title: Assessment of the ergonomically optimal operating surface height for laparoscopic surgery.
abstract: OBJECTIVE
  The aim of this study was to find the ergonomically optimal operating surface height for laparoscopic surgery in order to reduce discomfort in the upper extremities of the operators and the assistants. The operating surface height was defined as the level of the abdominal wall of a patient with pneumoperitoneum.
  
  
  METHODS
  Two pelvi-trainer tests were performed. One test was performed on six different operating surface heights. The (extreme) joint excursions of the shoulder, elbow, and wrist were measured by a video analysis method. Another test was performed by holding a laparoscope for 15 minutes while an electromyelograph of the biceps brachii was made. The results of both tests were evaluated subjectively by a questionnaire.
  
  
  RESULTS
  The ergonomically optimal operating surface height lies between a factor 0.7 and 0.8 of the elbow height of the operator/assistant. At this height, the joint excursions stay in the neutral zone for more than 90% of the total manipulation time, and the activity of the biceps brachii when holding the laparoscope stays within 15% of the maximum muscle activity.
  
  
  CONCLUSIONS
  The operating surface height influences the (extreme) upper joint excursions of the surgeon. The ergonomically optimal operating surface height reduces the discomfort in the shoulders, back, and wrists of the surgeon during laparoscopic surgery. This optimal table height range for laparoscopic surgery is lower than those currently available.
authors.affiliation: Faculty of Design, Engineering and Production, Subfaculty Industrial Design Engineering, Delft University of Technology, The Netherlands. m.a.vanveelen@io.tudelft.nl
authors.forename: M A
authors.initials: MA
authors.lastname: van Veelen
authors.forename: G
authors.initials: G
authors.lastname: Kazemier
authors.forename: J
authors.initials: J
authors.lastname: Koopman
authors.forename: R H M
authors.initials: RH
authors.lastname: Goossens
authors.forename: D W
authors.initials: DW
authors.lastname: Meijer
mesh_terms: D004576:Electromyography; D004867:Equipment Design; D006804:Ergonomics; D006749:Hospital Design and Construction / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D009873:Operating Rooms; D011187:Posture / Q000502:physiology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014741:Video Recording