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J Neurol Surg A Cent Eur Neurosurg 2019; 80(05): 333-340
DOI: 10.1055/s-0038-1676622
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Reducing Surgeon's Physical Stress in Minimally Invasive Neurosurgery

Atsushi Nakayashiki
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Tomohiro Kawaguchi
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Atsuhiro Nakagawa
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Fusako Mochizuki
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Hiroaki Furukawa
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Arata Nagai
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Takuya Suematsu
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Teiji Tominaga
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
› Author Affiliations Funding Source This study was funded in part by a grant from the Japanese Foundation for Research and Promotion of Endoscopy. This work was also supported in part by the Translational Research Network Program, Grant-in-Aid for Scientific Research (A) 15H01707, Grant-in-Aid for Scientific Research (B) 15H04945, 16H04309, and 26282116, Grant-in-Aid for Scientific Research (C) 16K11126, 26462629, 26462197, and 26462196, and Grant-in-Aid for Challenging Exploratory Research 16K15810 and 25670565 from the Japanese Ministry of Education, Culture, Sports, Science, and Technology (MEXT). Drs. Nakagawa and Tominaga received research support for this study from Seiko Epson Co., Ltd., under a collaborative research contract with Tohoku University, and Drs. Kawaguchi, Nakagawa, and Tominaga are patent holders with Seiko Epson Co., Ltd.
Further Information

Publication History

04 December 2017

31 July 2018

Publication Date:
24 April 2019 (online)

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Abstract

Background and Study Aims Various minimally invasive approaches are used in neurosurgery. Surgeons must perform nondynamic fine movements in a narrow corridor, so specially designed surgical devices are essential. Unsophisticated instruments may pose potential hazards. The purpose of this study was to assess the factors associated with muscle fatigue during minimally invasive neurosurgery and to investigate whether physical stress can be reduced by refining the devices used.

Material and Methods Four physical aspects of a handpiece were investigated: torque of conduits (0.20, 0.28, and 0.37 kgf*cm), shape of hand grip (five types), angle of the nozzle (0, 20, and 40 degrees), and weight balance (neutral, proximal, and distal). To evaluate muscle fatigue, surface electromyography was recorded from the extensor carpi radialis muscle and flexor carpi radialis muscle during a geometric tracing task. The maximum voluntary contraction (MVC) of each muscle and %MVC (muscle contraction during a task/MVC × 100) were used as the indexes of muscle fatigue.

Results The shape of the hand grip significantly reduced %MVC, which is associated with muscle fatigue. The torque of conduits and angle of the nozzle tended to reduce muscle fatigue but not significantly. Weight balance did not affect muscle fatigue. Based on these results, we made two refined models: model α (torque of conduits 0.2 kgf*cm, angle of nozzle 20 degrees, neutral balance, hand grip with a 2.9 × 2.0-cm oval section with angled finger rest), and model β (torque of conduits 0.2 kgf*cm, angle of nozzle 20 degrees, neutral balance, hand grip with a 2.9-cm round section with a curved finger rest). The %MVC was significantly decreased with both types (p < 0.05 and p < 0.01, respectively), indicating reduction of muscle fatigue.

Conclusions The geometrically refined surgical device can improve muscle load during surgery and reduce the surgeon's physical stress, thus minimizing the risk of complications.

Keywords

muscle fatigue - stress reduction - pulsed water jet - medical device development

Supplementary Material

 

  • References

  • 1 Bodzin AS, Leiby BE, Ramirez CG, Frank AM, Doria C. Liver resection using Cavitron ultrasonic surgical aspirator (CUSA) versus harmonic scalpel: a retrospective cohort study. Int J Surg 2014; 12 (05) 500-503
    CrossrefPubMedGoogle Scholar
  • 2 Nicolai P, Paderno A, Farina D, Piazza C. Microdebrider cavitation and transcervical removal of parapharyngeal schwannomas approaching the skull base. Eur Arch Otorhinolaryngol 2014; 271 (12) 3305-3311
    CrossrefPubMedGoogle Scholar
  • 3 Weibl P, Shariat SF, Klatte T. Partial nephrectomy driven by Cavitron ultrasonic surgical aspirator under zero ischemia: a pilot study. World J Urol 2015; 33 (12) 2015-2021
    CrossrefPubMedGoogle Scholar
  • 4 Georgilas I, Dagnino G, Tarassoli P, Atkins R, Dogramadzi S. Robot-assisted fracture surgery: surgical requirements and system design. Ann Biomed Eng 2018;
    PubMedGoogle Scholar
  • 5 Martin JL, Barnett J. Integrating the results of user research into medical device development: insights from a case study. BMC Med Inform Decis Mak 2012; 12: 74
    CrossrefPubMedGoogle Scholar
  • 6 Seto T, Yamamoto H, Takayama K, Nakagawa A, Tominaga T. Characteristics of an actuator-driven pulsed water jet generator to dissecting soft tissue. Rev Sci Instrum 2011; 82 (05) 055105
    CrossrefPubMedGoogle Scholar
  • 7 Oertel J, Gaab MR, Pillich DT, Schroeder HW, Warzok R, Piek J. Comparison of waterjet dissection and ultrasonic aspiration: an in vivo study in the rabbit brain. J Neurosurg 2004; 100 (03) 498-504
    CrossrefPubMedGoogle Scholar
  • 8 Endo T, Nakagawa A, Fujimura M, Sonoda Y, Shimizu H, Tominaga T. Usefulness of pulsed water jet in dissecting sphenoid ridge meningioma while preserving arteries [in Japanese]. No Shinkei Geka 2014; 42 (11) 1019-1025
    PubMedGoogle Scholar
  • 9 Kawaguchi T, Nakagawa A, Endo T, Fujimura M, Sonoda Y, Tominaga T. Ventricle wall dissection and vascular preservation with the pulsed water jet device: novel tissue dissector for flexible neuroendoscopic surgery. J Neurosurg 2016; 124 (03) 817-822
    CrossrefPubMedGoogle Scholar
  • 10 Nakagawa A, Kumabe T, Kanamori M. , et al. Clinical application of pulsed laser-induced liquid jet: preliminary report in glioma surgery [in Japanese]. No Shinkei Geka 2008; 36 (11) 1005-1010
    PubMedGoogle Scholar
  • 11 Ogawa Y, Nakagawa A, Takayama K, Tominaga T. Pulsed laser-induced liquid jet for skull base tumor removal with vascular preservation through the transsphenoidal approach: a clinical investigation. Acta Neurochir (Wien) 2011; 153 (04) 823-830
    CrossrefPubMedGoogle Scholar
  • 12 Ogawa Y, Nakagawa A, Washio T, Arafune T, Tominaga T. Tissue dissection before direct manipulation to the pathology with pulsed laser-induced liquid jet system in skull base surgery—preservation of fine vessels and maintained optic nerve function. Acta Neurochir (Wien) 2013; 155 (10) 1879-1886
    CrossrefPubMedGoogle Scholar
  • 13 Endo T, Takahashi Y, Nakagawa A, Niizuma K, Fujimura M, Tominaga T. Use of actuator-driven pulsed water jet in brain and spinal cord cavernous malformations resection. Neurosurgery 2015; 11 (Suppl. 03) 394-403 ; discussion 403
    CrossrefPubMedGoogle Scholar
  • 14 Youssef Y, Lee G, Godinez C. , et al. Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position. Surg Endosc 2011; 25 (07) 2168-2174
    CrossrefPubMedGoogle Scholar
  • 15 McAtamney L, Nigel Corlett E. RULA: a survey method for the investigation of work-related upper limb disorders. Appl Ergon 1993; 24 (02) 91-99
    CrossrefPubMedGoogle Scholar
  • 16 Berguer R, Gerber S, Kilpatrick G, Beckley D. An ergonomic comparison of in-line vs pistol-grip handle configuration in a laparoscopic grasper. Surg Endosc 1998; 12 (06) 805-808
    CrossrefPubMedGoogle Scholar
  • 17 Berguer R, Gerber S, Kilpatrick G, Remler M, Beckley D. A comparison of forearm and thumb muscle electromyographic responses to the use of laparoscopic instruments with either a finger grasp or a palm grasp. Ergonomics 1999; 42 (12) 1634-1645
    CrossrefPubMedGoogle Scholar
  • 18 Lawrence JH, De Luca CJ. Myoelectric signal versus force relationship in different human muscles. J Appl Physiol 1983; 54 (06) 1653-1659
    CrossrefPubMedGoogle Scholar
  • 19 Lee EC, Rafiq A, Merrell R, Ackerman R, Dennerlein JT. Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems. Surg Endosc 2005; 19 (08) 1064-1070
    CrossrefPubMedGoogle Scholar
  • 20 Matern U, Kuttler G, Giebmeyer C, Waller P, Faist M. Ergonomic aspects of five different types of laparoscopic instrument handles under dynamic conditions with respect to specific laparoscopic tasks: an electromyographic-based study. Surg Endosc 2004; 18 (08) 1231-1241
    CrossrefPubMedGoogle Scholar
  • 21 Stucky CH, Cromwell KD, Voss RK. , et al. Surgeon symptoms, strain, and selections: systematic review and meta-analysis of surgical ergonomics. Ann Med Surg (Lond) 2018; 27 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 22 Vereczkei A, Feussner H, Negele T. , et al. Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy. Surg Endosc 2004; 18 (07) 1118-1122
    PubMedGoogle Scholar
  • 23 Zihni AM, Ohu I, Cavallo JA, Ousley J, Cho S, Awad MM. FLS tasks can be used as an ergonomic discriminator between laparoscopic and robotic surgery. Surg Endosc 2014; 28 (08) 2459-2465
    CrossrefPubMedGoogle Scholar
  • 24 Sun H, Zhang X, Zhao Y, Zhang Y, Zhong X, Fan Z. A novel feature optimization for wearable human-computer interfaces using surface electromyography sensors. Sensors (Basel) 2018; 18 (03) E869
    CrossrefPubMedGoogle Scholar
  • 25 Zhang JY, Liu SL, Feng QM, Gao JQ, Zhang Q. Correlative evaluation of mental and physical workload of laparoscopic surgeons based on surface electromyography and eye-tracking signals. Sci Rep 2017; 7 (01) 11095
    CrossrefPubMedGoogle Scholar
  • 26 Hagberg M. The amplitude distribution of surface EMG in static and intermittent static muscular performance. Eur J Appl Physiol Occup Physiol 1979; 40 (04) 265-272
    CrossrefPubMedGoogle Scholar
  • 27 Jonsson B. Measurement and evaluation of local muscular strain in the shoulder during constrained work. J Hum Ergol (Tokyo) 1982; 11 (01) 73-88
    PubMedGoogle Scholar
  • 28 Jonsson B. Kinesiology: with special reference to electromyographic kinesiology. Electroencephalogr Clin Neurophysiol Suppl 1978; (34) 417-428
    PubMedGoogle Scholar
  • 29 IEC 62366-1:2015. Medical devices—Part 1: Application of usability engineering to medical devices. Available at: https://www.iso.org/standard/63179.html
    PubMedGoogle Scholar
  • 30 Aarås A. Relationship between trapezius load and the incidence of musculoskeletal illness in the neck and shoulder. Int J Ind Ergon 1994; 14 (04) 341-348
    CrossrefPubMedGoogle Scholar
  • 31 Ankrum DR. On the confusion between static load level and static task. Appl Ergon 2000; 31 (05) 545-546
    CrossrefPubMedGoogle Scholar