A COMPARISON OF SURGEONS POSTURE DURING LAPAROSCOPIC AND OPEN SURGICAL-PROCEDURES

Background: There is increasing recognition of surgeons' physical fati gue in the new ergonomic environment of laparoscopic surgery. The purp ose of this study was to determine what the differences are in the mov ement of the surgeon's axial skeleton between laparoscopic and open op erations. Methods: Surgeons' body positions were recorded on videotape during four laparoscopic (LAP) and six open (OF) operations. The perc ent of time the head and back were in a normal, bent, or twisted posit ion as well as the number of changes in head and back position were ta bulated using a computer program. A separate laboratory study was perf ormed on four surgeons ''walking'' a 0.5-inch polyethylene tubing forw ard and backward using laparoscopic and open techniques, The movements of the surgeons' head, trunk, and pelvis were measured using a three- camera kinematic system (Kin). The center of pressure was recorded usi ng a floor-mounted forceplate (Fp). Results: In the operating room sur geons' head and back positions were more often straight in laparoscopi c procedures and more often bent in open operations. The number of cha nges in back position per minute were significantly decreased when the laparoscopic-only part of surgery was analyzed. In the laboratory the subjects' head position was significantly (p = 0.02) more upright and the anteroposte rior (AP) and rotational range of motion of the head was significantly reduced during laparoscopy. Subjects' CP was more an terior and there was a significant reduction in the AP range of motion of the CP during laparoscopy.Conclusions: Our study suggests that sur geons exhibit decreased mobility of the head and back and less anterop osterior weight shifting during laparoscopic manipulations despite a m ore upright posture. This more restricted posture during laparoscopic surgery \may induce fatigue by limiting the natural changes in body po sture that occur during open surgery.