Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 87

Endoscopic surgery challenges the surgeon's natural view of the operating field. One basic ergonomic consideration—the correct position of the video display relative to the user's eyes—is often ignored in veterinary endoscopy. It has been shown that the preferred viewing angle for video displays is between 10 and 25° below the line of sight. Excessive height of monitors may cause neck and back pain for the surgeon. Ceiling booms and mobile stands allow the surgeon to place the monitor at the ideal position [54, 65, 66].

Laparoscopic and thoracoscopic instruments require four to six times more force than open surgery instruments to complete the same task. It is therefore not surprising that surgeons report increased fatigue after endoscopic surgery. Furthermore, endoscopic surgery has changed the surgeon's posture to a more upright axial skeletal posture during laparoscopy compared to open surgery. This upright posture, however, seems to be accompanied by substantially less body movement and weight shifting than during open procedures. Increased static postural fatigue may occur during MIS. With incorrect movements and incorrect postures, surgeons significantly increase the physical load on the shoulder, neck, and arm musculature [56, 66, 67].

As with the monitor positioning, awareness of some basic ergonomic rules that affect the surgeon's posture, such as lowering the height of the OR table to accommodate the increased length of rigid instruments, is lacking in veterinary medicine. The choice of the surgical table is of utmost importance in addressing these ergonomic challenges. Electrically adjustable hydraulic tables allowing Trendelenburg to reverse‐Trendelenburg positioning and lateral side tilt are ideal. V‐top tables are also beneficial because they permit smooth tilting of the patient from one side to the other, facilitating access to different organs during surgery [67–70].