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A6148 - A Prospective, Randomized, Controlled Trial of Ergonomic Outcomes Comparing Rotational Head to Conventional Bronchoscopes During Bronchoscopy
Author Block: C. Gilbert1, J. Thiboutot2, C. Mallow2, D. H. Yu3, N. J. Pastis4, B. Salwen2, C. Argento5, A. Chen6, H. J. Lee2, L. B. Yarmus7; 1Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, United States, 2Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, United States, 3Pulmonary and Critical Care, 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, Washington University in St. Louis, St. Louis, MO, United States, 7Pulmonary and Critical Care, Johns Hopkins University, Clarksville, MD, United States.
INTRODUCTION
Ergonomics within the practice of endoscopy remains poorly studied, however, there is potential for significant impact on healthcare providers quality of life and job satisfaction. Improved ergonomic designs within other disciplines such as laparoscopy has demonstrated improved pain scores and satisfaction among surgeons. The recent introduction of a new rotational head flexible bronchoscope offers improved bronchoscope tube flexion and rotation, with the potential to improve ergonomics during bronchoscopy procedures. We aim to examine the impact of the new rotational head bronchoscope design on ergonomics during standard bronchoscopic procedures.
METHODS
A prospective, randomized cross-over trial comparing flexible bronchoscopes, a standard flexible bronchoscope (Olympus, BF-1T180) to a rotational head flexible bronchoscope (Olympus, BF-1TH190), was performed. Subjects performed a full airway exam to the subsegmental level followed by targeted sampling of three pre-defined areas (RB1, RB7, LB 1+2) with endobronchial brush, transbronchial needle and forceps biopsy. During bronchoscopy, subjects were fitted with electromyography and real time 3-D myoMOTION (Noraxon, AZ) sensors for ergonomic assessment. Simulated bronchoscopy was performed with the Laerdal Sim-Man Classic (Wappingers Falls, NY) in a randomized fashion. Ergonomic assessment was performed with Electromyography (EMG) and the validated Rapid Upper Limb Assessment (RULA) score.
RESULTS
A total of 78 bronchoscopies was performed by 13 subjects of varying skill level. Each subject was randomized to perform bronchoscopy using the flexible bronchoscopy or the rotational head flexible bronchoscopy at each of the pre-defined areas before cross-over for a total of 6 bronchoscopies per subject. Use of the rotational head flexible bronchoscope resulted in improved overall RULA and EMG scores. When utilizing the rotational head flexible bronchoscope during access to the left upper lobe target (RB 1+2) there was a significant improvement in the RULA score (absolute difference of 0.36, p=0.036) and improvement in EMG measurements.
DISCUSSION
The use of the rotational head flexible bronchoscope offers improvement in ergonomics during the performance of bronchoscopy procedure in simulation models. Prospective in-human intraprocedural studies are needed to further assess the impact of the ergonomic benefit provided by the rotational head flexible bronchoscope.