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Minimally invasive surgeons have a prevalence of work-related musculoskeletal complaints of up to 86% due to the exposure to static loading, awkward postures, work pressure, and patient's wellbeing. Researchers have developed postural interventions to counteract the prevalence of musculoskeletal complaints and disorders, such as robot-assisted surgeries, arm-support systems, and rotatable handle pieces. An alternative intervention is to implement work breaks during the surgeries, which has shown to give promising results including that surgery duration does not prolong.
The aim of the current study is to simulate 90-min laparoscopic surgery activities in the laboratory and compare two intervention situations with the control situation. The control situation is without work breaks. The two intervention situations include 2.5-min breaks provided two times, i.e. after every 30-min work period, which are passive (rest) or active (targeted mobilization exercises). The assessment is based on changes in muscular activity on the back and upper extremities, back and upper extremity postures, feelings of discomfort, and work performance.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| No breaks | No Intervention | Subjects will simulate a 90-min laparoscopic activities in the laboratory. | |
| Passive breaks | Experimental | Subjects will simulate a 90-min laparoscopic activities in the laboratory, and after 30 and 60 min of work, they will be provided a 2.5-min break during which they can have a rest. |
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| Active breaks | Experimental | Subjects will simulate a 90-min laparoscopic activities in the laboratory, and after 30 and 60 min of work, they will be provided a 2.5-min break during which they will be performing some mobilisation exercises for the back, shoulder, and neck. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Work break schedule | Behavioral | Participants will receive 2.5-min breaks during a 90-min simulated laparoscopic surgery in the laboratory. The breaks will be either passive (simple rest) or active (selected mobilization exercises). |
| Measure | Description | Time Frame |
|---|---|---|
| Rating of perceived discomfort | Discomfort will be assessed using an 11-point numeric rating scale, ranging from 0 (no discomfort at all) to 10 (maximally imaginable discomfort). It will be assessed directly before and directly after each experimental condition. | Change from baseline (0 min) to directly after (90 min) each experimental condition |
| Measure | Description | Time Frame |
|---|---|---|
| Root-mean-square of electrical muscle activity recordings using electromyography | Selected target muscles in the arms (deltoid acromialis, extensor digitorum, flexor carpi radialis), shoulder (trapezius descendens) and back (erector spinae lumbalis) will be continuously recorded with electromyography. From the electromyographic signal, the root-mean-square will be calculated and averaged over the time period in each experimental condition. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen | Tübingen | Baden-Wurttemberg | 72074 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33444192 | Background | Luger T, Rieger MA, Bonsch R, Kramer B, Seibt R, Steinhilber B. Active and passive work breaks during simulated laparoscopy among laparoscopic surgeons: study protocol for a controlled, randomised cross-over laboratory trial. BMJ Open. 2020 Nov 19;10(11):e038952. doi: 10.1136/bmjopen-2020-038952. | |
| 37084097 | Derived |
| Label | URL |
|---|---|
| Homepage of the responsible Institute | View source |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Jul 7, 2023 | |
| Reset | Feb 22, 2024 | |
| Release | Dec 3, 2025 | |
| Reset | Dec 19, 2025 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Jul 7, 2023 | Feb 22, 2024 | |||
| Dec 3, 2025 |
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The study is not blinded, because the subject(s) will know which of the three experimental conditions they are exposed to (control without breaks; intervention with passive or active breaks). The same applies to the experimenter(s).
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| Average root-mean-square of muscle activity over the time period running from baseline (0 min) to directly after (90 min) each experimental condition |
| Median power frequency of electrical muscle activity recordings using electromyography | Selected target muscles in the arms (deltoid acromialis, extensor digitorum, flexor carpi radialis), shoulder (trapezius descendens) and back (erector spinae lumbalis) will be continuously recorded with electromyography. From the electromyographic signal, the median power frequency will be calculated and averaged over the time period in each experimental condition. | Average median power frequency f muscle activity over the time period running from baseline (0 min) to directly after (90 min) each experimental condition |
| Posture of the spine / back | Using gravimetric position sensors, the curvature of the back will be recorded as well as the head position and movement with respect to the trunk. Recordings are continuous and average angles (kyphosis, lordosis, neck angle) will be calculated per time period. | Average posture over time period baseline (0 min) to end (90 min) of each experimental condition |
| Heart rate | Continuous recording electrocardiography allows calculating the heart rate, a parameter reflecting the central stress state of the participant. The average heart rate will be calculated per time period. | Average heart activity over time period baseline (0 min) to end (90 min) of each experimental condition |
| Work performance | Using the Peg-Transfer Board (Simulab, Seattle, WA, USA), subjects will perform this task for exaclty 1 minute. Time is recorded after one repetition is finished and final performance for the overall minute is recorded as well. | Change from baseline (0 min) to directly after (90 min) each experimental condition |
| Workload | Using the Hart and Staveland's NASA Task Load Index (TLX) method, workload is assessed for 6 dimensions where participants put a cross on one of the 21 lines on the 21-point scales, which range from left (very satisfied; way too much; much to short; clearly increased) to right (very unsatisfied; way too few; much to long; clearly reduced). | Assessed at 90 min, directly after each experimental condition |
| Participant evaluation | Self-developed questionnaire assessing aspects of applicability and acceptability of the tested interventions in the field. All questions will be multiple choice questions, resulting in categorical variables (scales ranging from 1 [very satisfied / true] to 4 [very unsatisfied / not true]). | Assessed at 90 min, directly after the experimental conditions with intervention |
| Luger T, Bonsch R, Seibt R, Kramer B, Rieger MA, Steinhilber B. Intraoperative active and passive breaks during minimally invasive surgery influence upper extremity physical strain and physical stress response-A controlled, randomized cross-over, laboratory trial. Surg Endosc. 2023 Aug;37(8):5975-5988. doi: 10.1007/s00464-023-10042-9. Epub 2023 Apr 21. |
| Page 285: poster presentation with preliminary results presented at the PREMUS 2019 conference in Bologna, Italy | View source |
| Dec 19, 2025 |