Optimisation d’un instrument laparoscopique ergonomique pluri-articulé motorisé pour une efficacité et un confort opératoires accrus

A task in operating patients through small incisions and with long and straight instruments requires accuracy but imposes cognitive and physical workload to the surgeons. Nonetheless, the minimally-invasive surgery benefits clearly to the patients and has therefore been developed a lot these last decades. Postural constraints for the surgeon during the realization of such procedures lead to pain and to the development of work-related musculoskeletal disorders. Different medical devices have appeared on the market to offer to the surgeon a more important intracorporeal mobility with additional distal degrees of freedom implemented on the instrument shaft. Some present purely mechanical architecture, others own mechatronical commands. The improvement of the Dex™ on the surgeons’ gesture is a reduced abduction of the shoulder in comparison with standard laparoscopy. The measurement of the muscular condition in terms of fatigue or force during a specific surgical task permits to quantify the occupational comfort and to compare two working configurations using standard or motorized instruments. The JASA (Joint Analysis of Spectraand Amplitude) method is thus applied and discussed. Finally, a novel design of the instrument is proposed under the name of AELI (articulated and ergonomical laparoscopic instrument) in order to improve the surgeons’ gesture and comfort.La laparoscopie est une technique chirurgicale qui consiste à intervenir dans la cavité abdominale d’un patient à travers des incisions de quelques dizaines de millimètres. Elle présente de nombreux avantages pour le patient en regard de la chirurgie ouverte : une cicatrisation et une récupération plus rapides, moins de risques d’infection et des douleurs post-opératoires réduites. Néanmoins, le chirurgien est soumis à davantage de contraintes, que ce soit d’un point de vue cognitif, avec une vision indirecte, et souvent bidimensionnelle, des structures anatomiques surlesquelles intervenir couplée à une réduction du sens du toucher, ou d’un point de vue postural, avec l’adoption d’orientations articulaires délétères pour les structures musculosquelettiques. Dans ce contexte, après avoir passé en revue les différents instruments utilisés au bloc pour réaliser ce type de procédure, l’intérêt est porté sur le Dex™, un instrument articulé motorisé tenu en main qui permet une pratique dextre au pied du patient. L’étude de cet instrument porte sur son influence sur le confort opératoire du chirurgien au cours d’un geste de suture, particulièrement contraignant à effectuer avec des instruments standards. Afin de quantifier le confort, des méthodes de détermination de l’état musculaire, notamment la méthode JASA (pour Joint Analysis of Spectra and Amplitude), sont mises en œuvre et discutées. Enfin, une évolution de l’instrument est proposée afin d’accroître la dextérité et le confort du chirurgien au cours de sa pratique

Impact of a motorised articulated laparoscopic needle holder with ergonomic handle on the gesture smoothness: a pilot study

International audiencePurpose: The objective of this study is to assess the smoothness of a laparoscopic gesture performed with a motorised articulated instrument in comparison with a conventional one. Methods: One right-handed laparoscopic expert surgeon has been recruited for this study. He performed ten vesicourethral anastomoses, in a pelvic stand, using two kinds of laparoscopic instruments (standard and motorised) for different operating room conditions, especially table height adjustments. A 3-axis accelerometer and cameras are used to record information on the dominant upper limb motions during the tasks. Results: Two different methods are applied in order to evaluate the gesture smoothness. Both are using the acceleration data of the elbow collected during the surgical procedure. The first method uses the first-order derivative of the acceleration and is called log dimensionless jerk. The second one is based on the acceleration's Fourier spectrum and is called SPARC. For similar surgical trials of 2.5 stitches, the two methods tend to show that the gesture smoothness is globally improved by using the motorised articulated laparoscopic needle-holder. Conclusions: These preliminary results give a first indication on the benefit of the motorisations and articulations of a surgical instrument on the gesture performance. They have to be validated with more trials

Définition d'un Nouvel Espace de Travail pour un Instrument Laparoscopique Motorisé Pluri-Articulé

National audienc

New joint analysis of electromyography spectrum and amplitude-based methods towards real-time muscular fatigue evaluation during a simulated surgical procedure: A pilot analysis on the statistical significance

International audienceThe Joint Analysis of Spectral and Amplitude (JASA) method offers a valuable tool for the indication of four muscle conditions in occupational field studies. It has both advantages of an easy computation and an ergonomic display of the results. However, several limitations are pointed out such as the lack of information on the change of the muscle condition all along the completion of task. This paper proposes two evolutions of the JASA method to quantify muscular fatigue in real time for comfort analysis. The evolutionary method focuses on increased time windows; and the sequential method analyses the muscle conditions on constant sliding time lapses. A pilot study is conducted for a minimally-invasive laparo-scopic procedure. The outcome results obtained with the original, the evolutionary and the sequential methods are compared. Both new methods provide a complementary analysis of the muscular fatigue over a task and the statistical significance of the condition

Ergonomic Surgical Practice Analysed Through sEMG Monitoring of Muscular Activity.

International audienc

An Innovative Laparoscopic Instrument Evaluated by SEMG Analysis

International audienceReplacing open surgery in several surgical domains, laparoscopic procedures are responsible for additional solicitations to the surgeons. The shape and length of the instruments lead to non-ergonomic postures. Regions mainly affected are neck, shoulders and distal parts of the upper limbs.EMG activities are used to evaluate the benefit of using a new surgical articulated and motorised hand-held instrument