title: Objective ergonomic risk assessment of wrist and spine with motion analysis technique during simulated laparoscopic cholecystectomy in experienced and novice surgeons.
abstract: BACKGROUND
  There is a rise in prevalence of work-related musculoskeletal disorders in surgeons performing laparoscopic surgeries due to lack of ergonomic considerations to the minimal access surgical environment. The objective of this study was to assess the physical ergonomics in experienced and novice surgeons during a simulated laparoscopic cholecystectomy.
  
  
  METHODS
  Thirty-two surgeons participated in this study and were distributed in two groups (experienced and novices) based on the inclusion criteria. Both groups were screened for the spinal and wrist movements on the orientation sensor-based, motion analysis device while performing a simulated laparoscopic cholecystectomy. Simultaneous video recording was used to estimate the other joint positions. The RULA (Rapid Upper Limb Assessment) ergonomic risk scores were estimated with the acquired data.
  
  
  RESULTS
  We found that surgeons in both novice and experienced groups scored a high on the RULA. Limited awareness of the influence of monitor position on the postural risk caused surgeons to adopt non-neutral range cervical postures. The thoracolumbar spine is subjected to static postural demand. Awkward wrist postures were adopted during the surgery by both groups. There was no statistically significant difference in the RULA scores between the novice and experienced, but some differences in maximum joint excursions between them as detected on the motion analysis system.
  
  
  CONCLUSIONS
  Both experienced and novice surgeons adopted poor spinal and wrist ergonomics during simulated cholecystectomy. We concluded that the physical ergonomic risk is medium as estimated by the RULA scoring method, during this minimally invasive surgical procedure, demanding implementation of change in the ergonomic practices.
authors.affiliation: Department of Musculoskeletal Physiotherapy, School of Physiotherapy, D. Y. Patil University, Mumbai, Maharashtra, India.
authors.forename: Twinkle Yogesh
authors.initials: TY
authors.lastname: Dabholkar
authors.affiliation: Department of Musculoskeletal Physiotherapy, School of Physiotherapy, D. Y. Patil University, Mumbai, Maharashtra, India.
authors.forename: Sujata Sudhir
authors.initials: SS
authors.lastname: Yardi
authors.affiliation: Medical Simulation Laboratory, D. Y. Patil University, Navi Mumbai, Mumbai, Maharashtra, India.
authors.forename: Sanjay Narahari
authors.initials: SN
authors.lastname: Oak
authors.affiliation: Department of Musculoskeletal Physiotherapy, School of Physiotherapy, D. Y. Patil University, Mumbai, Maharashtra, India.
authors.forename: Sneha
authors.initials: S
authors.lastname: Ramchandani