title: Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study.
abstract: OBJECTIVE
  To compare resident, fellow, and attending urologic and gynecologic surgeons' musculoskeletal and mental strain during laparoscopic and robotic sacrocolpopexy.
  
  
  METHODS
  Prospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Patients who underwent robotic or laparoscopic sacrocolpopexy from October 2009 to January 2011.
  
  
  METHODS
  The Body Part Discomfort (BPD) survey was completed before cases, and the National Aeronautics and Space Administration Task Load Index and BPD survey were completed after cases. Higher scores on BPD and the National Aeronautics and Space Administration Task Load Index indicate greater musculoskeletal discomfort and mental strain. BPD scores were averaged over the following body regions: head/neck, back, hand/wrist, arms, and knees/ankles/feet. Changes in body region-specific discomfort scores were the primary outcomes.
  
  
  RESULTS
  Multivariable analysis was performed using mixed-effects linear regression with surgeon as a random effect. Sixteen surgeons participated (53% fellows, 34% residents, and 13% attendings). Thirty-three robotic and 53 laparoscopic cases were analyzed, with a median surgical time of 231 minutes (interquartile range, 204-293 minutes) versus 227 minutes (interquartile range, 203-272 minutes; p = .31), a median estimated blood loss of 100 mL (interquartile range, 50-175 mL) versus 150 mL (interquartile range, 50-200 mL; p = .22), and a mean patient body mass index of 27 ± 4 versus 26 ± 4 kg/m(2) (p = .26), respectively. Robotic surgeries were associated with lower neck/shoulder (-0.19 [interquartile range, -0.32 to -0.01], T = -2.49) and back discomfort scores (-0.35 [interquartile range, -0.58 to 0], T = -2.38) than laparoscopic surgeries. Knee/ankle/foot and arm discomfort increased with case length (0.18 [interquartile range, 0.02-0.3], T = 2.81) and (0.07 [interquartile range, 0.01-0.14], p = .03), respectively.
  
  
  CONCLUSIONS
  Surgeons performing minimally invasive sacrocolpopexy experienced less neck, shoulder, and back discomfort when surgery was performed robotically.
authors.affiliation: Division of Female Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: megan.tarr@gmail.com.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Tarr
authors.affiliation: Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Brancato
authors.affiliation: Division of Female Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Cunkelman
authors.affiliation: Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Anthony
authors.initials: A
authors.lastname: Polcari
authors.affiliation: Section of Biostatistics, Qualitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nutter
authors.affiliation: Division of Female Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
mesh_terms: D000368:Aged; D006804:Ergonomics; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008328:Man-Machine Systems; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology / Q000517:prevention & control*; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D011187:Posture; D011446:Prospective Studies; D012371:Robotics; D066231:Surgeons; D011795:Surveys and Questionnaires; D014481:United States; D016526:Workload
keywords: Ergonomics; Laparoscopic; Robotic; Sacrocolpopexy