ISE Italian School of Endoscopy Hysteroscopy lv.1 Salerno Jan. 27-28, 2018 Ergonomics in Hysteroscopy Luigi Fasolino, MD
What is ergonomics? The term ergonomics is derived from the Greek words "ergon" meaning work and "nomos" meaning natural laws or arrangement. Ergonomics is "the scientific study of people at work, in terms of equipment design, workplace layout, the working environment, safety, productivity, and training". Ergonomics is based on anatomy, physiology, psychology, and engineering, combined in a systems approach. Why Ergonomics? No pain for the surgeon, no pain for the patient
Ergonomic Challenges During Hysteroscopy The importance of ergonomics in the setting of hysteroscopy cannot be underestimated. Studies have shown that correct ergonomics can reduce operative time, surgeons stress and fatigue, improving his efficiency. During hysteroscopy we assume a relatively static posture during major part of the procedure which, ergonomically speaking, contributes to the inefficiency. These static postures have been demonstrated to be more disabling and harmful than dynamic postures are since muscles and tendons build up lactic acid and toxins when held for prolonged periods in same postures
PHYSICAL CONSTRAINTS TO SURGEON DUE TO INEFFICIENT APPLICATION OF ERGONOMICS Neck pain and spondylosis has been observed to be a recurring complaint among surgeons in high-volume centers in the first decade after the advent of minimal access surgery.. shoulder pain due to abduction of shoulder. backache. hand finger joint pain. tenosynovitis. burning eyes. stress exhaustion. hand muscle injury.
Problems in MIGS. Two-dimensional vision. Loss of depth perception to some extent.. Tremor enhancement.. View is not under control of the surgeon.. Decoupling of the visual and motor axes.. Loss of tactile feedback owing to substitution of instruments. Visual orientation changes with the loss of depth perception due to indirect visual input. Loss of peripheral vision caused by the limited viewing spectrum offered.. Relatively static posture which, ergonomically speaking, contributes to the inefficiency.
CRITICAL ERGONOMIC ADJUSTMENTS The goal of proper posture is comfort, efficiency of movement, and minimization of the risk of musculoskeletal injuries to the operator.. OT position. OT height. Visual Display position. Don t get wet!!!. Choosing Hysteroscopic Instruments. Ensure the Correct Angle Manipulation for The Instruments. Assume A Correct Elbow/Arms position ( angle, rotation, abduction). Choosing the correct Handling. Choosing the best Surgical Strategy
CRITICAL ERGONOMIC ADJUSTMENTS. OT/SURGEON POSITION In front of the surgeon, obviously. OT HEIGHT For office hysteroscopy, the table s height should be adjusted so that patient s knees, after positioning, are slightly higher or at the level of the surgeon s shoulders. VISUAL DISPLAY POSITION Ergonomically, the best view for hysteroscopy is with the monitor image at or within 25 optimal degrees up to the horizontal plane of the eye. This leads to least neck strain according to the available studies. It is not advisable to have a "chin-up" arrangement on the part of the surgeon. 0-25 90-120 elbows
CRITICAL ERGONOMIC ADJUSTMENTS.CHOOSING HYSTEROSCOPIC INSTRUMENTS With their restrictions, it is not surprising that hysteroscopic instruments are more awkward and difficult to use than open instruments. Various attributes of the hysteroscopic instruments account for their handling characteristics, including decreased mechanical efficiency, increased length, movement about a fulcrum on the genitals ( the cervix), and the design of the handle. These factors, together, can produce substantial hand and shoulder fatigue and discomfort during hysteroscopic procedures
CRITICAL ERGONOMIC ADJUSTMENTS The device: Flow Light Outer Inner Op. channel Camera Flow. Don t get wet!!!
CRITICAL ERGONOMIC ADJUSTMENTS 1. Handling - Ergonomics!! - No over abduction/rotation - Confortable - Easy to manipulate
CRITICAL ERGONOMIC ADJUSTMENTS 1. Handling - Ergonomics!! - No over abduction/rotation - Confortable - Easy to manipulate
THE RIGHT INSTRUMENT
THE RIGHT INSTRUMENT 2. Speed up!! - Recognition of the instruments - The right choice A color code is necessary
THE RIGHT INSTRUMENT Grasping Color code: Biopsy Color code:
THE RIGHT INSTRUMENT Scissors Color code:
I M IN OFFICE, WHAT CAN I DO?
HYSTEROSCOPIC TECHNIQUE - GOALS The ideal style:. Has to respect ergonomic laws. The action should be transparent to the surgeon and feel CON-CON ( confortableconfident).it should also be universal. It should be stress-less. It should be easy-reproductible
CONCLUSIONS. The lack of complete awareness among surgeons. Communication gap between the practitioners of hysteroscopy and the designers of the instruments. Inadequate knowledge of the techniques. Inadequate teaching received from the mentors Frequent innovations in electrosurgery, technology, OR environment, always looking for patient s safety, must make us think that even surgeon s body has to move in the same directions, looking for safety and efficiency. Respecting ergonomics in OR makes us Less Stressed More Efficient
THANK YOU Luigi Fasolino, MD www.ise.surgery