Journal of Minimally Invasive Surgical Sciences

Published by: Kowsar

Ergonomic Challenges Encountered by Laparoscopic Surgeons, Surgical First Assistants, and Operating Room Nurses Involved in Minimally Invasive Surgeries by Using RULA Method

Abdolreza Pazouki 1 , Leila Sadati 2 , * , Fatemeh Zarei 3 , Ehsan Golchini 4 , Robab Fruzesh 5 and Jalal Bakhtiary 6
Authors Information
1 MD, Fellowship of Minimally Invasive Surgery, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, IR Iran
2 BscN, MScN, Faculty member, Operating Room Group, Para medicine Faculty, Alborz University of Medical Sciences, Karaj, IR Iran
3 MS of Occupational Health Engineering, School of Public Health, Alborz University of Medical Sciences, Karaj, IR Iran
4 BS, Master Degree of Anatomy, Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
5 BScN, MScN, Operating Room Group, Paramedicine Faculty. Alborz University of Medical Science, Karaj, IR Iran
6 MD, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, IR Iran
Article information
  • Journal of Minimally Invasive Surgical Sciences: November 2017, 6 (4); e60053
  • Published Online: August 31, 2017
  • Article Type: Research Article
  • Received: April 12, 2017
  • Revised: July 10, 2017
  • Accepted: August 1, 2017
  • DOI: 10.5812/minsurgery.60053

To Cite: Pazouki A, Sadati L, Zarei F, Golchini E, Fruzesh R, et al. Ergonomic Challenges Encountered by Laparoscopic Surgeons, Surgical First Assistants, and Operating Room Nurses Involved in Minimally Invasive Surgeries by Using RULA Method, J Minim Invasive Surg Sci. 2017 ; 6(4):e60053. doi: 10.5812/minsurgery.60053.

Copyright © 2017, Journal of Minimally Invasive Surgical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Choi SD. A Review of the Ergonomic Issues in the Laparoscopic Operating Room. J Healthcare Engin. 2012;3(4):587-603.
  • 2. Wauben LSGL, Van Veelen MA, Gossot D, Goossens RHM. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endoscopy Other InterventTechniques. 2006;20(8):1268-74.
  • 3. Smith WD, Berguer R, Nguyen NT. Monitor height affects surgeons' stress level and performance on minimally invasive surgery tasks. Stud Health Technol Inform. 2005;111:498-501. [PubMed: 15718786].
  • 4. Reddy PP, Reddy TP, Roig-Francoli J, Cone L, Sivan B, DeFoor WR, et al. The impact of the alexander technique on improving posture and surgical ergonomics during minimally invasive surgery: pilot study. J Urol. 2011;186(4 Suppl):1658-62. doi: 10.1016/j.juro.2011.04.013. [PubMed: 21855928].
  • 5. van Det MJ, Meijerink WJ, Hoff C, Totte ER, Pierie JP. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc. 2009;23(6):1279-85. doi: 10.1007/s00464-008-0148-x. [PubMed: 18830751].
  • 6. Lee G, Lee T, Dexter D, Godinez C, Meenaghan N, Catania R, et al. Ergonomic risk associated with assisting in minimally invasive surgery. Surg Endosc. 2009;23(1):182-8. doi: 10.1007/s00464-008-0141-4. [PubMed: 18815838].
  • 7. Mirmohammadi SJ, Mehrparvar AH, Olia MB, Mirmohammadi M. Effects of training intervention on non-ergonomic positions among video display terminals (VDT) users. Work. 2012;42(3):429-33. doi: 10.3233/WOR-2012-1400. [PubMed: 22523021].
  • 8. Welcker K, Kesieme EB, Internullo E, Kranenburg van Koppen LJC. Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons. Interact Cardiovasc Thorac Surg. 2012;15(2):197-200. doi: 10.1093/icvts/ivs173.
  • 9. Rosenblatt PL, McKinney J, Adams SR. Ergonomics in the operating room: protecting the surgeon. J Minim Invasive Gynecol. 2013;20(6):744. doi: 10.1016/j.jmig.2013.07.006. [PubMed: 23969139].
  • 10. Sari V, Nieboer TE, Vierhout ME, Stegeman DF, Kluivers KB. The operation room as a hostile environment for surgeons: physical complaints during and after laparoscopy. Minim Invasive Ther Allied Technol. 2010;19(2):105-9. doi: 10.3109/13645701003643972. [PubMed: 20158410].
  • 11. Kelts GI, McMains KC, Chen PG, Weitzel EK. Monitor height ergonomics: A comparison of operating room video display terminals. Allergy Rhinol (Providence). 2015;6(1):28-32. doi: 10.2500/ar.2015.6.0119. [PubMed: 25860168].
  • 12. Zehetner J, Kaltenbacher A, Wayand W, Shamiyeh A. Screen height as an ergonomic factor in laparoscopic surgery. Surg Endosc. 2006;20(1):139-41. doi: 10.1007/s00464-005-0251-1. [PubMed: 16333548].
  • 13. Lee G, Lee T, Dexter D, Klein R, Park A. Methodological infrastructure in surgical ergonomics: a review of tasks, models, and measurement systems. Surg Innov. 2007;14(3):153-67. doi: 10.1177/1553350607307956. [PubMed: 17928614].
  • 14. Matern U. Ergonomic deficiencies in the operating room: examples from minimally invasive surgery. Work. 2009;33(2):165-8. doi: 10.3233/WOR-2009-0862. [PubMed: 19713625].
  • 15. Supe AN, Kulkarni GV, Supe PA. Ergonomics in laparoscopic surgery. J Minim Access Surg. 2010;6(2):31-6. doi: 10.4103/0972-9941.65161. [PubMed: 20814508].
  • 16. Bell AK, Saide MB, Johanas JT, Leisk GG, Schwaitzberg SD, Cao CG. Innovative dynamic minimally invasive training environment (DynaMITE). Surg Innov. 2007;14(3):217-24. doi: 10.1177/1553350607308157. [PubMed: 17928622].
  • 17. Szeto GP, Cheng SW, Poon JT, Ting AC, Tsang RC, Ho P. Surgeons' static posture and movement repetitions in open and laparoscopic surgery. J Surg Res. 2012;172(1):e19-31. doi: 10.1016/j.jss.2011.08.004. [PubMed: 22079837].
  • 18. Takala EP, Pehkonen I, Forsman M, Hansson GA, Mathiassen SE, Neumann WP, et al. Systematic evaluation of observational methods assessing biomechanical exposures at work. Scand J Work Environ Health. 2010;36(1):3-24. [PubMed: 19953213].
  • 19. Tjiam IM, Goossens RH, Schout BM, Koldewijn EL, Hendrikx AJ, Muijtjens AM, et al. Ergonomics in endourology and laparoscopy: an overview of musculoskeletal problems in urology. J Endourol. 2014;28(5):605-11. doi: 10.1089/end.2013.0654. [PubMed: 24417180].
  • 20. Miller K, Benden M, Pickens A, Shipp E, Zheng Q. Ergonomics principles associated with laparoscopic surgeon injury/illness. Human Factors. 2012;54(6):1087-92.
  • 21. Shergill AK, McQuaid KR, Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc. 2009;70(1):145-53. doi: 10.1016/j.gie.2008.12.235. [PubMed: 19559836].
  • 22. Attarchi M, Raeisi S, Namvar M, Golabadi M. Association between shift working and musculoskeletal symptoms among nursing personnel. Iran J Nurs Midwifery Res. 2014;19(3):309-14. [PubMed: 24949072].
  • 23. Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D. Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg. 2010;210(3):306-13. doi: 10.1016/j.jamcollsurg.2009.10.017. [PubMed: 20193893].
  • 24. Gofrit ON, Mikahail AA, Zorn KC, Zagaja GP, Steinberg GD, Shalhav AL. Surgeons' perceptions and injuries during and after urologic laparoscopic surgery. Urology. 2008;71(3):404-7. doi: 10.1016/j.urology.2007.07.077. [PubMed: 18342173].
  • 25. Liang B, Qi L, Yang J, Cao Z, Zu X, Liu L, et al. Ergonomic status of laparoscopic urologic surgery: survey results from 241 urologic surgeons in china. PLoS One. 2013;8(7). e70423. doi: 10.1371/journal.pone.0070423. [PubMed: 23936202].
  • 26. Franasiak J, Ko EM, Kidd J, Secord AA, Bell M, Boggess JF, et al. Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery. Gynecol Oncol. 2012;126(3):437-42. doi: 10.1016/j.ygyno.2012.05.016. [PubMed: 22613351].
  • 27. Moreira RF, Sato TO, Foltran FA, Silva LC, Coury HJ. Prevalence of musculoskeletal symptoms in hospital nurse technicians and licensed practical nurses: associations with demographic factors. Braz J Phys Ther. 2014;18(4):323-33. [PubMed: 25054385].

Featured Image:

Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments