View Abstract

A6159 - Experienced Bronchoscopists Demonstrate Improved Ergonomics with a Rotational Head Bronchoscope When Performing Simulated Bronchoscopy
Author Block: J. Thiboutot1, C. Gilbert2, C. Mallow1, D. H. Yu3, M. Dinga1, D. Lutz1, N. J. Pastis4, C. Argento5, A. Chen6, H. J. Lee1, L. B. Yarmus7; 1Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 2Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, United States, 3Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, CA, United States, 4Division of Pulmonary/Critical Care, Med Univ of S Carolina, Charleston, SC, United States, 5Pulmonary, Allergy, and Critical Care, Northwestern University, Chicago, IL, United States, 6Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, United States, 7Pulmonary and Critical Care Medicine, Johns Hopkins University, Clarksville, MD, United States.
INTRODUCTION
Bronchoscopy is a common procedure performed by pulmonologists and critical care physicians. The ergonomics surrounding bronchoscopy have been poorly studied, but survey data suggest individuals complain of pain and discomfort during and after bronchoscopic procedures. We sought to describe if operator experience may impact overall ergonomic assessment scores during simulated bronchoscopy sessions.
METHODS
Subjects were recruited from a randomized, cross-over trial assessing the ergonomic impact of a rotational head flexible bronchoscope design versus a standard flexible bronchoscope. All subjects performed the same simulated bronchoscopy procedures, attempting to sample three pre-defined areas. Ergonomic assessment was performed utilizing a validated ergonomic assessment tool, the Rapid Upper Limb Assessment (RULA). A total of 13 myoMOTION sensors (Noraxon, Scottsdale, AZ) captured angular velocity and orientation during bronchoscopic procedures. RULA scores were calculated each millisecond the duration of each bronchoscopy procedure and averaged for an overall RULA score. 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 was performed with bronchoscopists randomized to using a standard flexible bronchoscope (Olympus, BF-1T180) or a rotational head flexible bronchoscope (Olympus, BF-1TH190). When comparing mean RULA scores across skill levels, beginner bronchoscopists were found to have higher mean RULA scores when compared to non-beginners (4.85 versus 4.42, p=0.007). There was no significant difference in mean RULA scores when compared by age or gender.
DISCUSSION
Within a simulated bronchoscopy session of various experience levels, subjects with less experience in bronchoscopy had higher RULA scores. These higher RULA scores represent poor ergonomics and potential inappropriate musculoskeletal strain in these less experienced bronchoscopists during bronchoscopic procedures. Additional research utilizing the rotational head bronchoscopes and corrective educational metrics to improve intraprocedural ergonomics warrants additional study.