title: Laparoendoscopic single site (LESS) in vivo suturing using a magnetic anchoring and guidance system (MAGS) camera in a porcine model: impact on ergonomics and workload.
abstract: OBJECTIVE
  To compare the ergonomics and workload of the surgeon during single-site suturing while using the magnetic anchoring and guidance system (MAGS) camera vs a conventional laparoscope.
  
  
  METHODS
  Seven urologic surgeons were enrolled and divided into an expert group (n=2) and a novice group (n=5) according to their laparoendoscopic single-site (LESS) experience. Each surgeon performed 2 conventional LESS and 2 MAGS camera-assisted LESS vesicostomy closures in a porcine model. A Likert scale (scoring 1-5) questionnaire assessing workload, ergonomics, technical difficulty, visualization, and needle handling, as well as a validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire were used to evaluate the tasks and workloads.
  
  
  RESULTS
  MAGS LESS suturing was universally favored by expert and novice surgeons compared with conventional LESS in workload (3.4 vs 4.2), ergonomics (3.4 vs 4.4), technical challenge (3.3 vs 4.3), visualization (2.4 vs 3.3), and needle handling (3.1 vs 3.9 respectively; P<.05 for all categories). Surgeon NASA-TLX assessments found MAGS LESS suturing significantly decreased the workload in physical demand (P=.004), temporal demand (P=.017), and effort (P=.006). External instrument clashing was significantly reduced in MAGS LESS suturing (P<.001). The total operative time of MAGS LESS suturing was comparable to that of conventional LESS (P=.89).
  
  
  CONCLUSIONS
  MAGS camera technology significantly decreased surgeon workload and improved ergonomics. Nevertheless, LESS suturing and knot tying remains a challenging task that requires training, regardless of which camera is used.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Gang
authors.initials: G
authors.lastname: Yin
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.forename: Stephen
authors.initials: S
authors.lastname: Faddegon
authors.forename: Yung Khan
authors.initials: YK
authors.lastname: Tan
authors.forename: Zhuo-Wei
authors.initials: ZW
authors.lastname: Liu
authors.forename: Ephrem O
authors.initials: EO
authors.lastname: Olweny
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000818:Animals; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D053715:Cystotomy / Q000295:instrumentation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D059346:Magnets; D008328:Man-Machine Systems; D023421:Models, Animal; D061646:Operative Time; D005082:Physical Exertion; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013552:Swine; D013647:Task Performance and Analysis; D016526:Workload