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M O N T H 2 0 1 4 | S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
T A B L E S
F
our clinical studies, including my
own in the journal Surgical
Endoscopy, assessed how high the
operating surface should be during
laparoscopy to improve surgeon ergonom-
ics. They all concluded that the table should
be set so surgeons using long, pistol grip
instruments can position their forearms
close to parallel with the floor, without having to flare their elbows and lift their
shoulders. That typically means patients should be positioned lower than they
would during open procedures. Ultimately, finding the optimal table height and con-
figuration demands compromising between spine and arm position, and the muscle
effort and fatigue of the respective muscle groups.
My study determined table height should put instruments at or 10cm below the
surgeons' elbows in order to maximize their comfort and decrease muscle strain,
which translates to 64 to 77cm off the floor. Tables need to be even lower for sur-
geons operating near the anterior abdomen wall instead of the posterior wall.
Additionally, operating on bariatric patients in the Trendelenburg and reverse
Trendelenburg positions presents particular challenges related to proper instru-
ment positioning and surgical access.
How low a table can go is often determined by how much the surface is tilted or
how deep it's placed in the reverse Trendelenburg position. During upper-abdomi-
nal surgery, for example, the table can be lowered only so far in reverse
Trendelenburg before its front hits its base. In that situation, surgeons should stand
on 1 or 2 lifts to have the proper torso and arm posture for the duration of the case.
When surgeons stand between the patient's legs during procedures, the foot of the
table is down, limiting how low the table can go. In those instances, surgeons
should consider standing on a lift and placing needed foot-pedal controls on anoth-
ERGONOMIC STUDIES
What's the Optimal Table Height?
LOWER LIMIT Research shows the operating
surface should be 64 to 77cm off the floor during
laparoscopic cases.
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