title: An ergonomic evaluation of surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery.
abstract: BACKGROUND
  Many surgeons have complained of fatigue and musculoskeletal pain after laparoscopic surgery. We evaluated differences in surgeons' axial skeletal and upper extremity movements during laparoscopic and open operations.
  
  
  METHODS
  Five surgeons were videotaped performing 16 operations (8 laparoscopic and 8 open) to record their neck, trunk, shoulder, elbow, and wrist movements during the first hour of surgery. We also compared postprocedural complaints of pain, stiffness, or numbness between the two groups.
  
  
  RESULTS
  Compared with surgeons performing open surgery, surgeons performing laparoscopic surgery exhibited less lateral neck flexion; less trunk flexion; more internal rotation of the shoulders; more elbow flexion; more wrist supination and wrist ulnar and radial deviation. There was a trend of more shoulder stiffness after laparoscopic operations than after open operations.
  
  
  CONCLUSIONS
  Laparoscopic surgery involves a more static posture of the neck and trunk, but more frequent awkward movements of the upper extremities than open surgery. Ergonomic changes in the operating room environment and instrument design could ease the physical stress imposed on surgeons during laparoscopic operations.
authors.affiliation: Department of Surgery, University of Califorinia, Davis, Medical Center, 2221 Stockton Blvd., 3rd Flr., Sacramento, CA 95817-2214, USA. ninh.nguyen@ucdmc.ucdavis.edu
authors.forename: N T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: H S
authors.initials: HS
authors.lastname: Ho
authors.forename: W D
authors.initials: WD
authors.lastname: Smith
authors.forename: C
authors.initials: C
authors.lastname: Philipps
authors.forename: C
authors.initials: C
authors.lastname: Lewis
authors.forename: R M
authors.initials: RM
authors.lastname: De Vera
authors.forename: R
authors.initials: R
authors.lastname: Berguer
mesh_terms: D000328:Adult; D001132:Arm / Q000502:physiology; D006804:Ergonomics; D005260:Female; D013502:General Surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009333:Neck / Q000502:physiology; D013514:Surgical Procedures, Operative; D014743:Videotape Recording