Joanna Bartnicka

Advantages and Disadvantages of 1-Incision, 2-Incision, 3-Incision, and 4-Incision Laparoscopic Cholecystectomy: A Workflow Comparison Study.

A comparison of 1-port, 2-port, 3-port, and 4-port laparoscopic cholecystectomy techniques from the point of view of workflow criteria was made to both identify specific workflow components that can cause surgical disturbances and indicate good and bad practices. As a case study, laparoscopic cholecystectomies, including manual tasks and interactions within teamwork members, were video-recorded and analyzed on the basis of specially encoded workflow information. The parameters for comparison were defined as follows: surgery time, tool and hand activeness, operator’s passive work, collisions, and operator interventions. It was found that 1-port cholecystectomy is the worst technique because of nonergonomic body position, technical complexity, organizational anomalies, and operational dynamism. The differences between laparoscopic techniques are closely linked to the costs of the medical procedures. Hence, knowledge about the surgical workflow can be used for both planning surgical procedures and balancing the expenses associated with surgery.

Ergonomic study on wrist posture when using laparoscopic tools in four different techniques regarding minimally invasive surgery

Purpose. With reference to four minimally invasive surgery (MIS) cholecystectomies, the aims were (a) to recognize the factors influencing dominant wrist postures manifested by the surgeon; (b) to detect risk factors involved in maintaining deviated wrist postures; (c) to compare the wrist postures of surgeons while using laparoscopic tools. Methods. Video films were recorded during live surgeries. The films were synchronized with wrist joint angles obtained from wireless electrogoniometers placed on the surgeons hand. The analysis was conducted for five laparoscopic tools used during all surgical techniques. Results. The most common wrist posture was extension. In the case of one laparoscopic tool, the mean values defining extended wrist posture were distinct in all four surgical techniques. For one type of surgical technique, considered the most beneficial for patients, more extreme postures were noticed regarding all laparoscopic tools. We recognized a new factor, apart from the tools handle design, that influences extreme and deviated wrist postures. It involves three areas of task specification including the type of action, type of motion patterns and motion dynamism. Conclusions. The outcomes proved that the surgical technique which is best for the patient imposes the greatest strain on the surgeons wrist. 

Educational Needs in Neurological Rehabilitation – “Brain4Train” Survey Outcomes from European Countries

The aim of this paper is to present the first outcomes of an international project titled “Development of innovative Training contents based on the applicability of Virtual Reality in the field of Stroke Rehabilitation”. Particularly two aspects were described: (1) recognition of educational needs of medics who support neurological patients in their rehabilitation process, (2) the concept of structure and contents of an e-learning course about this topic.

The Role of Virtual Reality and Biomechanical Technologies in Stroke Rehabilitation

The aim of this paper is to present a spectrum of virtual reality and biomechanical technologies that can be potentially used in supporting the rehabilitation of people after stroke, in both clinical and home conditions. The methodology was based on a systematic review of up-to-date, published research works available in Elsevier Science Direct database including peer-reviewed journal articles. As a result, trends, possible promising solutions and gaps in the area of innovative rehabilitation tools for post-stroke patients were recognized and discussed. Particularly, the new knowledge and good practices focused on the applicability of biomechanical systems and Virtual Reality (VR) technologies in stroke treatment were searched, which is the subject of an educational and international Erasmus+ project entitled “Development of innovative training contents based on the applicability of virtual reality in the field of stroke rehabilitation- Brain4Train”. The training content, which is one of the project outcomes, will be provided to all interested professionals engaged in post-stroke patients’ rehabilitation, in order to make them capable to develop customized rehabilitation programs based on techno-innovative rehabilitation models.

Train4OrthoMIS Online Course as a Manner of Improving Ergonomics in Orthopaedic Surgery

The paper presents the research outcomes on ergonomic needs among orthopaedic surgeons and the way of improving working conditions while performing orthopaedic surgeries. The international survey was conducted among orthopaedic surgeons in Europe, that revealed physical ailments of surgeons like neck pain, thoracic and lumbar pain, musculoskeletal stress, fatigue in the legs and feet as well as mental fatigue or headache. In turn to the most important deficiencies in ergonomics area are: awkward body postures, having to stand, the position and height of the operating table.

Identification of musculoskeletal hazards for laparoscopic surgeons

Introduction. This article is dedicated to the problematic of hazards that accompany surgeons during laparoscopic procedures, and may affected in excessive loads of certain segments of musculoskeletal system. Aim. The work focuses on new, in relation to the literature, methods for identifying hazards based on cross-sectional ergonomic analysis with the use of video recording and measurements of body position surgeon during the real surgical procedures. Material and methods. Research included three phases: diagnostic, simulation and fundamental. The aim of the diagnostic study was to determine the main problems in the field of body position ergonomics and the associated risks for the musculoskeletal system. Simulation study aimed at identifying the constraints and determining the conditions that are necessary in terms of making video recordings of real surgical procedures as well as real-time acquisition of measurement data defining postures surgeon. The aim of the fundamental study was to acquire basic knowledge about how to identify hazards for musculoskeletal of surgeons based on video recordings in real operational conditions, and to investigate the possibility of creating hazard maps in the field of musculoskeletal disorders. Results. There was identified relationships between the certain stressed body postures of surgeons and particular stage of the procedure as well as the type of surgical instruments. Conclusions. The synchronization of both video recordings of surgery and quantitative data identifying critical positions of the musculoskeletal system makes it possible to create hazard maps for surgeons and enables identification of the weak and strong points of the entire surgical procedure. This methodology may also reveal new knowledge in the work organization, workflow and ergonomics in surgery.