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Human factors and ergonomics in the minimally invasive surgical operating room: Evaluating workload and risk factors for musculoskeletal illness through simulation and in situ measurement

Bethany Rose Lowndes, University of Nebraska - Lincoln


The healthcare industry expends a considerable portion of the United States’ financial and personnel resources. Despite the magnitude of the resources involved in the healthcare industry, care quality is not proportional to the cost. Poor quality of care in the form of medical errors that lead to patient harm are a primary threat to patient safety and are very costly to both patients and providers. Elevated workload and musculoskeletal pain and disorders in medical professionals can be linked to these errors. The advancement of minimally invasive surgery (MIS) has increased patient benefits but has been accompanied by ergonomic disadvantages to the surgeon and surgical team. In order to prevent provider harm, and therefore reduce the risk of a patient safety or quality breach, this work was the result of clinical, human factors, and biomedical methodologies in collaboration with medical professional to quantify the workload and identify the risk factors for musculoskeletal pain and disorders in the MIS operating room (OR). This dissertation begins with a background of the engineering methodologies used to study the healthcare system and improve the quality of healthcare delivery. Next a review of the human factors and ergonomic efforts in the operating room is covered to discuss how OR conditions evolved to current practice. The first two studies identified a higher workload for the surgeon and surgical team–especially the surgeon and assistant–when using a single port compared to the 4-port laparoscopic surgical technique. Patient factors including age, gender, body mass index, abnormal liver function test, and American Society of Anesthesiologists class were identified in the third research study as factors that could impact surgical team workload and patient safety due to the increase in surgical duration for laparoscopic cholecystectomy procedures. Finally, in the last two studies novel technologies (articulating instruments) and technique improvements to single port procedures were analyzed for usability and did not improve performance or workload for the users. All five studies illustrate how human factors and ergonomic principles can assess and improve patient and provider safety in the MIS OR. This research identified higher workload for the surgeon and surgical team during single port procedures with possible contributions from patient factors. No technique or technology advancements were demonstrated to improve workload and performance of single port surgery, calling for further research and development to improve both patients and provider safety and satisfaction.

Subject Area

Biomedical engineering|Industrial engineering

Recommended Citation

Lowndes, Bethany Rose, "Human factors and ergonomics in the minimally invasive surgical operating room: Evaluating workload and risk factors for musculoskeletal illness through simulation and in situ measurement" (2015). ETD collection for University of Nebraska - Lincoln. AAI3737770.