title: Ergonomic aspects related to surgeon position in laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  The aim is to evaluate the level of inclination of the surgeon's spinal column (ISSC) while performing laparoscopic radical prostatectomy (LRP) when using one trocar on each side of the patient abdomen ("torero" position) in two scenarios: With and without a thin head supporter adapted to the table.
  
  
  METHODS
  Based on trigonometric principles, we elaborated a formula to calculate the ISSC for a determined surgeon and surgical table while performing LRP in the torero position. The parameters considered were the width of the surgical table (m), the distance between the surgeon's anterior superior iliac spines (q), and the distance from the central point between the surgeon's anterior superior iliac spines to the surgeon's head (h). We used the formula alpha = 90 degree-cos(-1)(b/h) (where b = q/2 + m/2) in an Excel sheet to calculate the angle of inclination of the surgeon's spinal column. We applied the measures of 12 surgeons with different biotypes of our staff to calculate the ISSC with and without the thin head supporter.
  
  
  RESULTS
  The use of a thin head supporter reduced the mean ISCC in the torero position from 36.1 +/- 3.73 degrees (range 31.3 to 49.8 degrees) to 22.1 +/- 4.9 degrees (range 18.7 to 32.9 degrees), which corresponds to a reduction of 38.8% in the mean angle of inclination. This difference was statistically significant (P < 0.001).
  
  
  CONCLUSIONS
  The use of a thin head supporter adapted to the surgical table objectively reduces lateral inclination of the surgeon's spinal column in the torero position, making LRP a more comfortable procedure.
authors.affiliation: Department of Urology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Anuar I
authors.initials: AI
authors.lastname: Mitre
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Duarte
authors.forename: Marco A
authors.initials: MA
authors.lastname: Arap
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Coelho
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Lopes
authors.forename: Flavio
authors.initials: F
authors.lastname: Trigo-Rocha
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D006804:Ergonomics; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010820:Physicians; D011187:Posture; D011468:Prostatectomy / Q000379:methods*