Monitor position in laparoscopic surgery

Background: One of the key problems in laparoscopy is the ergonomic positioning of the monitor. In this study we tested task performance and muscle strain of subjects in relation to monitor position during laparoscopic Surgery. Methods: Eighteen subjects simulated laparoscopic suturing by threading tiny pearls with a curved needle. This was repeated in three monitor positions (15 min each): frontal at eye level (A), frontal in height of the operating field (B), and 45° to the right side at eye level (C). Subjects were not allowed to turn their heads during these sessions. After the test they were asked for their preferred monitor position. During all tests the electro-myographic (EMG) activity of the main neck muscles was recorded and the number of pearls was Counted. Results: The EMG activity was significantly lower for position A compared to positions C and B ( p < 0.05). No significant difference was found between positions B and C. The number of threaded pearls as an indicator for task performance was highest for position B. The difference was statistically significant compared to position C (p = 0.0008) but not between positions A and C (p = 0.0508) or A and B (p = 0.0575). When asked for the preferred monitor position, nine Subjects chose two monitors in the frontal positions A and B. No Subject preferred the monitor at the side position (C). Conclusion: Regarding EMG data, the monitor positioned frontal at eye level is preferable. Reflecting personal preferences of subjects and task performance., it should be of advantage to place two monitors in front of the surgeon: one in position A for lowest neck strain and the other in position B for difficult tasks with optimal task performance. The monitor position at the side is not advisable.