title: Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines.
abstract: BACKGROUND
  With minimally invasive surgery (MIS), a man-machine environment was brought into the operating room, which created mental and physical challenges for the operating team. The science of ergonomics analyzes these challenges and formulates guidelines for creating a work environment that is safe and comfortable for its operators while effectiveness and efficiency of the process are maintained. This review aimed to formulate the ergonomic challenges related to monitor positioning in MIS. Background and guidelines are formulated for optimal ergonomic monitor positioning within the possibilities of the modern MIS suite, using multiple monitors suspended from the ceiling.
  
  
  METHODS
  All evidence-based experimental ergonomic studies conducted in the fields of laparoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches and selected for quality and applicability. Data from ergonomic studies were evaluated in terms of effectiveness and efficiency as well as comfort and safety aspects. Recommendations for individual monitor positioning are formulated to create a personal balance between these two ergonomic aspects.
  
  
  RESULTS
  Misalignment in the eye-hand-target axis because of limited freedom in monitor positioning is recognized as an important ergonomic drawback during MIS. Realignment of the eye-hand-target axis improves personal values of comfort and safety as well as procedural values of effectiveness and efficiency.
  
  
  CONCLUSIONS
  Monitor position is an important ergonomic factor during MIS. In the horizontal plain, the monitor should be straight in front of each person and aligned with the forearm-instrument motor axis to avoid axial rotation of the spine. In the sagittal plain, the monitor should be positioned lower than eye level to avoid neck extension.
authors.affiliation: Department of Surgery, Leeuwarden Medical Center, PO Box 888, 8901 BR, Leeuwarden, The Netherlands. marc.van.det@znb.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: van Det
authors.forename: W J H J
authors.initials: WJ
authors.lastname: Meijerink
authors.forename: C
authors.initials: C
authors.lastname: Hoff
authors.forename: E R
authors.initials: ER
authors.lastname: Totté
authors.forename: J P E N
authors.initials: JP
authors.lastname: Pierie
mesh_terms: D004867:Equipment Design; D006804:Ergonomics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards*; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000592:standards; D009873:Operating Rooms / Q000592:standards*; D011187:Posture / Q000502:physiology*; D017410:Practice Guidelines as Topic; D012449:Safety / Q000592:standards