Can armrests improve comfort and task performance in laparoscopic surgery?

Objective: The study sought to determine whether the support provided by armrests influenced task quality, task efficiency, and surgeon comfort during laparoscopic surgery. Summary Background Data: Complex laparoscopic surgery requires precise movements, and usually long execution times and an uncomfortable stance. Discomfort in the shoulders, back, and neck is an established complaint among laparoscopic surgeons and is related to the unnatural postures adopted during laparoscopic interventions. Discomfort, and the associated fatigue, is a contributory factor in the execution of errors. Methods: Nineteen subjects completed a bimanual simulated laparoscopic task both with and without the aid of bilateral armrests. The task was completed in both an ideal unstressed posture and an uncomfortable, stressed elevated posture that more closely represents real laparoscopic operating conditions. Task duration was prolonged sufficiently to precipitate muscular fatigue. The participants also completed a visual analogue scale instrument on level of discomfort symptoms experienced in every part of the upper limbs and vertebral spine. Execution errors (task quality) and completion times (task efficiency) were recorded automatically by the laparoscopic simulator. Results: Error rates and discomfort measures were significantly improved when the armrests were used, but there was no significant change in task completion time. Conclusions: The use of armrests in simulated laparoscopic surgery brings measurable comfort and task performance benefits, which could transfer to actual surgical procedures.