<p>Training and ergonomics evaluation for laparoscopic surgery is an important tool for the assessment of trainees. Timely and objective assessment helps surgeons improve hand dexterity and movement precision, and perform surgery in an ergonomic manner. Traditionally, skill is evaluated by expert surgeons observing trainees, but this approach is both expensive and subjective. The approach proposed by this research employs an Ascension 3DGuidance trakSTAR system that captures the positions and orientations of hand and laparoscopic tool trajectories. Recorded trajectories are automatically analysed to extract meaningful feedback for training evaluation using statistical and machine learning methods.</p> <p>The data are acquired while a subject performs a standardized task such as peg transfer or suturing. The system records laproscopic instrument positions, hand, forearms, elbows trajectories, as well as wrist angles. We propose several metrics that attempt to objectively quantify the skill level or ergonomics of the procedure. The metrics for surgical skills are based on surgical instrument tip trajectories, whereas the ergonomics metric uses wrist angles. These metrics have been developed using statistical and machine learning methods.</p> <p>The metrics have been experimentally evaluated by using a population of seven first year postgraduate urology residents, one general surgery resident, and eight fourth year postgraduate urology residents and fellows. The machine learning approach discriminated correctly in 73% of cases between experts and novices. The machine learning approach applied to ergonomics data correctly discriminates between experts and novices in 88% of the cases for the peg transfer task and 75% for the suturing task. We also propose a method to derive a competency-based score using either statistical or machine learning derived metrics.</p> <p>Initial experimental data show that the proposed methods discriminate between the skills and ergonomics of expert and novice surgeons. The proposed system can be a valuable tool for research and training evaluation in laparoscopic surgery.</p> / Master of Applied Science (MASc)

Surgeons have been identified as one of the highest risk groups in healthcare to develop work-related musculoskeletal disorders (WMSDs). Especially the neck and shoulders are found to be at high musculoskeletal risk due to surgeons commonly operating in a static and awkward posture for a prolonged time. Raising ergonomic awareness has been found to favour postural improvement among healthcare professionals. This thesis therefore aimed to design and evaluate an individual ergonomic report as means for risk assessment and ergonomic education for surgeons. Hereby, two surgeons and two ergonomists were included in the design process for early user feedback. Thematic analysis was applied to analyse the user feedback and potential improvements were identified and performed. The final individual ergonomic report was evaluated as a material used in an individual educational session (i.e., the intervention group) and compared against the use of an ergonomic guideline (i.e., the control group). Each group consisted of two surgeons. Both questionnaire and semi-structured interview were used to evaluate the session. The results from the questionnaire showed similarly positive ratings on the user experience of both groups, but higher ratings were given on the perceived impact by the intervention group. The interview results also showed more positive responses by the intervention group in terms of the usability. Furthermore, facilitators and barriers for adopting ergonomic principles were collected from the surgeons. Multiple ways to improve surgical ergonomics as perceived by the surgeons were also identified, e.g., the use of ergonomic equipment, and implementation of stretch breaks in the OR. The results show the potential of an individual ergonomic assessment report as ergonomic intervention for surgeons to raise their awareness and knowledge about ergonomic principles which can contribute to decreasing their risk of developing WMSDs as well as improved surgical performance and patient safety. Future studies can regard further ergonomic risk parameters and incorporate practical instructions on ergonomic principles into educational ergonomic intervention. / Kirurger har identifierats som en av de högsta riskgrupperna inom hälso- och sjukvården att utveckla arbetsrelaterade belastningsskador. Särskilt nacke och axlar har visat sig ha hög risk för belastningsskador på grund av att kirurger ofta arbetar i en statisk och ogynnsam kroppsställning under en längre tid. Att öka den ergonomiska medvetenheten har visat sig gynna en förbättring av arbetsställning bland vårdpersonal. Denna avhandling syftade därför till att utforma och utvärdera en individuell ergonomisk rapport som ett medel för riskbedömning och ergonomisk utbildning bland kirurger. Två kirurger och två ergonomer deltog i designprocessen och tidig användarfeedback samlades. Tematisk analys användes för att analysera användarfeedback och potentiella förbättringar identifierades och genomfördes. Den slutliga individuella ergonomirapporten utvärderades som ett material som användes i en individuell utbildningssession (dvs interventionsgruppen) och jämfördes med användningen av en broschyr på kirurgergonomi (dvs kontrollgruppen). Varje grupp bestod av två kirurger. Både frågeformulär och semistrukturerad intervju användes för att utvärdera utbildningssessionen. Resultaten från frågeformuläret visade lika positiva användarupplevelse betyg från båda grupperna, men högre betyg gavs på den upplevda effekten av interventionsgruppen. Dessutom identifierades faciliteter och barriärer för att anta ergonomiska principer från kirurgerna. Flera sätt att förbättra kirurgisk ergonomi som uppfattades av kirurgerna identifierades också, till exempel användning av ergonomisk utrustning och implementering av sträcknings pausar i operationssalen. Resultaten visar att individuell ergonomisk bedömningsrapport som ergonomisk intervention för kirurger har potential för att öka medvetenhet och kunskap om ergonomiska principer. Detta kan bidra till att minska kirurgers risk att utveckla arbetsrelaterade belastningsskador samt förbättrad kirurgisk prestanda och patientsäkerhet. Framtida studier kan ta hänsyn till ytterligare ergonomiska riskparametrar och införliva praktiska instruktioner om ergonomiska principer i pedagogisk ergonomisk intervention.