Evaluating the Ergonomics of Surgical Residents During Laparoscopic Simulation: A Novel Computerized Approach

Abstract

Background Assessment of residents’ body positioning during laparoscopy has not been adequately investigated. This study presents a novel computer vision technique to automate ergonomic evaluation and demonstrates this approach through simulated laparoscopy. Methods Surgical residents at a single academic institution were video recorded performing tasks from the Fundamentals of Laparoscopic Surgery (FLS). Ergonomics were assessed by 2 raters using the Rapid Upper Limb Assessment (RULA) tool. Additionally, a novel computer software program was used to measure ergonomics from the video recordings. All participants completed a survey on musculoskeletal complaints, which was graded by severity. Results Ten residents participated; all performed FLS in postures that exceeded acceptable ergonomic risks as determined by both the human and computerized RULA scores ( P < .001). Lower-level residents scored worse than upper-level residents on the human-graded RULA assessment ( P = .04). There was no difference in computer-graded RULA scores by resident level ( P = .39) and computer-graded scores did not correlate with human scores ( P = .75). Shoulder and wrist position were the greatest contributors to higher computer-graded scores ( P < .001). Self-reported musculoskeletal complaints did not differ at resident level ( P = .74); however, all residents reported having at least 1 form of musculoskeletal complaint occurring “often.” Conclusions Surgery residents demonstrated suboptimal ergonomics while performing simulated laparoscopic tasks. A novel computer program to measure ergonomics did not agree with the scores generated by the human raters, although it concluded that resident ergonomics remain a concern, especially regarding shoulder and wrist positioning.