Hallbeck, M Susan

Objective: To evaluate the effectiveness of an intraoperative exoskeleton that supports surgeons’ heads, necks, and backs to reduce neck discomfort. Background: Surgeons are at a considerable risk of developing neck pain and related injuries. Passive exoskeletons are a potential intervention to support surgeons’ body parts and alleviate strain and discomfort. Methods: The NekSpine (a passive neck exoskeleton) was trialed on 12 surgeons (7 males and 5 females) across 6 specialties. Each surgeon performed 4 surgical procedures, 2 with the NekSpine (exoskeleton) and 2 without (baseline). Exoskeleton and baseline surgeries were paired primarily by surgical procedure and secondarily by duration. Surgeons completed surveys that included the NASA-TLX and usability questions before and after surgical procedures to evaluate body part discomfort, overall fatigue, workload, and potential disruptions to the surgical workflow. Surgeons also wore inertial measurement units to objectively record their upper arms, neck, and torso postures. Results: Use of the exoskeleton yielded significant decreases in discomfort in the neck, left shoulder, right shoulder, and left arm. Reductions in percent surgical duration in risk 4 (extreme risk postures) coupled with increases spent in risk 2 (moderate risk postures) for the neck and torso were noted. Surgeons reported overall favorable usability results with the exoskeleton not interfering with the surgical workflow, and most stated that they would use the exoskeleton again. Conclusions: The NekSpine is a promising intervention to alleviate surgeons’ neck discomfort and improve their neck and torso postures.

This study shows what employees in the Environment, Health and Safety (EHS) area within private Brazilian companies think about the relationship between ergonomic risks and Homogeneous Exposure Groups (HEG). Thirty-seven professionals from different market segments answered a questionnaire via Google Docs. The results show that 75.6% of the companies sampled use HEG in order to map occupational risks. Within those companies, 54% include ergonomic risks in their HEG, which has negative consequences to both employees and employers in these companies.

This discussion panel aims to identify ergonomic concerns, solutions and research needs, physical stresses, and outcomes related to clinical and surgical procedures. This session will begin with formal presentations to demonstrate current ergonomic concerns and research initiatives associated with clinical and surgical procedures to frame the panel discussion for the second part of the session. Discussion of different procedures will help to identify solutions and research needs that relate to a broad range of ergonomic problems. Questions will be collected from the attendees and speakers and organized so as to guide the panel discussion and to engage all of the speakers in the discussion to achieve the symposium aims.

Briefings are suggested to be an important mechanism for establishing and maintaining cohesive teams. However, there is still much to learn about briefings and how best to design and implement them for surgical teams in the operating room. Currently, there are no formally recognized protocols or methodologies for conducting surgical team briefings. This research reports preliminary findings from an effort to develop a model of team briefings for gynecological surgical teams. Semi-structured interviews were conducted using techniques derived from Applied Cognitive Task Analysis (Millitello & Hutton, 1998) with thirteen surgical team members spanning six different roles including surgeon, surgical resident, registered nurse, certified surgical assistant, certified scrub technician, and anesthesia. Findings reveal that informational needs are consistent across the team but also vary by individual role, illustrating the importance of addressing all stakeholders in potential interventions. Implications for the development of a team briefing model are discussed.

Laparoendoscopic single-site surgery (LESS) is a new minimally invasive surgical technique that presents physical and mental challenges to surgeons. Currently, LESS procedures are commonly performed using surgical instruments designed for traditional multi-incision laparoscopic surgery. A pilot study was conducted to determine which laparoscopic instruments were the most efficient for LESS procedures. In a LESS surgical trainer, 24 novice users completed a simple surgical task using standard (non-articulating) straight laparoscopic graspers and two different articulating instruments. Task performance was scored based on completion time and the number of errors. Analyses showed that the use of the simpler straight instruments produced significantly faster times (p = 0.004 and p = 0.014) and higher task scores (p = 0.005 and p = 0.021) than the articulating instruments. These results suggest that standard laparoscopic hand instruments enable better novice performance for a basic LESS task.

This session will focus on lessons learned when developing solutions for real world problems in healthcare. Human factors (HF) practitioners bring unique knowledge, methods, and perspectives to work with clinicians to address numerous defects in the worksystem but require problem-solving skills that focus on solutions. The HF contribution may be in the area of process improvement (e.g., prevention of patient falls), systems design (e.g., designing crashcart), or identification of design flaws so robust intervention may be deployed (e.g., glucose meters). Six human factors practitioners who work within healthcare systems will present real world challenges which were discovered by HF methods, or which have heavy HF implications, but where direct HF influence on design lead to the ultimate effective solution. The session will be designed to lead to a discussion about how HF methods were adapted to individual problems at hand and to focus on developing solutions.

The Institute of Medicine lists investigations of the comparative effectiveness for minimally invasive surgical procedures as a research priority. As new minimally invasive procedures are developed, comparisons of the resulting workload contribute valuable information about the impact of the new procedures. Recent reports suggest that surgeon workload can influence patient outcomes. Measurements of stress and fatigue for the surgical team participating in a randomized NIH supported trial of single incision versus traditional laparoscopic cholecystectomy were obtained. These stress measures showed that the SURG-TLX was sensitive to the difficulty of the surgery. The SURG-TLX and a surgical difficulty score was obtained from the surgical team for 16 laparoscopic surgeries by surgical approach (8 SILC and 8 4-port) showed that for this small sample size, there were no statistically significant differences in length of surgery, degree of difficulty, nor patient considerations such as post-operative pain scores. In addition, no statistically significant differences in the individual Surg-TLX subscale scores or Surg-TLX total for the surgical team overall or for the surgeon alone by surgical platform. This is likely due to the small sample size reducing the power of the tests.