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Ergonomics in Laparoscopy Handbook of Laparoscopy Instruments 9
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Role of Robotic Surgery
●
Robotic surgery is better ergonomically than laparoscopy.
●
Allows port placements in shorter lengths without other tools' hindrance,
allowing access to deeper locations such as the oesophagus, pancreatic, and
retroperitoneum.
H.D. Monitors
●
A significant advantage of 16:9 H.D. displays in laparoscopic surgery is that the
images provide a natural, panoramic vision. Humans' horizontal field of view is
larger than the vertical field of view.
●
This more comprehensive, natural vision is less tiring for surgeons during
treatments.
●
Furthermore, when surgeons watch full-screen endoscopic pictures during
laparoscopic surgery, trocars and hand instruments approach the operative area
laterally. They are more apparent on a 16:9 monitor than on a 4:3 or 5:4 panel.
3-D Laparoscopy
●
The essential benefit of correct depth perceiving is critical during suturing and
other complicated procedures.
●
The learning curve for surgeons can be shortened by using a 3D depiction of
depth perception.
Clinical Significance
Physical Constraints to Surgeons due to ergonomic inefficiency:
In the initial ten years after the introduction of M.A.S., spine problems were a
regular complaint in major centres [9, 10].
Other physical limits cited include cervical spondylitis, shoulder pain from the
abduction of the shoulder (chicken wing scapula) during laparoscopy, backache,
hand finger joint pain, tenosynovitis, burning eyes, stress tiredness, and hand
muscle injury [27].
Solution
●
The arm should be gently extended, retroverted, and turned inwards at shoulder
level.
●
To avoid lactic acid build-up and tiredness, the surgeon must regularly relax his
pace and posture [9].
●
Using a magnified recording camera's eyepiece and the output to the display can
help with spatial awareness, eyesight, and loss of the surrounding field of vision.
10 Handbook of Laparoscopy Instruments (Pate) and Nayak
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Hence, assisting surgeons in working more effectively, especially when dealing
with delicate inner anatomy.
●
Surgeons' lack of thorough understanding
●
A lacuna in carrying out the facts between the operating surgeon and the
designers of the instruments.
CONCLUSION
●
Laparoscopic surgery provides patients with less painful surgery but is more
demanding for the surgeon.
●
The increased technological complexity and sometimes poorly adapted
equipment have led to increased complaints of surgeon fatigue and discomfort
during laparoscopic surgery.
●
Better ergonomic integration and understanding of ergonomics can make the
surgeon's life comfortable in the OR, reduce physical strain on the surgeon, and
increase productivity.
REFERENCES
[1] Kilbom A. Measurement and assessment of dynamic work. In: Wilson EC Jr, editor. Evaluation of
human work: A practical ergonomics methodology. London: Taylor and Francis; 1990. pp. 641–61.
[2] Joice P, Hanna GB, Cuschieri A. Ergonomic evaluation of laparoscopic bowel suturing. Am J Surg.
1998; 176: 373–8.
[http://dx.doi.org/10.1016/S0002-9610(98)00202-5] [PMID: 9817259]
[3] Van Veelen MA, Meiier DW. Ergnomics and design of laparoscopic instruments: results of a survey
among laparoscopic surgeons. J LaparoendoscAdvSurg Tech A. 1999; 9: 481–9.
[http://dx.doi.org/10.1089/lap.1999.9.481] [PMID: 10632508]
[4] Hanson DL. Evaluation of the Hawthorne effect on physical education research. Res Q. 1967; 38:
723–4.
[PMID: 5235929]
[5] Patkin M, Isabel L. Ergonomics, engineering and surgery of endosurgical dissection. J Royal CollSurg
Edinburgh. 1995; 40: 120–32.
[PMID: 7776275]
[6] Falk V, McLoughlin J, Guthart G, Salisbury JK, Walther T, Gummert J, et al. Dexterity enhancement
in endoscopic surgery by a computer-controlled mechanical wrist. Minim Invasive Ther Allied
Technol. 1999; 4: 235–42.
[http://dx.doi.org/10.3109/13645709909153167]
[7] Supe AN, Kulkarni GV, Supe PA. Ergonomic sinlaparo scopic surgery.J Minim Access Surg 2010
Apr-Jun; 6(2): 31-36.
[http://dx.doi.org/10.4103/0972-9941.65161] [PMID: 20814508]
[8] Wang Y, MacKenzie CL. Human-Computer Interaction INTERACT '99. Edinburgh, Scotland: IOS
Press; 1999. Effects of orientation disparity between haptic and graphic displays of objects in virtual
environments.
[9] Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ. A survey of static and dynamic work postures of
operating room staff. Int Arch Occup Environ Health. 1992; 63: 423–8.
[http://dx.doi.org/10.1007/BF00386939] [PMID: 1544692]
Ergonomics in Laparoscopy Handbook of Laparoscopy Instruments 11
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[10] Nguyen NT, Ho HS, Smith WD, Philipps C, Lewis C, De Vera RM, et al. An ergonomic evaluation of
surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery. Am J
Surg. 2001; 182: 720–4.
[http://dx.doi.org/10.1016/S0002-9610(01)00801-7] [PMID: 11839346]
[11] Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J. A comparison of surgeons' posture during
laparoscopic and open surgical procedures. Surg Endosc. 1997; 11: 139–42.
[http://dx.doi.org/10.1007/s004649900316] [PMID: 9069145]
[12] Stylopoulos N, Rattner D. Robotics and ergonomics. SCNA. 2003; 83: 1321–37.
[http://dx.doi.org/10.1016/S0039-6109(03)00161-0] [PMID: 14712869]
[13] Alarcon, A., and R. Berguer. "A Comparison of Operating Room Crowding between Open and
Laparoscopic Operations." Surgical Endoscopy Surg Endosc 10, no. 9 (1996): 916-19.
[http://dx.doi.org/10.1007/BF00188483] [PMID: 8703151]
[14] Curtis P, Bournas N, Magos A. Simple equipment to facilitate operative laparoscopic surgery (or how
to avoid a spaghetti junction) Br J Obstet Gynaecol. 1995; 102: 495–7.
[http://dx.doi.org/10.1111/j.1471-0528.1995.tb11327.x] [PMID: 7632646]
[15] Hemal AK, Srinivas M, Charles AR. Ergonomic Problems Associated with laparoscopy. J Endourol.
2001; 15: 499–503.
[http://dx.doi.org/10.1089/089277901750299294] [PMID: 11465329]
[16] Uchal M, Brogger J, Rukas R, Karlsen B, Bergamaschi R. In-line versus pistol-grip handles in a
laparoscopic simulators. A randomized controlled crossover trial. Surg Endosc. 2002; 16: 1771–3.
[http://dx.doi.org/10.1007/s00464-002-8816-8] [PMID: 12140629]
[17] De U. Ergonomics and Laparoscopy. Indian J Surg. 2005; 67: 164–6.
[18] Menozzi M, von Buol A, Krueger H, Miege C. Direction of gaze and comfort: Discovering the relation
for the ergonomic optimization of visual tasks. Ophthalmic Physiol Opt. 1994; 14: 393–9.
[http://dx.doi.org/10.1111/j.1475-1313.1994.tb00131.x] [PMID: 7845698]
[19] Hanna GB, Shimi SM, Cuschieri A. Task performance in endoscopic surgery is influenced by location
of the image display. Ann Surg. 1998; 227: 481–4.
[http://dx.doi.org/10.1097/00000658-199804000-00005] [PMID: 9563533] [PMCID: PMC1191300]
[20] Trejo A, Jung MC, Oleynikov D, Hallbeck MS. Effect of handle design and target location on the
insertion and aim with a laparoscopic surgical tool. Appl Ergon. 2007; 38: 745–53.
[http://dx.doi.org/10.1016/j.apergo.2006.12.004] [PMID: 17374356]
[21] Manasnayakorn S, Cuschieri A, Hanna GB. Ergonomic assessment of optimum operating table height
for hand-assisted laparoscopic surgery. Surg Endosc. 2009; 23: 783–9.
[http://dx.doi.org/10.1007/s00464-008-0068-9] [PMID: 18629584]
[22] Manasnayakorn S, Cuschieri A, Hanna GB. Ideal manipulation angle and instrument length in hand-
assistedlaparoscopic surgery. Surg Endosc. 2008; 22: 924–9.
[23] Rados C. FDA works to reduce preventable medical device injuries. FDA Consum 2003 Jul-Aug; 37
(4): 29-33.
[24] Forkey D, Smith W, Berguer R. 19th Annual International Conference of the IEEE Engineering in
Medicine and Biology Society. Chicago: IL; 1997. A comparison of thumb and forearm muscle effort
required for laparoscopic and open surgery using an ergonomic measurement station; pp. 1705–8.
[25] Mattern U, Waller P. Instruments for minimally invasive surgery: Principles of ergonomic handles.
SurgEndoscop. 1999;13:174–82.
[26] Berguer R, Forkey DL, Smith WD. The effect of laparoscopic instrument working angle on surgeons'
upper extremity workload. SurgEndosc. 2001; 15: 1027–9.
[PMID: 11443477]
12 Handbook of Laparoscopy Instruments (Pate) and Nayak
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[27] 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:
635-639.
Sterilization
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Handbook of Laparoscopy Instruments, 2023, 13-17 13
CHAPTER 2
Lamture Yeshwant Ramrao
1
Department of Surgery, J.NMC, Wardha, India
Abstract: Laparoscopic instruments should be sterilized by high-level disinfection
(H.L.D.). Sterilization is any process that removes or kills all microbial organisms,
such as fungi, bacteria, viruses, spore forms, etc., present on a surface, contained in a
fluid, or a compound such as biological culture media. Sterilization can be achieved by
applying heat, chemicals, and irradiation; high-pressure sterilization is a process that
destroys or eliminates all forms of microorganisms. Disinfection is a process that
eliminates many or all pathogenic microorganisms, except bacterial spores, on
inanimate objects. Decontamination is the removal of all pathogenic microorganisms
from objects to make them safe to handle / use/ discard.
1,*
, Varsha P. Gajbhiye1 and Deepak Lamture
1
Keywords: Autoclave, Bacteria, Cleaning, Disinfection, Decontamination, Fungi,
Microbial life, Spore, Viruses.
INTRODUCTION
Laparoscopic instruments should be sterilized by high-level disinfection (H.L.D.).
Sterilization is any process that removes or kills all microbial organisms, such as
fungi, bacteria, viruses, spore forms, etc., present on a surface, contained in a
fluid, or a compound such as biological culture media. Sterilization can be
achieved by applying heat, chemicals, and irradiation; high-pressure sterilisation
is a process that destroys or eliminates all forms of microbial life. Disinfection is a
process that eliminates many or all pathogenic microorganisms, except bacterial
spores, on inanimate objects. Decontamination is the removal of all pathogenic
microorganisms from objects to make them safe to handle / use/ discard.
Microbial Life and Sterilization
Laparoscopic instruments cannot be easily dismantled Fig. (2.1), used to harbour
blood/tissue within their shafts. With a sterile sponge, visible blood and tissue
should be wiped off. All contaminated instruments should be placed and soaked
for 10 minutes in a container containing a disinfectant solution. Because of the
*
Corresponding author Lamture Yeshwant Ramrao: Department of Surgery, J.NMC Wardha; India;
E-mail: yash18671@gmail.com
All rights reserved-© 2023 Bentham Science Publishers
Lamture Yeshwant Ramrao (Ed.)
14 Handbook of Laparoscopy Instruments Yeshwant Ramrao et al.
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fear of damage, devices should not be left in this solution for longer. Laparoscopic
instruments are best rinsed in running water to clear the particulate matter and
residues of chemicals used for cleaning. The instruments should be dried at the
end of the cleaning process before they are packed for sterlisation.
Fig. (2.1). Organisms to be destroyed in Sterilization.
Three sterilization processes are available: steam, ethylene oxide, and peracetic
acid.
Steam Sterilization
Steam sterilization is one of the most common forms of sterilization in general
practice. Autoclaving at 121°C for 15 minutes is ideal for all reusable metal
instruments. It is a cheap alternative and effective too. Before sterilization, all the
devices, tubing, and cords should be wrapped doubly in a cloth to prevent contact
with the hot metallic container, which is then placed in the autoclave [1].
The autoclave is the equipment used to remove microorganisms (Viruses,
Bacteria, fungi, etc.) and spores using high-pressure and high-temperature steam
sterilization.
History of Autoclave
A French-born physicist Denis Papin invented a prototype of the autoclave called
the steam digester, also known as the pressure cooker, in 1679.1 An autoclave is
another term for the steam sterilizer. After Papin's steam cooker Fig (2.2), Charles
Chamberland modified it in 1887 as the Colleague of Pasteur.
Sterilization Handbook of Laparoscopy Instruments 15
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Fig. (2.2). Papin’s steam cooker.
Principle of Autoclave
Liquid Water cannot be heated above 100°C in an open vessel at 100°C. If water
is heated in a sealed vessel, pressure rises, and the boiling point of water is raised.
The boiling point of water is directly proportional to the pressure when the
volume is constant.
When pressure is increased in a closed vessel, the temperature increases
proportionately. i.e. for about 15 pounds of pressure per square inch (Psi), the
temperature rises to 121oC. This pressure and temperature are kept constant for 20
minutes during autoclaving. It is sufficient to kill all the vegetative forms and
spores of the organism [2].
Mechanism
●
By coagulating and denaturing enzymes and structural proteins.
●
Resistant spores generally require 121 °C for 15-30 minutes.
●
Moist heat is more effective than dry heat.
The gas used for gas sterilization is ethylene oxide. It is suitable for all disposable
instruments, insulated hand instruments, and tubing. Gas sterilization with
ethylene oxide causes no damage to instruments, and it is non-corrosive to optics
but costly (Fig. 2.3).
16 Handbook of Laparoscopy Instruments Yeshwant Ramrao et al.
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Fig. (2.3). An autoclave.
High-Level Disinfection
High-level disinfection classically is defined as “complete elimination of all
microorganisms in or on an instrument, except for small numbers of bacterial
spores”.
The agents used are 2% glutaraldehyde, peracetic acid, and 6% stabilized
hydrogen peroxide.
Fiberoptic light cords, cameras, and telescopes are soaked in 2% glutaraldehyde
for at least 10 minutes.
Soaking must not be more than 20 minutes. Imersion of metallic instruments like
trocars and hand instruments is recommended for 60 minutes. Formaldehyde can
be used, but its use for sterilizing instruments and other items is not recommended
nowadays [3].
STERRAD” is one of the new sterilization systems. It takes about 75 minutes for
sterilization.
After sterilization or H.L.D., items should be stored appropriately immediately to
avoid contamination.
Spaulding Classification of Medical Devices
Critical objects which generally enter sterile tissue or the vascular system or
through which blood flows should be sterile.
Sterilization Handbook of Laparoscopy Instruments 17
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Semi-critical- objects that touch mucous membranes or skin that is not intact
require a disinfection process (high-level disinfection [H.L.D.]) that kills all
microorganisms but high numbers of bacterial spores.
Non-critical- objects that touch only intact skin require low-level disinfection (or
non-germicidal detergent).
CONCLUSION
Laparoscopic instruments should be sterilized by sterilization or high-level
disinfection (H.L.D.). Organisms to be destroyed in sterilization are bacteria,
viruses, fungi, protozoan, and helminths. The used and infected instruments are
advised to be kept and soaked for about 10 minutes in a container containing a
disinfectant solution. However, there remains a risk of damage to the instruments
during the process. The most commonly used method is steam sterilization.
Autoclaving at 121°C for 15 minutes is ideal for all reusable metal instruments.
When sterilization is unavailable or not possible, high-level disinfection is used to
sterilize the instruments.
REFERENCES
[1] Gupta P, Bhartia VK. Hand-assisted laparoscopic surgery using Gelport. J Minim Access Surg 2005;
1(3): 110-5.
[http://dx.doi.org/10.4103/0972-9941.18994] [PMID: 21188007]
[2] FDA works to reduce preventable medical device injuries. Magazine article by Carol Rados. FDA
Consum 2003; 37: 28.
[3] Forkey D, Smith W, Berguer R. A comparison of thumb and forearm muscle effort required for
laparoscopic and open surgery using an ergonomic measurement station. 19th Annual International
Conference of the IEEE Engineering in Medicine and Biology Society. 1705-8.
18 Handbook of Laparoscopy Instruments, 2023, 18-28
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CHAPTER 3
Operation Theatre Layout, Equipment Setup and
Troubleshooting
Harshal Ramteke
Yeshwant Ramrao
1
Department of Surgery, Jawaharlal Nehru Medical College (D.M.I.M.S.), Wardha, Maharashtra,
India
2
Department of Obstetrics and Gynaecology, N.K.P.S.I.M.S. & L.M.H., Nagpur, Maharashtra,
India
3
Department of Surgery, Jawaharlal Nehru Medical College (D.M.I.M.S.), Wardha, Maharashtra,
India
Abstract: The surgical theatre is a vital and intricate setting where time and resources
are typically limited. Laparoscopic surgical procedures demand specific technical and
analytical skills from operating room personnel, as there is a high chance of mistakes
leading to potentially fatal repercussions in laparoscopic surgery [1]. The acquisition of
complete, precise, and appropriate knowledge about linkage and interaction between
human beings and laparoscopic equipment in operation theatre must be considered of
utmost importance. To avoid difficulties during surgery, a surgeon must become
familiar with this equipment and instruments [2].
1,*
, Rohini Bhoyar2, Ashirwad Sankhe3 and Lamture
3
Keywords: Anaesthetic equipments, CO2 cylinder, Electrocautery, Laparoscopic
surgery, Location of doors, Operating table, Operation theatre, Patient safety,
Room layout, Room size, Troubleshooting, Video monitors.
INTRODUCTION
In laparoscopic surgery, appropriate training of operating room personnel about
the operating theatre setup, usage and troubleshooting of equipment is crucial [3].
OPERATING THEATRE LAYOUT AND EQUIPMENT POSITION [4]
General Considerations
The size of the operating theatre, position of doors, electrical sockets, anaesthesia
*
Corresponding author Harshal Ramteke: Department of Surgery, J.N.M.C., D.M.I.M.S., Wardha, Maharashtra-
442001; India; Tel: +91 9766631898, E-mail: drharshalsurg@yahoo.com
All rights reserved-© 2023 Bentham Science Publishers
Lamture Yeshwant Ramrao (Ed.)
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