Norasi, Hamid

Exoskeletons are ergonomic devices that can support workers to improve performance and worker safety. This study created an apparatus that simulated a head-and-neck exoskeleton designed for surgeons to test the effects of varying tension forces on muscle activation (splenius capitis, splenius cervices, and erector spinae), body part discomfort, dexterity, cognition, and overall usability of the device. Eight participants were involved in twelve trials over two days and held static postures (looking down at 45° or 90°) for 20 minutes with 10-minute breaks between trials. Six trials utilized tension forces, which were recorded every two minutes and then averaged for each trial. A bivariate regression analysis ( on each metric vs. average tension forces demonstrated that increasing tension forces led to decreased muscle activity of the left splenius capitis, change in general body pain, change in neck discomfort, and the rate of discomfort developing, and improved usability scores.

Despite advances in medical technology, intraoperative adverse events (IAE) continue to occur in hospital’s complex systems. Current approaches to understanding and mitigating IAEs rely on retrospective data analyses to recognize the series of events leading to an IAE. This paper discusses current challenges and highlights the potential of the Operating Room Blackbox (ORBB) system use to enhance patient safety.

The neck muscle fatigue and subjective discomfort due to neck postural exposure was evaluated. Ten male participants were asked to hold one of the two static neck postural exposures for 30 minutes (one condition per day): 1) Neck flexion (N-45) where head and neck were flexed 45º relative to trunk while the participant was standing upright, and 2) Trunk flexion (T-45) where head and neck were not flexed relative to trunk, but trunk was flexed 45º. Surface electromyography was used to collect muscle activity of neck extensors. T-45 caused higher fatigue in neck extensor muscles (p=0.0229) and higher neck subjective discomfort (p=0.0088) compared to N-45, but the long-term effects of these two conditions are not clear because of the difference in the role of passive tissues. We recommend that work assessment tools consider both measures of neck postural exposure (neck flexion and trunk flexion) in their assessment tools.

Abstract Background This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics. Methods Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected. Results The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the “surgeon at abdomen” showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the “surgeon at chest” showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference. Conclusion Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.

Musculoskeletal disorders and intraoperative pain are prevalent among vascular surgeons which can negatively affect their surgical performance and quality of life. The effectiveness of a lower back support exoskeleton to reduce discomfort of the back, subjective fatigue, and the workload associated with performing vascular surgery was evaluated, as well as the participants’ intraoperative upper body postures. Three vascular surgeons were asked to rate their discomfort and fatigue before, during and after performing surgery, and their subjective workload post-operatively. Inertial measurement units (IMUs) were used to measure their intraoperative body postures. No significant differences were found between exoskeleton and baseline discomfort, fatigue, workload, or intraoperative postures. This indicates that although the exoskeleton did not restrict the vascular surgeons’ postures, this exoskeleton was ineffective at reducing their discomfort or workload. Future studies with exoskeletons specifically designed for healthcare applications may show more efficacy in reducing the ergonomic risks to surgeons.

Ames, IA Cardiac sonographers suffer from high prevalence of work-related upper extremity musculoskeletal pain due to awkward postures and fatigue accumulation. Sonographers can choose either left- or right-hand scanning, or alternate between both, however, the impact of each scanning technique on the upper extremity muscles remains unknown. Four ambidextrous cardiac sonographers performed between four to six cardiac scans using left- and right-hand while postural and muscle activity were collected from specific muscles on the upper extremities. A comparison of the posture showed that apart from forearm pitch and 90 th percentile upper arm deviation, upper extremity postures between the two scanning techniques did not differ significantly. Furthermore, while right-hand scanning (RHS) appeared to induce slightly higher muscle activity in the deltoids compared to left-hand scanning (LHS), the difference between the two techniques was not significant. We recommend alternating between these two techniques to distribute muscle stress evenly to prevent muscle overuse.

Two attending surgeons (surgeon at abdomen and surgeon at chest) and nine surgical trainees completed electronic surveys after deep inferior epigastric perforator (DIEP) flap surgical procedures. The survey included workload and teamwork subscales. The results indicated that DIEP flap surgery is a highly demanding surgical procedure both physically and cognitively. For the surgeon at abdomen, most of workload subscales were significantly higher than the paired trainees (p<0.05), while their teamwork subscales were not significantly different. The surgical trainees should know that the attending surgeon’s self-perceived workload could be higher than theirs even when their self-perceived teamwork is similar. For the surgeon at chest, most of teamwork subscales were significantly higher than the paired trainees (p<0.05), while their workload subscales were not significantly different. The attending surgeons should know that even when their self-evaluation of workload is similar to their trainees, the trainee’s evaluation of teamwork could be less than theirs.

The electromyographic (EMG) normalization (often to maximum voluntary isometric contraction [MVIC]) is used to control for interparticipant and day-to-day variations. Repeated MVIC exertions may be inadvisable from participants’ safety perspective. This study developed a technique to predict the MVIC EMG from submaximal isometric voluntary contraction EMG. On day 1, 10 participants executed moment exertions of 100%, 60%, 40%, and 20% of the maximum (biceps brachii, rectus femoris, neck flexors, and neck extensors) as the EMG data were collected. On day 2, the participants replicated the joint moment values from day 1 (60%, 40%, and 20%) and also performed MVIC exertions. Using the ratios between the MVIC EMGs and submaximal isometric voluntary contraction EMG data values established on day 1, and the day 2 submaximal isometric voluntary contraction EMG data values, the day 2 MVIC EMGs were predicted. The average absolute percentage error between the predicted and actual MVIC EMG values for day 2 were calculated: biceps brachii, 45%; rectus femoris, 27%; right and left neck flexors, 27% and 33%, respectively; and right and left neck extensors, both 29%. There will be a trade-off between the required accuracy of the MVIC EMG and the risk of injury due to exerting actual MVIC. Thus, using the developed predictive technique may depend on the study circumstances.

The main goal of this pilot study was to create, implement and evaluate a strategy for introducing exoskeletons in the operating room (OR) at a quaternary care academic hospital. The strategy consisted of operating-room-specific considerations, introducing exoskeletons to surgeons, and a post-surgery survey. Three male attending vascular surgeons participated in eleven data collections to date. Low interference with surgeon’s ability to perform surgery was found for all surgical procedures, except for two open abdominal aortic procedures. The surgeons reported little to no limit on range of motion, except for one open abdominal aortic procedure. Lower than expected perceived improvement of ability to perform surgery and increase of physical comfort was self-reported. The responses indicate that the surgeons are willing to keep trying an exoskeleton intervention. In conclusion, a feasible process was created to introduce passive exoskeleton as an ergonomic intervention to vascular surgeons in their ORs.

The goal of this study was to evaluate residents’ workload and teamwork and the correlation between their workload and teamwork subscales during deep inferior epigastric perforator (DIEP) flap surgery. Ten residents who assisted during DIEP flap procedures completed an electronic survey following each DIEP flap procedure from July 2019 to August 2020. The survey contained items from the NASA-TLX and SURG-TLX and questions to measure teamwork subscales. Across 29 surgical cases, 38 surveys were recorded. Overall, the means of workload subscales were mostly greater than 10 and less than 15 (range=020) and the means of all teamwork subscales were greater than 15 (range=0-20). Good teamwork was correlated with lower distractions (Rs= -0.36 to -0.48) and better performance (Rs=0.35 to 0.52). Also, all the teamwork subscales were highly correlated (Rs= 0.59 to 0.92). Our findings suggest that good teamwork, low distractions, and successful performance are generally observed together; however, a causative relationship could not be established based on these results.