title: Evaluation of the effect of a laparoscopic robotized needle holder on ergonomics and skills.
abstract: BACKGROUND
  Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DOF) of forceps. To reduce this limitation, a new 5-mm robotized needle holder with two intracorporeal DOF, Jaimy(®), has been developed. The aim of this study was to evaluate its effects on ergonomics and skills.
  
  
  METHODS
  Fourteen surgeons including eight senior and six residents were crossover randomized and stratified based on experience. Three suturing tasks were performed with both Jaimy(®) and a classic needle holder (NH): task 1: Peg-Board; task 2: hexagonal suture; task 3: frontal suture. Postural ergonomics of the dominant arm were evaluated with an ergonomics score (RULA score) thanks to motion capture, and muscular ergonomics with electromyography of six muscular groups (flexor and extensor carpis, biceps, triceps, deltoid, trapeze). Performance outcomes are a quantitative and qualitative score, and skills outcomes are the measurement of the number of movements and the path length travelled by the instrument.
  
  
  RESULTS
  The RULA score showed a statistically improved posture with Jaimy(®) (p < 0.001). The cumulative muscular workload (CMW) of four muscles was not different. However, the CMW was in favor of the NH for the flexor carpi ulnaris (p < 0.001) and the triceps (p = 0.027). The number of movements was not different (p = 0.39) although the path length was shorter with Jaimy(®) (p = 0.012). The score for task 1 was in favor of the NH (p = 0.006) with a higher quantity score. Task 2 score was not different (p = 0.086): The quality part of the score was in favor of Jaimy(®) (p = 0.009) and the quantity part was higher with the NH (p = 0.04). The score for task 3 was higher with Jaimy(®) (p = 0.001).
  
  
  CONCLUSIONS
  This study suggests that the use of a robotized needle holder improves both posture and the quality of laparoscopic sutures.
authors.affiliation: Institut des Systèmes Intelligents et de Robotique, Université Pierre et Marie Curie, Paris, France. thierry.bensignor@gmail.com.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bensignor
authors.affiliation: Institut des Systèmes Intelligents et de Robotique, Université Pierre et Marie Curie, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Morel
authors.affiliation: Institut des Systèmes Intelligents et de Robotique, Université Pierre et Marie Curie, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Reversat
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D004576:Electromyography; D006804:Ergonomics; D005069:Evaluation Studies as Topic; D005542:Forearm / Q000502:physiology; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000639:trends; D009048:Motor Skills; D018482:Muscle, Skeletal / Q000502:physiology; D009339:Needles; D011597:Psychomotor Performance; D065287:Robotic Surgical Procedures / Q000295:instrumentation* / Q000639:trends; D066231:Surgeons; D013537:Sutures / Q000639:trends; D016526:Workload
keywords: Ergonomics; Laparoscopic needle holder; Motion capture; Robotized instrument; Skill assessment