Ergonomics n Laparoscopic Surgery.pptx

laparoscopic surgery

1. ERGONOMICS IN LAPAROSCO OIC SURGERY Dr. Nauman Danawar General Surge on Syrian& Arab board, MRCSI

2. The outline 1- I deal relaxation position 2- W aist line table 3- G aze daown veiw for monitor 4- S traight line principle 5- B aseball baimond cocept : -half instument should be in and half instument out. -T elescope in the middle. -M anipulation angle 60 degree. 6- I deal angles: M anipulation angle Azimuth angle Elevation angle

3. ERGONOMICS IN LAPAROSCOPY Ergonomics is a Greek word E rg= work N omi= natural law Ergonomics is the science of best suiting the worker to his job. (H ow to work safely and comfotably)

4. 1- 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 (accepted abduction up to 15 degree). Arms alongside the body. Elbows bent to 90 -120 degrees. (hand of instrument at the level of elbow) Forearms in a horizontal or slightly descending axis. Hands pronated (physiological resting position). Hands and fingers lightly grip the handpiece . Over grip for the assistant.

5. Ideal relaxed position

6. 2- Waist line table (surgeon height cm X 0.49) Table height should be at or below the waist line of the operating surgeon in order to avoid muscular fatigue from the non-physiological position of the surgeon’s arms during the procedure.

7. 3- Gaze down view of monitor - Gaze down view of monitor ( around 15-40 degree) The monitor: - Must be high resolution, and facing the surgeon. - placed at 25 degree gaze dawn. - The distance from surgeon: 5x diagonal screen diameter ( 5x 21 inch=105 inch distance).

8. 4- Straight Line Principle surgeon , target and the monitor must be in a straight line.

9. 5- Baseball diamond concept -half instument should be in and half instument out, - T elescope in the middle. - m anipulation angle 60 degree.

10. half instument should be in and half instument out target, length of instruments, and draw a line around the target target : is the area of maximum dissection. appendectomy: the base of appendix cholecystectomy: calot’s triangle

11. L ength of my instruments: S tandard adult 36 cm M orbid obese 45 cm P ediatric 28 cm N ewnate. 20 cm

12. draw a line around the target

13. L ever type 2 ( port near to target) Ideally, we achieve lever type 1 T he drawbacks in type 2 lever are: movement is rectified. power outside is magnified ( tissue tear or avulsion). Increased elevation angle (muscles fatigue). Direct coupling if using metal port, or static capacitor when using plastic one (bowel injury). So, type 2 lever is dangerous and uncomfortable. L ever type 1 L ever type 2

14. lever type 3 ( port is far from the target) T he drawbacks in type 3 lever are: movement is magnified inside (overshooting). power is rectified. decrease elevation angle (the instruments with touch the patient body). again, type 3 lever is dangerous and uncomfortable.

15. M anipulation angle 60 degree

16. Applying baseball diamond concept in OR

17. 6- Ideal Angles working angels Manipulation angle the angle between two working ports. The ideal manipulation angle is 60º Azimuth angle the angle between one instrument and the optical axis of the endoscope. The ideal azimuth angle is equal for both the active and assisting instruments. Elevation angle the angle between the instrument and the horizontal plane. The ideal elevation angle is 60º.

18. Ideal Angles

19. SUMMARY The 3 component of baseball diamond are essential to work safely and comfortably. 1- Half of the instrument should be in and half out 2- Telescope in the middle 3- Manipulation angle should be 60 degree.

20. Thank you