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Ergonomic Impact of an Automated Device for Endoscopic Tool Insertion and Transfer

Sang Hyun Kim, Hyuk Soon Choi, Bo Mee Lee,Han Jo Jeon, Jae Min Lee,Eun Sun Kim, Bora Keum,Yoon Tae Jeen,Hong Sik Lee, Bo Ryun Kim,Joo Ha Hwang,Hoon Jai Chun

Gastrointestinal Endoscopy(2025)

Department of Physical Medicine and Rehabilitation

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Abstract
Background and Aims Endoscopists frequently experience musculoskeletal injuries, particularly in the distal upper extremities, due to substantial forces, awkward postures, and repetitive movements during procedures. A significant but underexplored risk factor is the repetitive exchange of endoscopic instruments. This study aimed to develop and evaluate an automatic endoscopic instrument insertion and transfer device, "INSERTrument," to reduce ergonomic strain and assess its impact on wrist movements and postures. Methods The INSERTrument was evaluated during in vivo gastric endoscopic submucosal dissection (ESD) procedures on porcine models, conducted by two experienced endoscopists. Outcomes included the number of wrist snaps, total instrument exchange time, and the percentage of time spent in high-risk wrist postures. Inertial measurement units (IMUs) were used to objectively analyze wrist joint angles. The device's performance was compared to conventional manual methods across various endoscopic instruments. Results The INSERTrument significantly reduced the number of wrist snaps per instrument exchange (7.3 ± 1.0 vs. 69.3 ± 8.3; p < 0.05) and per ESD procedure (68.6 ± 9.4 vs. 656.0 ± 71.8; p < 0.05), achieving an average reduction of approximately 90% compared to the conventional manual method. The total instrument exchange time per ESD was also significantly reduced in the INSERTrument group compared to the conventional group (127.6 ± 19.4 sec vs. 151.6 ± 10.9 sec; p < 0.05). IMU data revealed that the INSERTrument significantly decreased the percentage of time spent in high-risk wrist postures (10.4 ± 2.4% vs. 44.4 ± 5.1%; p<0.05). Conclusions The use of INSERTrument minimized repetitive wrist movements and high-risk postures associated with endoscopic instrument exchanges. These findings suggest that INSERTrument could improve the ergonomics of endoscopic procedures, potentially reducing the incidence of musculoskeletal injuries among endoscopists. Further studies are warranted to explore the long-term benefits and clinical implications of this device in routine endoscopic practice.
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要点】:研究开发并评估了一种自动化内镜工具插入和传递设备“INSERTrument”,以减少内镜医师在操作过程中经历的 ergonomic strain,并显著降低手腕动作和不良姿势的风险。

方法】:通过在猪模型上进行活体胃内镜下黏膜剥离术(ESD),并由两位经验丰富的内镜医师操作,使用惯性测量单位(IMUs)来客观分析手腕关节角度,对比评估了INSERTrument与传统手动方法。

实验】:在活体猪模型上进行了ESD操作实验,使用的数据集包括手腕关节角度的IMU数据。实验结果显示,INSERTrument在每次工具交换和整个ESD过程中显著减少了手腕的快速摆动次数和不良姿势的时间百分比,同时减少了工具交换的总时间。