambulatory surgery centers for single-incision abdominal, urologic, gynecologic and colorectal surgeries. It plans to introduce the product in Europe before pursuing FDA approval.
Becton, Dickinson and Company (Franklin Lakes, N.J.)
Sometimes ergonomic improvements fit in the palm of the hand. This is the case with the company’s Snowden-Pencer in-line and pistol-grip surgical instruments. The instruments feature contoured handles that enable surgeons to position their hands in the most comfortable way. Designers equipped the ergonomic instruments with a one-piece ratchet mechanism that allows surgeons to flip a lever to lock or unlock it.
The Road Ahead
As more procedures become minimally invasive, surgeons will be subject to greater physical strain as they manipulate tools inside smaller spaces. In addition to designing surgical devices to enhance ergonomics, academic institutions are developing courses that teach doctors how to reduce the fatigue brought on by manipulating surgical tools and instruments. The Duke University School of Medicine has collaborated with the Duke Ergonomics Center to initiate a program that teaches junior residents and medical students about maintaining the proper posture in the operating room to minimize strain caused by five- to eight-hour procedures.
The European Commission instituted the Train4OrthoMIS project to develop an online vocational course to train orthopedic surgeons in ergonomic performance of minimally invasive surgery on hips and spines. The e-learning tool is available in English, German, Polish, and Spanish, a sign that ergonomic surgical training knows no borders.
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