Research and Reports in Urology (Sep 2019)
An Ergonomic Assessment Of Four Different Donor Nephrectomy Approaches For The Surgeons And Their Assistants
Abstract
Baptiste Marçon,1 Willy Ngueyon Sime,2 Francis Guillemin,2 Nicolas Hubert,1 François Lagrange,1 Céline Huselstein,3 Jacques Hubert1,4 1Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, France; 2Clinical Epidemiology Center Inserm CIC-EC 1433, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54505, France; 3Department of Health Sciences and Engineering, Faculty of Medicine, Lorraine University, Nancy, France; 4IADI-UL-INSERM (U1254), University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, FranceCorrespondence: Baptiste MarçonDepartment of Urology, University Hospital Nancy-Brabois, Allée du Morvan, Vandœuvre-lès-Nancy, Nancy 54511, FranceTel +33 06 75 08 86 01Email [email protected]: Open surgery is increasingly being replaced by laparoscopic approaches that are more demanding for the surgical team. The physical and mental workload of these approaches have not been quantified.Materials and methods: A multicenter prospective study was performed evaluating the physical and mental stresses of 4 surgical approaches (open surgery [OS], standard laparoscopy [SL], hand-assisted laparoscopy [HAL], and robot-assisted laparoscopy [RAL]) for donor nephrectomy for the surgeon and their assistant. The Borg Scale was used to evaluate exertion in different body parts every 30 mins during surgery and the NASA-TLX score was used to evaluate overall workload.Results: 264 nephrectomies were performed over a 33-month period and 258 questionnaires evaluating these surgeries were obtained. Surgeons experienced less left shoulder and arm exertion and left forearm and hand exertion, but greater lower back exertion, as measured by the Borg scale, with RAL. Leg exertion was significantly greater with OS. Assistant surgeons experienced increased exertion in the back, right shoulder and arm, and right forearm and hand with RAL. NASA Task load index (TLX) surgeon scores showed mental demand was similar for all 4 surgical approaches. Physical demand was lower and overall performance was higher with RAL.Discussion: Four different nephrectomy surgical approaches were evaluated in a multicenter setting. Surgeon and assistant scores of physical exertions were generally in the “easy” range but confirmed that robotic surgery is an ergonomic progress compared to other techniques, except for the axial skeleton. Further, it degrades the working conditions for the assistant.Keywords: ergonomics, surgery, nephrectomy, laparoscopy, robot, bed-side assistant, living donor
