Few surgeons are attentive to posture and ergonomics in the midst of surgery, particularly during laparoscopy, yet 100% of laparoscopic surgeons report mental fatigue and musculoskeletal problems related to the operating room. Technique and positioning is imperative for proficiency with laparoscopic instruments and needs to be stressed early in training during residency as technique evolves. Videography holds promise in providing feedback on a surgeon’s posture during the procedure, but has not yet been assessed for benefit. We performed a randomized, prospective study to assess the benefits of videography feedback in a laparoscopic simulation laboratory.

After a short introductory laparoscopic instrument and handling teaching session, medical were randomized into a videography and non-videography group to practice their skills and perform a peg transfer skill, based on the Fundamentals of Laparoscopic Surgery (FLS) developed by the Society of American Gastrointestinal and Endoscopic Surgeons. The students returned after 3 weeks after their initial session. The videography group reviewed their individual video and received corrective feedback.  Both the control and videography groups then performed the timed task again at the interval assessment. The time difference for task completion was calculated between interval and initial times. A univariate analysis was performed for our outcome and possible confounders.

A total of 18 participants with 36 assessment times were studied. Age and gender were similar between the two groups (p= 0.66, 0.63 respectively). There was no association between gender and time difference (p=0.38). The time difference for the videography and non-videography group was significantly different at a mean time = 49.00+/-6.4, and 29.11+/-6.4 seconds respectively (p = 0.034).

Ergonomics play an important role in the decreasing the physical symptoms associated with muscular fatigue due to prolonged awkward surgical postures, and increase a surgeon’s speed to complete a procedure.

The group receiving video postural feedback was able to perform the timed task twenty seconds faster on average, as compared to those without ergonomic feedback. This demonstrates that coaching on ergonomics with this inexpensive format can achieve measureable improvement at low cost.

Limitations of the study include a small size, and the student population that may not translate to a practicing surgeon. We targeted the medical student population as they would be less likely to have developed maladaptive habits for laparoscopic surgery and may be more amenable to change in technique. Age and initial time were not different between the two groups, and gender was not associated with time difference. This eliminated these 3 variables as possible confounders.

Video feedback can increase the efficiency of laparoscopic teaching, and may be a useful tool in resident education and training.

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