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Muscular Strain and Fatigue among Urologists during Transurethral Resections Using Direct and Monitor Endoscopy

Objectives: The aims of the study were to analyze muscular strain and fatigue of urologists during the performance of transurethral resections using direct and video endoscpoy and to reduce the muscular effort by an ergonomic arrangement of the operation equipment. Methods: The study was performed before, during and after the introduction of a video-guided resection method. Muscular strain and fatigue were studied by means of surface electromyograms derived from various shoulder and back muscles of surgeons. Results: During direct endoscopy, muscular strain was found to be significantly higher for the shoulder muscles than during monitor endoscopy. The occurrence of muscular fatigue was established for at least one of the muscles under test in all operations during the application of direct endoscopy. A routine use of the video method was facilitated by arranging the operation equipment according to ergonomic principles. This results in a reduction in muscular fatigue, in particular for the trapezius muscle. For this muscle the number of operations accompanied with fatigue was lowered from about 80% before redesign to about 42% after redesign. Conclusion: Muscular strain and fatigue of urologists occurring during transurethral resections is reduced by applying video endoscopy instead of using direct endoscopy. The routine use of the video method requires an ergonomic arrangement of the operation equipment.