Digestive endoscopy practice is associated with various musculoskeletal disorders
for the operator. This has been the subject of numerous studies and a guideline recently
published by the American Society for Gastrointestinal Endoscopy [1]
[2]. Although these recommendations call for a neutral position for the operator, they
are often difficult to implement in practice. Of particular concern are procedures
performed under both fluoroscopic and endoscopic guidance, as they require the operator
to alternate the attention between two monitors, often positioned on different axes
relative to the right hand holding the endoscope. When the room is dedicated to endoscopic
retrograde cholangiopancreatography (ERCP), where the operator’s neutral position
is usually with their back to the patient, conventional procedures result in twisting
movements of the knees, hips, back, and neck, with the latter two being at greatest
risk of endoscopy-related injury [3].
We report the case of a patient with esophageal stricture (eosinophilic esophagitis)
referred for dilation using the BougieCap (Ovesco, Tübingen, Germany) technique under
double fluoroscopic and endoscopic control. The procedure was performed in an ERCP
room with a screen layout optimized for an operator with their back to the patient.
The procedure therefore required a great deal of twisting on the part of the operator
([Fig. 1]
a). An augmented reality headset (ClearSurgery, Oullins, France) is a promising device
for optimizing the ergonomics of gastrointestinal endoscopy, as it allows the operator
to place the monitors in their field of view, whichever position is preferable, regardless
of the environment in the room. In this example, the headset was held by an independent
doctor not involved in the therapeutic procedure, as the system is currently undergoing
the Conformité Européenne marking process ([Video 1]). The use of this technique would allow the operator to perform the procedure in
a neutral position, while allowing the nurses to place the screens at their convenience
([Fig. 1]
b).
Fig. 1 Operator positioning during endoscopy. a The conventional position of endoscopy screens in a room dedicated to endoscopic
retrograde cholangiopancreatography forces the operator to make significant twisting
movements when performing a procedure such as esophageal dilation. b The augmented reality headset allows the screens to be placed wherever the operator
wishes in their field of view, to enable a neutral position.
Use of augmented reality digestive endoscopy to optimize ergonomics.Video 1
Although this augmented reality strategy is still undergoing approval, it seems a
promising device for preventing endoscopy-related injuries by promoting optimal ergonomics
for both the operator and the nurse, maintaining them in a neutral position and significantly
improving the ergonomic aspect of the procedure.
Endoscopy_UCTN_Code_TTT_1AU_2AF
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
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by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
