Training, efficiency and ergonomics in minimally invasive surgery

PhD ceremony: Mr. M.J. van Det, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Training, efficiency and ergonomics in minimally invasive surgery

Promotor(s): prof. J.P.E.N. Pierie

Faculty: Medical Sciences

Keyhole surgery (laparoscopy) has several proven benefits for the patient. For the surgical team, however, this type of surgery involves several challenges. Improvements are required regarding the ergonomics and efficiency of the operative process, and the training of surgeons who want to apply this technology. These subjects are addressed in this thesis. First, we investigated the best ergonomic posture for performing laparoscopic surgery. The position of the monitor is particularly important. The monitor needs to be positioned well below eye level, close to the operating area and in line with the working direction of the surgeon. We demonstrated that a specially designed laparoscopic operating theatre can significantly improve the ergonomic situation of the surgical team and the interoperative efficiency. Secondly, we investigated a new method for procedural training inside the operating theatre. A group of residents was assigned to a curriculum for laparoscopic gallbladder surgery. After learning the skills on a simulator, they started procedural training inside the OR. During 6 procedures they received a stepwise video instruction on the next step to be executed. After watching the instruction, they performed that particular step of the procedure. The assessments of the residents who were trained with this method improved faster than in a control group. We demonstrated that this method is effective and uniform while the efficiency of the operative process is not affected.