Predicting Wrist Ergonomics in Laparoscopy using the HandX®

Itai Meshorer, Amit Milstein, Oliver Nathan, Lior Soffer, Barak Rattner, Michal Sudak, A. Szold
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Abstract

Laparoscopic surgery has become increasingly popular due to its benefits over open surgery. However, one of the major challenges in laparoscopic surgery is the ergonomics of the surgeon. Ergonomics plays a crucial role in laparoscopic surgery, as surgeons are at risk of developing musculoskeletal disorders (MSDs) due to prolonged and repetitive motions [1,2]. One of the most common areas affected by MSDs in surgeons is the wrist, which can be affected by various factors such as handle design, awkward postures, and high force demands [3]. Laparoscopic surgery requires precise and delicate movements, that can put a significant strain on the wrist. Wrist flexion and deviation refer to the bending of the wrist forward and backward and twisting of the wrist to the left or right, respectively. Optimal wrist posture minimizes the degree of flexion and deviation, allowing for a neutral wrist position. On the other hand, excessive wrist flexion and deviation can lead to musculoskeletal pain, fatigue, and reduced grip strength. Neutral wrist posture with a lower degree of flexion and deviation has been shown to reduce musculoskeletal symptoms, increase dexterity, and improve surgical precision. Additionally, forearm rotation (pronation and supination) also plays a role in wrist ergonomics. Based on the rapid upper limb assessment (RULA), for wrist flexion/extension a range of 0-15° is recommended, and close to neutral position for wrist deviation, whilst pronation or supination of the forearm is considered ergonomic for up to 45° [4], [5]. The HandX® [6] is a hand-held laparoscopic, software-driven, robotic platform, used to manipulate 5mm fully articulating instruments. The HandX has four robotic degree-of-freedom (DoF), here we focus on the two DoF’s for controlling articulation. The HandX’s sphere-like control interface (CI) allows the surgeon to manipulate the articulated instruments' end-effector in all directions, over two axes: pitch and yaw
使用HandX®预测腹腔镜手术中手腕的人体工程学
腹腔镜手术由于其优于开放手术的优点而越来越受欢迎。然而,腹腔镜手术的主要挑战之一是外科医生的人体工程学。人体工程学在腹腔镜手术中起着至关重要的作用,因为外科医生由于长时间和重复的运动而有发生肌肉骨骼疾病(MSDs)的风险[1,2]。腕部是外科医生中最常见的受msd影响的部位之一,其受各种因素的影响,如手柄设计、笨拙的姿势和高的力需求[3]。腹腔镜手术需要精确而精细的动作,这可能会对手腕造成很大的压力。手腕屈曲和偏曲是指手腕向前向后弯曲,手腕向左或向右扭曲。最佳手腕姿势最大限度地减少屈曲和偏差的程度,允许一个中立的手腕位置。另一方面,过度的手腕屈曲和偏离会导致肌肉骨骼疼痛、疲劳和握力下降。具有较低屈曲和偏差程度的中性手腕姿势已被证明可以减少肌肉骨骼症状,增加灵活性,并提高手术精度。此外,前臂旋转(旋前和旋后)也在手腕人体工程学中发挥作用。根据快速上肢评估(RULA),手腕屈伸的范围建议为0-15°,手腕偏离时建议接近中立位,而前臂旋前或旋后的45°被认为符合人体工程学[4],[5]。HandX®[6]是一种手持式腹腔镜,软件驱动的机器人平台,用于操作5mm全关节仪器。HandX有四个机器人自由度(DoF),这里我们主要关注两个自由度来控制关节。HandX的球形控制界面(CI)允许外科医生在两个轴上(俯仰和偏航)的各个方向上操纵关节式器械的末端执行器
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