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A1724 - Experienced Bronchoscopists Have Reduced Musculoskeletal Strain During Bronchoscopy
Author Block: B. Salwen1, J. Thiboutot1, C. Mallow1, D. H. Yu1, N. J. Pastis2, C. Argento3, A. C. Chen4, H. J. Lee1, C. Gilbert5, L. B. Yarmus1; 1Interventional Pulmonology, Johns Hopkins University, Baltimore, MD, United States, 2Division of Pulmonary/Critical Care, Med Univ of S Carolina, Charleston, SC, United States, 3Pulmonary, Allergy, and Critical Care, Northwestern University, Chicago, IL, United States, 4Washington Univ School of Med, Saint Louis, MO, United States, 5Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, United States.
Rationale
Current training guidelines recommend at least 100 flexible bronchoscopies be performed during fellowship to establish competency. It remains unclear as to how operator experience and technique effects musculoskeletal strain during bronchoscopy. The aim of this project was to examine the impact of experience level on muscle usage during flexible bronchoscopy.
Methods
Subjects were recruited from a prospective, randomized cross-over trial assessing the ergonomic impact of bronchoscope design. All subjects performed bronchoscopic maneuvers in an attempt to access three distinct areas (right upper lobe, right lower lobe, left upper lobe) within a simulated sampling procedure utilizing a standard flexible bronchoscope and a new, rotational head flexible bronchoscope. Musculoskeletal usage was captured with surface electromyography (EMG) each millisecond of the following muscle groups: left and right flexor and extensor carpi radialis, left brachioradialis, biceps, and left and right anterior deltoid. EMG data was analyzed by muscle group, as well as by total EMG ”burden” or sum of the muscle groups. Experience was defined as beginner (less than 100 total lifetime bronchoscopies), intermediate (more than 100 but less than 1000 total lifetime bronchoscopies), and expert (more than 1000 total lifetime bronchoscopies).
Results
A total of 78 simulated bronchoscopy procedures were performed with bronchoscopists randomized to using a standard flexible bronchoscope (Olympus, BF-1T180) or a rotational head flexible bronchoscope (Olympus, BF-1TH190). A comparison of EMG measurements between age, sex, and skill levels was performed. The total EMG burden was significantly higher in non-expert (beginner and intermediate) level bronchoscopists when compared to expert level bronchoscopists (114,991 uV*s versus 60,920 uV*s; p=0.007). Increasing age was also associated with less total EMG burden (p=0.036). There was improved overall EMG burden with the rotational head bronchoscope.
Discussion
Subjects with more experience and advanced age appear to utilize significantly less muscle conduction during bronchoscopy when compared to less experienced bronchoscopists. Muscle overuse during bronchoscopy may lead to increased overall strain during procedures and potentially lead to operator fatigue and/or pain. Utilization of improved ergonomic design in both the bronchoscopy environment and ergonomically appropriate room layout may help improve operator outcomes. Further study is needed to identify additional factors in excessive muscle usage and modifications that may alleviate overuse.