Spezielle ergonomische Grundlagen der videoskopischen Chirurgie

Abstract

Ergonomic analyses evaluate the principles of a working process and aim at the improvement of such structures. In surgery these studies examine the quality of an operative procedure and the efficiency of various manipulations. Generally a surgeon has aquir-ed the ergonomic principles by refining his manual capability. However these experiences cannot be transferred to laparoscopy automatically, because videoscopic surgery bases on its own er-gonomic rules: The surgeon does not control the action of his hands by direct vision, but evaluates the moves in the monitor, which displays a 2-dimensional view of a 3-dimensional anatomy. Moreover the scope represents the surgeon’s eye, but limits (and alterates) the size of the picture. If it is managed by an assistant, surgical and optical focus may divert. Working through tro-cars distorts the tactile feedback and leads to paradoxic movements (fulcrum effect: 1. and 2. order failure). Finally more complex laparoscopic procedures require additional technical skills (suturing, knotting, tissue management). Most of these principles and techniques can be learned easily, but they must be trained and practised frequently, if the surgeon want to offer the same expertise, which he is used to in open surgery.