title: Development of an arm support system to improve ergonomics in laparoscopic surgery: study design and provisional results.
abstract: BACKGROUND
  Laparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder-neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operation room settings.
  
  
  METHODS
  A systematic approach to develop an ASsyst started in October 2012 consisting of five consecutive steps. In step 1, 14 laparoscopic interventions were observed using subjective and objective measures to determine key indicators for the conception of an ASsyst in LS. In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods. During the third step, prototypes of ASsyst were tested in an experimental setting. Steps 4 and 5 are currently in process and include the final development of the ASsyst using the most promising concept for the evaluation during simulated LS.
  
  
  RESULTS
  Increased levels of physical stress were found in LS. Asymmetric strains were common. Three prototypes of ASsyst emerged from step 1 and 2. These prototypes were a cable construction with a noose for the lower arm, a support from below the elbow and a pneumatic vest supporting the upper arm. The experimental testing of these prototypes demonstrated reduced physical stress when compared to the unsupported environment. The support from below the elbow seemed to be the most practical in terms of implementation in various operation room settings and acceptance by surgeons. Step 4 and 5 are still in process.
  
  
  CONCLUSIONS
  Ergonomic problems have been identified in LS that could be addressed by an ASsyst. The concept of supporting the elbow from below has been found to be the most promising approach.
authors.affiliation: Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany, benjamin.steinhilber@med.uni-tuebingen.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Steinhilber
authors.forename: Sascha
authors.initials: S
authors.lastname: Hoffmann
authors.forename: Kristian
authors.initials: K
authors.lastname: Karlovic
authors.forename: Stefan
authors.initials: S
authors.lastname: Pfeffer
authors.forename: Thomas
authors.initials: T
authors.lastname: Maier
authors.forename: Omar
authors.initials: O
authors.lastname: Hallasheh
authors.forename: Stephan
authors.initials: S
authors.lastname: Kruck
authors.forename: Robert
authors.initials: R
authors.lastname: Seibt
authors.forename: Monika A
authors.initials: MA
authors.lastname: Rieger
authors.forename: Michael
authors.initials: M
authors.lastname: Heidingsfeld
authors.forename: Ronny
authors.initials: R
authors.lastname: Feuer
authors.forename: Oliver
authors.initials: O
authors.lastname: Sawodny
authors.forename: Ralf
authors.initials: R
authors.lastname: Rothmund
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
mesh_terms: D001132:Arm / Q000502:physiology*; D004867:Equipment Design; D006804:Ergonomics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D013312:Stress, Physiological