Spine Surgeon's Kinematics during Discectomy, Part II: Operating Table Height and Visualization Methods, Including Microscope
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Global spine journal,
v.4 suppl.1,
2014년, pp.s-0034-1376702 - s-0034-1376702
Park, J. Y.
(Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea, Republic of Korea)
,
Kuh, S. U.
(Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea, Republic of Korea)
,
Cho, Y. E.
(Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea, Republic of Korea)
Introduction Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a...
Introduction Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope. Materials and Methods We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position. Results Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method. When using a microscope, lumbar lordosis, thoracic kyphosis, and cervical lordosis showed no differences according to table heights above the umbilicus. Conclusion This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue. Disclosure of Interest J. Y. Park: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) S. U. Kuh: None declared Y. E. Cho: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) References Wunderlich M, Jacob R, Stelzig Y, Rüther T, Leyk D. [Analysis of spinal stress during surgery in otolaryngology]. HNO 2010;58(8):791-798 Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. Spine surgeon's kinematics during discectomy according to operating table height and the methods to visualize the surgical field. Eur Spine J 2012;21(12):2704-2712 van Det MJ, Meijerink WJ, Hoff C, Totté ER, Pierie JP. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 2009;23(6):1279-1285 Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ. A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 1992;63(6):423-428 Shirzadi A, Mukherjee D, Drazin DG, et al. Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine 2012;37(24):E1517-E1523 Postacchini F, Postacchini R. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl (Wien) 2011;108:17-21 Kranenburg G, Gossot. Ergonomic problems encountered during video-assisted thoracic surgery. Minim Invasive Ther Allied Technol 2004;13(3):147-155 Lee
Introduction Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope. Materials and Methods We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position. Results Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method. When using a microscope, lumbar lordosis, thoracic kyphosis, and cervical lordosis showed no differences according to table heights above the umbilicus. Conclusion This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue. Disclosure of Interest J. Y. Park: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) S. U. Kuh: None declared Y. E. Cho: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) References Wunderlich M, Jacob R, Stelzig Y, Rüther T, Leyk D. [Analysis of spinal stress during surgery in otolaryngology]. HNO 2010;58(8):791-798 Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. Spine surgeon's kinematics during discectomy according to operating table height and the methods to visualize the surgical field. Eur Spine J 2012;21(12):2704-2712 van Det MJ, Meijerink WJ, Hoff C, Totté ER, Pierie JP. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 2009;23(6):1279-1285 Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ. A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 1992;63(6):423-428 Shirzadi A, Mukherjee D, Drazin DG, et al. Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine 2012;37(24):E1517-E1523 Postacchini F, Postacchini R. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl (Wien) 2011;108:17-21 Kranenburg G, Gossot. Ergonomic problems encountered during video-assisted thoracic surgery. Minim Invasive Ther Allied Technol 2004;13(3):147-155 Lee
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