Ergonomic problems encountered during video-assisted thoracic surgery.

In laparoscopic surgery, the way of thinking about operating room design is beginning to include ergonomic requirements. No study has yet been published about ergonomic concerns in Video-Assisted Thoracic Surgery (VATS). The aim of this paper is to describe ergonomic issues encountered in VATS and to propose recommendations for operating room design for thoracoscopic surgery. To obtain an inventory of the ergonomic problems fifteen thoracoscopic operations were attended at the Institut Mutualiste Montsouris (Paris, France). Ergonomics can be divided into three divisions: physical, perceptual and cognitive ergonomics. During the observations of thoracoscopic operations the physical problems were registered. The perceptual and cognitive problems were obtained from a literature study. In general two different positions of the surgeon can be distinguished, depending on the placement of the trocars and the endoscope. One position resembles the body position during laparoscopy, involving the same problems such as fatigue of the legs, a static body position, a large working area, extreme movements of the upper limbs and the wrist and stiffness of the neck. The other position is specific for VATS resulting in a rotated upper body while the surgeon has to lean over the patient to be able to handle the instruments. This awkward position causes even more serious problems. The study resulted in a list of ergonomic problems encountered during VATS. Reorganisation of the operating room set-up and monitor position, design of a dedicated operating table and specific instruments might help to overcome the current ergonomic problems.