Ergonomics of novices and experts during simulated endotracheal intubation.

Endotracheal Intubation (ETI) is an airway procedure commonly used to secure the airway for a variety of medical conditions. Proficiency in ETI procedures requires significant clinical experience and insufficient data currently exists describing the physical ergonomics of successful direct laryngoscopy. The research objectives of this study were to examine how ETI time, error and practitioner biomechanics varied among clinical experience levels and hospital bed heights. The participant population included novice and expert personnel, differentiated by their exposure to ETI procedures. Participants used a standard laryngoscope and blade to perform ETI trials on an airway manikin trainer at predesigned hospital bed heights. Participants were evaluated based on ETI time and accuracy, as well as wrist postures and muscle utilization. Hospital bed height did not affect task completion time, error rates or muscle utilization. Expert participants exhibited less ulnar deviation and forearm supination during task trials, as well as a higher utilization of the bicep brachii and anterior deltoid muscles. Expert grasped instrumentation differently, requiring less wrist manipulation required to achieve ideal instrument positions. By encouraging ergonomic best-practices in hand and arm postures during ETI training, the opportunity exists to improve patient safety and reduce the learning curve associated with ETI procedures.

Ergonomic evaluation of laparoendoscopic single-site surgery ports in a validated laparoscopic training model.

Although laparoendoscopic single-site surgery (LESS) is feasible among expert laparoscopic surgeons, it poses many technical challenges not seen in conventional laparoscopy (CL). Recent technological advancements in single-incision instrumentation have created more interest and widespread usage of LESS. However, neither LESS nor its novel instrumentation have been thoroughly studied or evaluated using human factors and ergonomics techniques. Consequently, the aim of this study was to compare the physical performance of LESS to CL using a standardized task. Wrist and elbow angular movements, range of motion and physical discomfort were assessed for 24 novice participants. There were no significant differences for physical comfort/discomfort ratings or elbow and wrist flexion/extension range of motion between CL and LESS. However, wrist radial/ulnar range of motion was significantly greater in LESS compared to CL (p < 0.05). Additionally, wrist radial/ ulnar range of motion was significantly greater using the SILS Port compared to the GelPOINT (p < 0.05). Although further investigation is needed, LESS resulted in greater wrist deviation and range of motion due to the close proximity of the instruments, restrictive nature of the single-port devices, and the need to achieve adequate instrument triangulation and visualization.

Laparoendoscopic single-site (LESS) surgery versus conventional laparoscopic surgery: comparison of surgical port performance in a surgical simulator with novices.

BACKGROUND: Although laparoendoscopic single-site (LESS) surgery is feasible, it poses many technical challenges not seen in conventional laparoscopy. Recent interest and widespread implementation of LESS stems from advancements in commercially available access port technology. Consequently, this study objectively compared the technical performance between conventional laparoscopic and LESS surgical ports in a modified Fundamentals of Laparoscopic Surgery (FLS) simulator. METHODS: The 24 novice participants in this study performed the FLS peg transfer task using two conventional laparoscopic 12-mm working ports, the SILS port, the TriPort access system, and the GelPOINT system with two standard length 5-mm graspers. Each participant completed the task using conventional laparoscopy first for familiarization, followed by each of the three LESS surgical ports in random order. Task completion time, errors, and subjective questionnaire ratings were used to compare conventional laparoscopy and the single-port devices. Congruent with FLS scoring procedures, task completion time and errors were used to compute a standardized task score for each port. RESULTS: The task score did not differ significantly between conventional laparoscopy and the single-port devices. Additionally, there were no task score differences between trials for either the SILS port or the GelPOINT system. There was a significant performance decrement starting with the TriPort versus starting with either the SILS port or the GelPOINT, which resulted in the lowest overall trial task score (p<0.05). Task completion difficulty and instrument maneuverability resulted in no significant differences between ports. Ease of use and overall rank were significant, with conventional laparoscopy rated as the easiest to use and the highest overall followed by the GelPOINT system. CONCLUSIONS: Overall, the TriPort may be more challenging for novices to use in learning the LESS procedure than either the SILS port or the GelPOINT system. The GelPOINT system may offer the most consistent platform for LESS performance and novice skill acquisition.