laparoscopic surgery

1. ERGONOMICS IN LAPAROSCOOIC SURGERY
Dr. Nauman Danawar
General Surgeon
Syrian& Arab board, MRCSI

2. The outline
1- Ideal relaxation position
2- Waist line table
3- Gaze daown veiw for monitor
4- Straight line principle
5- Baseball baimond cocept:
-half instument should be in and half instument out.
-Telescope in the middle.
-Manipulation angle 60 degree.
6- Ideal angles:
Manipulation angle
Azimuth angle
Elevation angle

3. ERGONOMICS IN LAPAROSCOPY
Ergonomics is a Greek word
Erg= work
Nomi= natural law
Ergonomics is the science of best suiting the worker to
his job.
(How to work safely and comfotably)

4. 1- Ideal relaxed position
 Straight head, in the axis of the trunk, without rotation or extension of the cervical spine.
 Shoulders in a relaxed and neutral position(accepted abduction up to 15 degree).
 Arms alongside the body.
 Elbows bent to 90-120 degrees.(hand of instrument at the level of elbow)
 Forearms in a horizontal or slightly descending axis.
 Hands pronated (physiological resting position).
 Hands and fingers lightly grip the handpiece.
 Over grip for the assistant.

5. Ideal relaxed position

6. 2- Waist line table (surgeon height cm X 0.49)
•Table height should be at or below the waist line of the operating surgeon
in order to avoid muscular fatigue from the non-physiological position of the
surgeon’s arms during the procedure.

7. 3- Gaze down view of monitor
- Gaze down view of monitor ( around 15-40 degree)
•The monitor:
- Must be high resolution, and facing the surgeon.
- placed at 25 degree gaze dawn.
- The distance from surgeon:
5x diagonal screen diameter ( 5x 21 inch=105 inch distance).

8. 4- Straight Line Principle
surgeon, target and the monitor must be in a straight line.

9. 5- Baseball diamond concept
-half instument should be in and half instument out,
-Telescope in the middle.
-manipulation angle 60 degree.

10. half instument should be in and half instument out
target, length of instruments, and draw a line around the target
target: is the area of maximum dissection.
appendectomy: the base of appendix
cholecystectomy: calot’s triangle

11. Length of my instruments:
Standard adult 36 cm
Morbid obese 45 cm
Pediatric 28 cm
Newnate. 20 cm

12. draw a line around the target

13. Lever type 2 ( port near to target)
Ideally, we achieve lever type 1
The drawbacks in type 2 lever are:
movement is rectified.
power outside is magnified ( tissue tear or avulsion).
Increased elevation angle (muscles fatigue).
Direct coupling if using metal port, or static capacitor when using plastic one
(bowel injury).
So, type 2 lever is dangerous and uncomfortable.
Lever type 1
Lever type 2

14. lever type 3 ( port is far from the target)
The drawbacks in type 3 lever are:
movement is magnified inside (overshooting).
power is rectified.
decrease elevation angle (the instruments with touch the patient body).
again, type 3 lever is dangerous and uncomfortable.

15. Manipulation angle 60 degree

16. Applying baseball diamond concept in OR

17. 6- Ideal Angles working angels
1. Manipulation angle the angle between two working ports.
The ideal manipulation angle is 60º
2. Azimuth angle the angle between one instrument and the optical
axis of the endoscope. The ideal azimuth angle is equal for both
the active and assisting instruments.
3. Elevation angle the angle between the instrument and the
horizontal plane. The ideal elevation angle is 60º.

18. Ideal Angles

19. SUMMARY
The 3 component of baseball diamond are essential to work safely and
comfortably.
1- Half of the instrument should be in and half out
2- Telescope in the middle
3- Manipulation angle should be 60 degree.

20. Thank you