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Tetteh E, Wang T, Kim JY, Smith T, Norasi H, Van Straaten MG, Lal G, Chrouser KL, Shao JM, Hallbeck MS. Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations. Am J Surg 2024; 235:115551. [PMID: 37981518 DOI: 10.1016/j.amjsurg.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The surgical profession is plagued with a high prevalence of work-related musculoskeletal disorders. While numerous interventions have been tested over the years, surgical ergonomics education is still uncommon. METHODS The available literature on surgical ergonomics was reviewed, and with input from surgeons, recommendations from the review were used to create pictorial reminders for open, laparoscopic, and robot-assisted surgical modalities. These simple pictorial ergonomic recommendations were then assessed for practicality by residents and surgeons. RESULTS A review of the current literature on surgical ergonomics covered evidence-based ergonomic recommendations on equipment during open and laparoscopic surgery, as well as proper adjustment of the surgical robot for robot-assisted surgeries. Ergonomic operative postures for the three modalities were examined, illustrated, and assessed. CONCLUSIONS The resulting illustrations of ergonomic guidelines across surgical modalities may be employed in developing ergonomic education materials and improving the identification and mitigation of ergonomic risks in the operating room.
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Affiliation(s)
- Emmanuel Tetteh
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianke Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Y Kim
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianqi Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | | | - Geeta Lal
- Department of Surgery, University of Iowa, Iowa City, USA
| | | | - Jenny M Shao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Clar C, Koutp A, Leithner A, Leitner L, Puchwein P, Vielgut I, Sadoghi P. Occupational injuries in orthopedic and trauma surgeons in Austria. Arch Orthop Trauma Surg 2024; 144:1171-1178. [PMID: 38265464 PMCID: PMC10896885 DOI: 10.1007/s00402-024-05200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/31/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The aim of this study was to investigate the frequency and type of injuries during the career of orthopedic and trauma surgeons in Austria. The hypothesis was that the percentage of occupational injuries among orthopedic and trauma surgeons aligns with the incidence reported in the United States, thus indicating the need for a workplace prevention program. METHODS A web-based survey was created to collect all necessary data and was sent to all orthopedic and trauma surgeons in Austria via e-mail. Relevant parameters included the surgeons' age, work experience, severity of pain, type of injury, and current pain. Descriptive and explorative statistical analysis was performed. RESULTS A web-based survey was sent to 1122 board-certified orthopedic surgeons and residents in Austria via e-mail. In total, the response rate was 135 (12%). Seventy-two surgeons (54%) had suffered from one or more occupational injuries during their career. We detected a significant raise of occupational injuries related to the work life duration in which operations were performed and the prevalence of injuries. Most injuries of surgeons were reported between 21 and 30 years of their professional life. According to the frequency at different locations, the distribution in descending order was 25% with injuries of the hand, 22% of finger(s), 12% of the foot, 10% of the spine, 2% of the neck, 3% of the head, and 2% of the abdomen. A causality of incapacity to work through injuries at the workplace was given as 4%. Four percent stated a sick leave of at least 3 weeks. In 7% of the facilities, there was no optimization of preventive measures following an occupational injury. We found no correlation of injuries and resident status. CONCLUSION Orthopedic surgeons in Austria show a high incidence of occupational injuries in line with the findings of colleagues from the United States. The impact on the health system consists of absenteeism in the workplace of highly specialized health service providers as well as the incapacity to work of a high quality, highly trained workforce of at least 4%. With more preventive measures and more attention and care in the rehabilitation phase after such injuries, a positive effect could be achieved. We believe that residents should be specifically trained on how to avoid such injuries.
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Affiliation(s)
- Clemens Clar
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Amir Koutp
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Paul Puchwein
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Ines Vielgut
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Brouwer NP, Kingma I, van Dijk W, van Dieën JH. Exposure to inclined trunk postures in surgical staff. J Biomech 2023; 161:111833. [PMID: 37845112 DOI: 10.1016/j.jbiomech.2023.111833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
In surgical staff, low-back pain (LBP) is prevalent and prolonged trunk inclination is hypothesized to be one of its potential causes. The aim of this study was to evaluate the magnitude and duration of trunk inclination in the sagittal plane of surgical assistants during surgical procedures. The three-dimensional trunk orientation was measured in 91 surgical assistants across four medical facilities during surgical procedures using an inertial measurement unit on the thorax. Per participant, Exposure Variation Analysis was used to evaluate the percentage of the total time of trunk inclination (< -10° (backward inclination); -10-10° (upright posture); 10-20° (light inclination); 20-30° (moderate inclination); >30° (strong inclination)) taking into account posture duration (< 10 s; 10-60 s; 60-300 s; > 300 s). Participants reported their LBP history and perceived low-back load during the procedure via a questionnaire. Participants were in an upright posture for 75% [63-84%] (median [interquartile range]) of the total surgery time (average surgery time: 174 min). Trunk inclination was beyond 20° and 30° for 4.3% [2.1-8.7%] and 1.5% [0.5-3.2%] of the surgery time, respectively. In most of the participants, the duration of trunk inclination beyond 20° or 30° was less than 60 s. Questionnaire response rate was 81%. Persistent or repeated LBP was reported by 49% of respondents, and was unrelated to the exposure to inclined trunk postures. It is concluded that other factors than prolonged trunk inclination, for instance handling of loads or prolonged standing may be causally related to the reported LBP in the investigated population.
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Affiliation(s)
- N P Brouwer
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - I Kingma
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - J H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
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Barrios EL, Polcz VE, Hensley SE, Sarosi GA, Mohr AM, Loftus TJ, Upchurch GR, Sumfest JM, Efron PA, Dunleavy K, Bible L, Terracina KP, Al-Mansour MR, Gravina N. A narrative review of ergonomic problems, principles, and potential solutions in surgical operations. Surgery 2023:S0039-6060(23)00177-0. [PMID: 37202309 DOI: 10.1016/j.surg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Ergonomic development and awareness are critical to the long-term health and well-being of surgeons. Work-related musculoskeletal disorders affect an overwhelming majority of surgeons, and various operative modalities (open, laparoscopic, and robotic surgery) differentially affect the musculoskeletal system. Previous reviews have addressed various aspects of surgical ergonomic history or methods of ergonomic assessment, but the purpose of this study is to synthesize ergonomic analysis by surgical modality while discussing future directions of the field based on current perioperative interventions. METHODS pubmed was queried for "ergonomics," "work-related musculoskeletal disorders," and "surgery," which returned 124 results. From the 122 English-language papers, a further search was conducted via the articles' sources for relevant literature. RESULTS Ninety-nine sources were ultimately included. Work-related musculoskeletal disorders culminate in detrimental effects ranging from chronic pain and paresthesias to reduced operative time and consideration for early retirement. Underreporting symptoms and a lack of awareness of proper ergonomic principles substantially hinder the widespread utilization of ergonomic techniques in the operating room, reducing the quality of life and career longevity. Therapeutic interventions exist at some institutions but require further research and development for necessary widespread implementation. CONCLUSION Awareness of proper ergonomic principles and the detrimental effects of musculoskeletal disorders is the first step in protecting against this universal problem. Implementing ergonomic practices in the operating room is at a crossroads, and incorporating these principles into everyday life must be a priority for all surgeons.
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Affiliation(s)
- Evan L Barrios
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Valerie E Polcz
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Sara E Hensley
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - George A Sarosi
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Tyler J Loftus
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Jill M Sumfest
- Gatorcare Health Management Corporation, University of Florida, Gainesville, FL
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Kim Dunleavy
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Letitia Bible
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Krista P Terracina
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Mazen R Al-Mansour
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, FL.
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Mavrovounis G, Meling TR, Lafuente J, Fountas KN, Demetriades AK. Tools and Modalities for Postural Ergonomics Research in Surgery and Neurosurgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:15-20. [PMID: 38153443 DOI: 10.1007/978-3-031-36084-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Work-related musculoskeletal disorders (WMSDs) are common amongst neurosurgeons and can affect a surgeon's ability to operate. Performing surgical ergonomics research is important to minimize the prevalence and effect of WMSDs on the surgeons. The aim of this review is to highlight some of the most important objective and subjective tools available for surgical ergonomics research. Subjective tools can be divided into three categories: (1) questionnaires (either validated or non-validated) filled out by the participants, (2) survey assessments/standardized scoring systems filled out by the researchers, and (3) video analysis. Subjective tools have the drawbacks of recall bias and intra-rater and inter-rater variability. Some of the most important objective tools available are surface electromyography, force plate/pressure sensors analysis, inertial measurement units (IMUs) and kinematics data capturing using reflective markers. Although these modalities do not have the drawbacks that hinder the use of subjective tools, using most of them in the real-life operating theatre, with the exception of IMUs, is challenging. Conducting surgical ergonomics research is important to optimize the performance of neurosurgeons. The advancements towards wearable, wireless technologies will make it easier for surgeons to perform ergonomics research in the operating room.
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Affiliation(s)
- Georgios Mavrovounis
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Torstein R Meling
- Department of Neurosurgery, The National Hospital of Denmark, Rigshospitalet, Copenhagen, Denmark
| | | | - Konstantinos N Fountas
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Kolz JM, Wagner SC, Vaccaro AR, Sebastian AS. Ergonomics in Spine Surgery. Clin Spine Surg 2022; 35:333-340. [PMID: 34321393 DOI: 10.1097/bsd.0000000000001238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.
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Affiliation(s)
- Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Scott C Wagner
- Walter Reed National Military Medical Center, Bethesda, MD
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Elzomor A, Tunkel A, Lee E, Jaamour F, Davidson L, Shaver TB, Niermeyer W, Benito D, Cole K, Zapanta P. Intraoperative stretching microbreaks reduce surgery-related musculoskeletal pain in otolaryngologists. Am J Otolaryngol 2022; 43:103594. [PMID: 36029617 DOI: 10.1016/j.amjoto.2022.103594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/07/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the role intraoperative otolaryngology stretching microbreak (OSMB) has on musculoskeletal (MSK) pain and discomfort in otolaryngologists. BACKGROUND Otolaryngology procedures subject surgeons to significant amounts of pain and strain over their years of training. MSK pain is a serious concern for otolaryngologists' career longevity as well as their general wellbeing. METHODS Participants from two different hospitals and one private practice were recruited to participate in this study. An initial ergonomic survey was obtained to assess baseline MSK pain, and its subjective impact on operative performance. The participants then completed three control days without OSMB exercises, followed by three intervention days with OSMB exercises which were completed at 20-40 minute intervals. Preoperative and postoperative pain rating surveys were completed before and after each procedure and at the end of the day to determine changes in pain and/or discomfort. RESULTS Ten otolaryngologists (50 % men, 50 % women; mean age 35.6 years) participated in this study. Half of the participants indicated that they were concerned their pain would limit their ability to operate in the future. 70 % of participants indicated that they have not attempted to treat this pain and 60 % did not try any stretching exercises outside the operating room (OR) to mitigate their symptoms. Participants reported neck, upper back, and lower back to be the primary MSK discomfort. OSMB improved participants' pain scores in neck, shoulders, hands, and lower back pain (p < 0.05). CONCLUSION MSK pain has shown to be a serious concern for the ability of otolaryngologists to continue performing surgery in the future. OSMB may be an effective strategy that can be implemented by otolaryngologists intraoperatively to improve MSK pain and overall well being.
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Affiliation(s)
- Amir Elzomor
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Alexandra Tunkel
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Esther Lee
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Farris Jaamour
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lauren Davidson
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Timothy Brandon Shaver
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Weston Niermeyer
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Daniel Benito
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Keith Cole
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University School of Health Sciences, Washington, DC, USA
| | - Philip Zapanta
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Otolaryngology - Head and Neck Surgery, Sovah Health, Danville, VA, USA
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Alqahtani SM, Alzahrani MM, Bicknell R, Pichora D. Prevalence and factors of work-related musculoskeletal disorders among hand surgeons. World J Orthop 2022; 13:465-471. [PMID: 35633751 PMCID: PMC9125005 DOI: 10.5312/wjo.v13.i5.465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/12/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The nature of tasks required by hand surgeons require both forceful and repetitive maneuvers, thus subjecting these surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice.
AIM To assess the prevalence, characteristics and impact of MSK disorders among hand surgeons.
METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant.
RESULTS Of the 578 respondents, 60.4% reported that they had sustained a work-related MSK injury, of which the most common diagnoses were lateral elbow epicondylitis (18.7%), low back pain (17.1%) and carpal tunnel syndrome (15.6%). Among those that reported an injury, 73.1 % required treatment and 29.2 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (P < 0.003), increasing years in practice (P < 0.001) and higher case load (P < 0.05).
CONCLUSION To our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence. These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries, thus minimizing the financial and psychological burden on these surgeons and the healthcare system.
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Affiliation(s)
- Saad M Alqahtani
- Department of Orthopaedics, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad M Alzahrani
- Department of Orthopaedics, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ryan Bicknell
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Ontario, Canada
| | - David Pichora
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Ontario, Canada
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Virtual Reality Simulator Enhances Ergonomics Skills for Neurosurgeons. INT J SEMANT WEB INF 2022. [DOI: 10.4018/ijswis.297041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper aims to assess the needs of neurosurgical training in order to strategize the future plans for simulation and rehearsal. The project main objective is to investigate the ability virtual reality to enhance the training.An online questionnaire has been conducted among surgeons practicing in different countries across the globe. The study shows significant differences in rehearsal methods and surgical teaching methods practiced by the respondents. Among respondents, 90% did believe that virtual reality technology can serve surgical training, and almost all respondents agreed that there is a gap in the existing neurosurgical training in terms of operating room ergonomics. Adequate education on surgical ergonomics might lead to an improvement in the outcomes for both surgeon and patient. The contribution of the paper is two fold. From one side investigates the new requirements for the enhancement of Neurosurgenos’ training and adoption on Virtual Reality Simulator. From the other side contributes to the body of knowledge related to the required Ergonomics skills.
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Prevalence of Back and Neck Pain in Orthopaedic Surgeons in Western New York. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202201000-00007. [PMID: 34989709 PMCID: PMC8740880 DOI: 10.5435/jaaosglobal-d-21-00252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
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Alzahrani MM, Alqahtani SM, Pichora D, Bicknell R. Work-related musculoskeletal injuries among upper extremity surgeons: A web-based survey. World J Orthop 2021; 12:891-898. [PMID: 34888149 PMCID: PMC8613686 DOI: 10.5312/wjo.v12.i11.891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/28/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Work-related injuries have gained recent attention, especially in the orthopaedic literature. As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers, these surgeons can be at increased risk of acquiring work-related musculoskeletal (MSK) disorders during their years in practice.
AIM To assess the prevalence, characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.
METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant.
RESULTS Of the 142 respondents, 90.8% were males and the majority were younger than 55 years old (65.5%). A work-related MSK injury was reported by 89.4% of respondents, of which the most common diagnoses were low back pain (26.1%) and lateral elbow epicondylitis (18.3%). Among those that reported an injury, 82.7% required treatment and 26% required time off work as a direct result of their injury. The need to undergo treatment due to the injury was associated with increased number of injuries (P < 0.01). Moreover, surgeons were more likely to require time off work when they had been in practice for > 21 years (P < 0.05).
CONCLUSION A high proportion of surgeons in our survey reported MSK injuries, with more than one quarter of surgeons reported requiring time off work due to an MSK injury. The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care. Awareness of operative ergonomics, irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.
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Affiliation(s)
- Mohammad M Alzahrani
- Department of Orthopaedics, Imam Adulrahman Bin Faisal University, Dammam, KSA 34212, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopaedics, Imam Adulrahman Bin Faisal University, Dammam, KSA 34212, Saudi Arabia
| | - David Pichora
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Canada
| | - Ryan Bicknell
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Canada
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Ergonomics for surgeons - prototype of an external surgeon support system reduces muscular activity and fatigue. J Electromyogr Kinesiol 2021; 60:102586. [PMID: 34450379 DOI: 10.1016/j.jelekin.2021.102586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since the unergonomic postures cannot be changed during a surgery, it seems reasonable to externally support the surgeon's posture in order to relieve the musculature. To evaluate this matter, we conducted a pilot study to investigate if a prototype of an external surgeon support system (S3) relieves the musculature in an objectively measurable manner. METHODS Simultaneous surface electromyography (EMG) was used alongside a combination of a laser Doppler flowmeter and a tissue spectrometer to record back and leg muscles during a simulated surgical situation. FINDINGS With S3, muscle activity was significantly lower (p < 0.05) and also fatigue decreased when compared to without S3. Muscle blood flow and oxygenation were relatively close to baseline with S3, but increased without S3. INTERPRETATION An ergonomic S3 is a possible approach to reduce muscle activity and fatigue and may therefore prevent chronic back pain amongst surgeons in the long term.
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Kawahira H, Nakamura R, Shimomura Y, Oshiro T, Okazumi S, Lefor AK. A wearable lower extremity support for laparoscopic surgeons: A pilot study. Asian J Endosc Surg 2021; 14:144-148. [PMID: 32643317 DOI: 10.1111/ases.12812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/15/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
Surgeons have increased physical stress during laparoscopic surgery due to operative site constraints. We developed a wearable device to reduce the physical stress on surgeons' lower extremities. The device mechanically facilitates maintaining a near-upright posture. The surgeon's knees are gently bent by a knee-joint locking mechanism, and fixing and releasing are performed independently on each side. The subjects were one female and two male surgeons, who wore the device during laparoscopic inguinal hernia repair or high anterior resection. Surface electromyogram (EMG) was conducted for both iliopsoas muscles. Control values were determined with the subject not wearing the device. Participants completed a post-procedure questionnaire. With the device, EMG activity had a tendency to decrease in the left iliopsoas muscle (P = .055), but it changed little on the right (P = .406). The post-procedure questionnaire showed an overall positive impression, although subjects reported some difficulty walking. This device decreases EMG activity and may improve a surgeon's work environment.
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Affiliation(s)
- Hiroshi Kawahira
- Medical Simulation Center, Jichi Medical Univerisity, Shimotsuke, Japan.,Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Ryoichi Nakamura
- Department of Biodesign, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihiro Shimomura
- Division of Design Science, Graduate School of Engineering, Chiba University, Chiba, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Medical Center Sakura Hospital, Sakura, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Medical Center Sakura Hospital, Sakura, Japan
| | - Alan K Lefor
- Medical Simulation Center, Jichi Medical Univerisity, Shimotsuke, Japan.,Department of Surgery, Jichi Medical University, Shimotsuke, Japan
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Luger T, Rieger MA, Bonsch R, Krämer B, Seibt R, Steinhilber B. Active and passive work breaks during simulated laparoscopy among laparoscopic surgeons: study protocol for a controlled, randomised cross-over laboratory trial. BMJ Open 2020; 10:e038952. [PMID: 33444192 PMCID: PMC7678387 DOI: 10.1136/bmjopen-2020-038952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Laparoscopy has partially replaced open surgery due to the lower infection rate for the patient and hence better and shorter recovery. However, the surgeon's physical load is higher due to longer duration static and awkward body postures, increasing the risk for developing work-related musculoskeletal disorders. Interventions of an organisational nature are work breaks, being either passive or active. The primary objectives of this study are to determine whether passive and active work breaks lead to less discomfort than no work breaks and whether active work breaks lead to less discomfort than passive work breaks. METHODS AND ANALYSIS A controlled, randomised cross-over trial will be performed in the laboratory, of which its protocol is described here according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Statement. Recruitment of 21 laparoscopic surgeons started in April 2019 and the study is ongoing. The participating surgeons will perform three 1.5 hour experimental conditions, one without work breaks, one with 2.5 min passive work breaks including rest, and one with 2.5 min active work breaks including mobility and stretching exercises. The work breaks will be taken after 30 and 60 min of work. During the experiments, outcomes will be recorded. The primary outcome is rating of perceived discomfort measured on an 11-point numeric rating scale. The secondary outcomes are performance, muscle activity of selected muscles, upper body angles, heart rate, workload and subjective evaluation of both interventions. The collected data will be tested using a one-way or two-factorial repeated-measures analysis of variance. ETHICS AND DISSEMINATION Ethical approval of the study protocol was received by the local medical ethical committee of the University of Tübingen in February 2019 (no 618/2018BO2). The results of this study will be presented at national and international conferences, submitted for publications in peer-reviewed journals and serve as the starting point for a feasibility study. TRIAL REGISTRATION NUMBER NCT03715816.
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Affiliation(s)
- Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tübingen, Germany
| | - Rosina Bonsch
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tübingen, Germany
| | - Bernhard Krämer
- Department of Gynecology, University Hospital of Tübingen, Tübingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tübingen, Germany
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tübingen, Germany
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15
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Stretching and Strength Training to Improve Postural Ergonomics and Endurance in the Operating Room. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2810. [PMID: 33133890 PMCID: PMC7572150 DOI: 10.1097/gox.0000000000002810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
Plastic surgeons report the highest prevalence of chronic musculoskeletal pain and fatigue among surgical subspecialties. Musculoskeletal pain impacts daily life, career longevity, and economic burden secondary to occupational injury. Poor postural awareness and ergonomic set up in the operating room represent the most common etiology. Methods A literature review was performed to highlight the ergonomic set-up, postural pitfalls, occupational injuries, and musculoskeletal pain in the operating room. An institutional survey was administered among resident and attending surgeons regarding musculoskeletal pain, posture, ergonomic education, and future improvements. Literature results, survey data, and intraoperative photographs were analyzed in collaboration with physical therapists and personal trainers. Results Survey results demonstrated that 97% of resident and attending respondents experienced musculoskeletal pain and 83% reported a lack of education in posture and ergonomics. The main postural pitfalls included head forward and flexed positioning, abduction and internal arm rotation, and kyphosis of the thoracic spine. The collaborators developed instructional videos to assess posture and biomechanics and demonstrate targeted stretching and strength exercises to address specific neck, back, and shoulder pain. Conclusions Poor posture is unavoidable in the operating room at times. These educational videos should be utilized for self-motivated and prophylactic conditioning outside of the operating room to maintain physical well-being throughout a career in plastic surgery. Future focus should be aimed at implementing dedicated ergonomic education and physical wellness programs early in surgical resident training.
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Lavé A, Gondar R, Demetriades AK, Meling TR. Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review. Acta Neurochir (Wien) 2020; 162:2213-2220. [PMID: 32705353 PMCID: PMC7415019 DOI: 10.1007/s00701-020-04494-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022]
Abstract
Background Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of life and career length. This systematic review aims to ascertain this association and to search for preventive measures. Methods We conducted a PRISMA-P-based review on ergonomics and WMSDs in neurosurgery over the last 15 years. Twelve original articles were included, of which 6 focused on spine surgery ergonomics, 5 cranio-facial surgery (mainly endoscopic), and one on both domains. Results We found a huge methodological and content diversity among studies with 5 surveys, 3 cross-sectional studies, 2 retrospective cohorts, and 2 technical notes. Spine surgeons have sustained neck flexion and neglect their posture during surgery. In a survey, low back pain was found in 62% of surgeons, 31% of them with a diagnosed lumbar disc herniation, and 23% of surgery rate. Pain in the neck (59%), shoulder (49%), finger (31%), and wrist (25%) are more frequent than in the general population. Carpal tunnel syndrome showed a linear relationship with increasing cumulative hours of spine surgery practice. Among cranial procedures, endoscopy was also significantly related to shoulder pain while pineal region surgery received some attempts to optimize ergonomics. Conclusions Ergonomics in neurosurgery remains underreported and lack attention from surgeons and authorities. Improvements shall target postural ergonomics, equipment design, weekly schedule adaptation, and exercise.
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Affiliation(s)
- Alexandre Lavé
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Renato Gondar
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Koshy K, Syed H, Luckiewicz A, Alsoof D, Koshy G, Harry L. Interventions to improve ergonomics in the operating theatre: A systematic review of ergonomics training and intra-operative microbreaks. Ann Med Surg (Lond) 2020; 55:135-142. [PMID: 32477512 PMCID: PMC7251302 DOI: 10.1016/j.amsu.2020.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/31/2020] [Accepted: 02/29/2020] [Indexed: 11/04/2022] Open
Abstract
Musculoskeletal occupational injury is prevalent within the surgical community. This is a multi-factorial issue, but is contributed to by physical posture, environmental hazards and administrative deficiency. There is growing awareness of this issue, with several behavioural, educational and administrative techniques being employed. The literature on this topic is, however, sporadic and difficult to access by healthcare practitioners. The aim of this systematic review was to evaluate the literature on the current interventions used to minimise musculoskeletal occupational injury in surgeons and interventionalists. This review will focus on administrative and human factor interventions, such as intra-operative microbreaks and ergonomics training.
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Affiliation(s)
- Kiron Koshy
- Royal Victoria Infirmary, Newcastle Upon Tyne Hospital Foundation Trust, Newcastle Upon Tyne, UK
| | - Habib Syed
- Brighton and Sussex Medical School, Brighton, East Sussex, UK
| | | | - Daniel Alsoof
- University College London Medical School, London, UK
| | - George Koshy
- Sancheti Institute of Orthopaedics and Rehabilitation, India
| | - Lorraine Harry
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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18
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Cha JS, Monfared S, Stefanidis D, Nussbaum MA, Yu D. Supporting Surgical Teams: Identifying Needs and Barriers for Exoskeleton Implementation in the Operating Room. HUMAN FACTORS 2020; 62:377-390. [PMID: 31593495 PMCID: PMC10027361 DOI: 10.1177/0018720819879271] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of this study was to identify potential needs and barriers related to using exoskeletons to decrease musculoskeletal (MS) symptoms for workers in the operating room (OR). BACKGROUND MS symptoms and injuries adversely impact worker health and performance in surgical environments. Half of the surgical team members (e.g., surgeons, nurses, trainees) report MS symptoms during and after surgery. Although the ergonomic risks in surgery are well recognized, little has been done to develop and sustain effective interventions. METHOD Surgical team members (n = 14) participated in focus groups, performed a 10-min simulated surgical task with a commercial upper-body exoskeleton, and then completed a usability questionnaire. Content analysis was conducted to determine relevant themes. RESULTS Four themes were identified: (1) characteristics of individuals, (2) perceived benefits, (3) environmental/societal factors, and (4) intervention characteristics. Participants noted that exoskeletons would benefit workers who stand in prolonged, static postures (e.g., holding instruments for visualization) and indicated that they could foresee a long-term decrease in MS symptoms with the intervention. Specifically, raising awareness of exoskeletons for early-career workers and obtaining buy-in from team members may increase future adoption of this technology. Mean participant responses from the System Usability Scale was 81.3 out of 100 (SD = 8.1), which was in the acceptable range of usability. CONCLUSION Adoption factors were identified to implement exoskeletons in the OR, such as the indicated need for exoskeletons and usability. Exoskeletons may be beneficial in the OR, but barriers such as maintenance and safety to adoption will need to be addressed. APPLICATION Findings from this work identify facilitators and barriers for sustained implementation of exoskeletons by surgical teams.
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Affiliation(s)
- Jackie S Cha
- 311308 Purdue University, West Lafayette, Indiana, USA
| | - Sara Monfared
- 12250 Indiana University School of Medicine, Indianapolis, USA
| | | | | | - Denny Yu
- 311308 Purdue University, West Lafayette, Indiana, USA
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19
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Abstract
Introduction Orthopaedic surgeons are significantly predisposed to musculoskeletal injury, and these injuries can have negative effects on surgeon function and patient outcomes. While this phenomenon has been studied in the non-Asian population of surgeons, no study has been carried out in the local or regional Asian setting. The aim of this study was to determine the prevalence, characteristics and associations of occupational injuries in orthopaedic surgeons and residents, and to assess its functional impact. Materials and Methods The Nordic Musculoskeletal Questionnaire was sent out to all orthopaedic consultants and residents at two institutions in Singapore, via an email link to an online survey. Separately, further questions on symptom description, severity and treatment were surveyed. Additional information like age, gender, height and weight were obtained as well. Results A total of 87.5% respondents have at least one injury. Neck symptoms (66.1%) were the most prevalent, and back symptoms had the highest median severity score (4.5/10). The 74.1% of these injuries were reported as directly attributable to work. Age was found to be associated with an increase in the total number of anatomical areas affected (p = 0.016). A seated operating position was associated with more severe back pain (p = 0.040). Conclusion There is a high prevalence of occupational injuries sustained in our population of orthopaedic surgeons. Neck symptoms, followed by back and wrist symptoms, were the predominant symptoms in our population. Targeted ergonomic interventions may be considered to prevent specific musculoskeletal injuries in our population of orthopaedic surgeons.
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Affiliation(s)
- Ksk Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Ebk Kwek
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore
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20
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Dalager T, Jensen PT, Eriksen JR, Jakobsen HL, Mogensen O, Søgaard K. Surgeons' posture and muscle strain during laparoscopic and robotic surgery. Br J Surg 2020; 107:756-766. [DOI: 10.1002/bjs.11394] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/22/2019] [Accepted: 09/18/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.
Methods
Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMGmax). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.
Results
The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.
Conclusion
Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture.
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Affiliation(s)
- T Dalager
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - P T Jensen
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J R Eriksen
- Department of Surgery, Colorectal Cancer Unit, Zealand University Hospital, Roskilde, Denmark
| | - H L Jakobsen
- Department of Gastroenterology, Herlev Hospital, Herlev, Denmark
| | - O Mogensen
- Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
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22
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Abstract
Surgeons face hazardous working conditions due to ergonomic deficiencies found throughout the operating room. More than 80% of surgeons have succumbed to a work-related injury or illness as a consequence of sustaining awkward or static positions throughout lengthy operations over a career. While the focus of the procedure is directed to the patient, there is little concurrent regard for proper posture or spinal stability. Even when symptoms of discomfort are experienced, they are often ignored. This results in decreased production and may ultimately threaten surgical careers. Surgeons are often unaware of recommendations or guidelines designed to improve their comfort while operating. Furthermore, there is a significant lack of any formal ergonomic education, especially for minimally invasive procedures. Several modifiable risk factors can be adjusted in the operating room to provide a safer working environment. In addition, strengthening, stability, and exercise programs directed by a trained therapist may be employed to improve the surgeon's musculoskeletal health.
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Affiliation(s)
| | - Justin A Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
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Abstract
PURPOSE OF REVIEW Work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons and result in significant disability. We aimed to review the English-language literature regarding ergonomic risk, prevalence of WMSDs, and unique ergonomic considerations of gynecologic surgery. RECENT FINDINGS Surgeon WMSDs are prevalent, with rates ranging from 66 to 94% for open surgery, 73-100% for conventional laparoscopy, 54-87% for vaginal surgery, and 23-80% for robotic-assisted surgery. Risk factors for injury in open surgery include use of loupes, headlamps, and microscopes. Unique risks in laparoscopic surgery include table and monitor position, long-shafted instruments, and poor instrument handle design. In vaginal surgery, improper table height and twisted trunk position create injury risk. Although robotic surgery offers some advantages in neck and shoulder strain, it remains associated with trunk, wrist, and finger strain. SUMMARY WMSDs are prevalent among surgeons but have received little attention because of under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed and implemented in order to protect surgeons from preventable, potentially career-altering injuries.
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Moss EL, Sarhanis P, Ind T, Smith M, Davies Q, Zecca M. Impact of Obesity on Surgeon Ergonomics in Robotic and Straight-Stick Laparoscopic Surgery. J Minim Invasive Gynecol 2019; 27:1063-1069. [PMID: 31326633 DOI: 10.1016/j.jmig.2019.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVE Work-related musculoskeletal symptoms (WMSs) are reported to be increasing in surgeons performing minimally invasive procedures. Therefore, we investigated the use of inertial measurement units (IMUs) and electromyography (EMG) sensor recorders to record real-time information on the muscle movement/activity required to perform training exercises in simulated in normal and high body mass index (BMI) models. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS Four consultant gynecologic oncology surgeons experienced in complex straight-stick (SS) laparoscopic and robotically assisted (RA) surgery. INTERVENTIONS Three exercises (hoops onto pegs and wire chase) using SS and RA surgery on 2 abdominal models: normal BMI and high BMI. MEASUREMENTS AND MAIN RESULTS We measured time to complete exercise and surgeon muscle movement/activity. The time to complete all exercises was significantly lower for RA surgery as compared with SS laparoscopy (p <.05 or better). The movement of the surgeons' core was significantly greater in high BMI SS laparoscopy compared with normal BMI SS laparoscopy for exercises 1 and 2 (p <.001). Muscle usage, as determined by EMG peak, was significantly higher in normal BMI SS laparoscopy and even higher in high BMI SS laparoscopy but was generally flat for all normal and high BMI RA surgery exercises (p <.05 or better). CONCLUSION Detailed real-time information can be collected through IMUs/EMG sensors. Our results indicate that RA surgery requires less surgeon movements and muscle activity to complete tasks compared with SS laparoscopy, particularly in a high BMI model. The implications of these results are that RA surgery in high BMI patients may therefore have less physical impact on the surgeon compared with SS laparoscopy and may result in lower WMS rates.
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Affiliation(s)
- Esther L Moss
- Leicester Cancer Research Centre (Miss Moss), University of Leicester, Leicester, United Kingdom; Department of Gynaecological Oncology (Miss Moss and Mr. Davies), University Hospitals of Leicester, Leicester, United Kingdom.
| | - Panos Sarhanis
- Department of Gynaecology (Mr. Sarhanis), Northwick Park Hospital, Harrow, United Kingdom
| | - Thomas Ind
- Department of Gynaecological Oncology (Mr. Ind), The Royal Marsden Hospital, London, United Kingdom
| | - Michael Smith
- Deparatment of Gynaecological Oncology (Mr. Smith), The Christie Hospital, Manchester, United Kingdom
| | - Quentin Davies
- Department of Gynaecological Oncology (Miss Moss and Mr. Davies), University Hospitals of Leicester, Leicester, United Kingdom
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering (Professor Zecca); National Centre for Sport and Exercise Medicine NCSEM-EM (Professor Zecca), Loughborough, United Kingdom
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Koshy K, Syed H, Luckiewicz A, Harry ML. Study protocol - Interventions to reduce musculoskeletal occupational injury in surgeons and interventionalists: A systematic review. Int J Surg Protoc 2019; 15:5-7. [PMID: 31851728 PMCID: PMC6913547 DOI: 10.1016/j.isjp.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/16/2022] Open
Abstract
Musculoskeletal occupational injury is prevalent within the surgical community. This is a multi-factorial issue, but is contributed to by physical posture, environmental hazards and administrative deficiency. There is growing awareness of this issue, with several behavioural, educational and administrative techniques being employed. The literature on this topic is, however, sporadic and difficult to access by healthcare practitioners. The primary aim of this systematic review is to evaluate the literature on the current interventions used to minimise musculoskeletal occupational injury in surgeons. This review will focus on administrative, human factor interventions and ergonomics training.
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Affiliation(s)
- Kiron Koshy
- Royal Victoria Infirmary, Newcastle upon Tyne Hospital Foundation Trust, Newcastle upon Tyne, UK
| | - Habib Syed
- Brighton and Sussex Medical School, Brighton, UK
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26
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Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc 2018; 33:1482-1490. [PMID: 30218263 DOI: 10.1007/s00464-018-6430-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although single-port laparoscopic cholecystectomy (SILC) is safe and effective, inherent surgeons' discomfort has prevented a large-scale adaptation of this technique. Recent advances in robotic technology suggest that da Vinci Single-Site™ cholecystectomy (dVSSC) may overcome this issue by reducing the stress load of the surgeon compared to SILC. However, evidence to objectively assess differences between the two approaches is lacking. METHODS 60 patients [36 women, 24 men (mean age 52 years)] with benign gallbladder disease were randomly assigned to dVSSC (n = 30) or SILC (n = 30) in this single-centre, single-blinded controlled trial. The primary endpoint was surgeon's stress load. Secondary endpoints included operating time, conversion rates, additional trocar placement, blood loss, length of hospital stay, procedure costs, health-related quality of life, cosmesis and complications. Data were collected preoperatively, during the hospital stay, and at 1 and 12 months' follow-up. RESULTS The dVSSC group showed a significant reduction of mental stress load of the surgeon compared to SILC [Subjective Mental Effort Questionnaire (SMEQ) score: median 25.0 (range 8-89) vs. 42.5 (range 13-110) points; p = 0.002] and a trend towards reduced physical stress load [Local Experienced Discomfort (LED) score: median 8 (range 2-27) vs. 12 (range 0-64) points; p = 0.088]. The length of hospital stay was longer in the SILC group [mean 3.06 (median 2; range 1-26) vs. 1.9 (median 2; range 1-4) days, p = 0.034] but overall hospital costs were higher for dVSSC [median 9734 (range 5775-16729) vs. 6900 (range 4156-99977) CHF; p = 0.001]. There were no differences in the rate of postoperative complications that required re-intervention (Dindo-Clavien grade ≥ IIIa; SILC n = 2 vs. dVSSC n = 0, p = 0.492) or other secondary endpoints. CONCLUSIONS Da Vinci Single-Site™ cholecystectomy provides significant benefits over Single-Port Laparoscopic Cholecystectomy in terms of surgeon's stress load, matches the standards of the laparoscopic single-incision approach with regard to patients' outcomes but increases expenses. Clinicaltrials.gov registration-No.: NCT02485392.
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Affiliation(s)
- Lukasz Filip Grochola
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Christopher Soll
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Adrian Zehnder
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Roland Wyss
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Pascal Herzog
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
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Abstract
OBJECTIVE Work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons and may result in practice modification. We aimed to perform a comprehensive review of the English-language literature regarding ergonomic risk, prevalence of WMSDs, and unique ergonomic considerations by route of surgery. METHODS Multiple searches were performed of PubMed and University library resources to access English-language publications related to surgeon ergonomics. Combinations of keywords were used for each mode of surgery, including the following: "ergonomics," "guidelines," "injury," "operating room," "safety," "surgeon," and "work-related musculoskeletal disorders." Each citation was read in detail, and references were reviewed. RESULTS Surgeon WMSDs are prevalent, with rates ranging from 66% to 94% for open surgery, 73% to 100% for conventional laparoscopy, 54% to 87% for vaginal surgery, and 23% to 80% for robotic-assisted surgery. Risk factors for injury in open surgery include use of loupes, headlamps, and microscopes. Unique risks in laparoscopic surgery include table and monitor position, long-shafted instruments, and poor instrument handle design. In vaginal surgery, improper table height and twisted trunk position create injury risk. Although robotic surgery offers some advantages, it remains associated with trunk, wrist, and finger strain. Surgeon WMSDs often result in disability but are under-reported to institutions. Additionally, existing research tools face limitations in the operating room environment. CONCLUSIONS Work-related musculoskeletal disorders are prevalent among surgeons but have received little attention owing to under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed to protect surgeons from preventable, potentially career-altering injuries.
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28
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Nishimoto W, Kawahira H, Shimomura Y, Nishizawa Y, Ito M. A standing posture support device that reduces laparoscopic surgeons' occupational lower limb stress. MINIM INVASIV THER 2018; 28:151-156. [PMID: 30039734 DOI: 10.1080/13645706.2018.1491407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We developed a surgical knee rest (SKR) that can be used to decrease the stress placed on the lower half of the body when surgeons work in the standing position. We tested the effectiveness of this device in the context of laparoscopic surgery. MATERIAL AND METHODS Five healthy, right-handed male surgeons participated, and we recorded surface electromyography (sEMG) signals from the two heads of the left and right gastrocnemius (Gc) muscles during laparoscopic resections of colorectal cancer. The outcome variable was the percentage of maximum Gc muscle effort generated, reported as percent maximal isometric voluntary contraction (%MVC), and this variable was compared between surgeries performed with and without use of the SKR. Assessment covered the first 100 min of surgery, subdivided into two 50-min periods. RESULTS Mean %MVC of the left Gc muscle for the full 100-min test period was significantly decreased when the SKR was used (p = .027, vs. SKR not used). Notably, mean %MVC of both Gc muscles was significantly decreased during the first 50 min of surgery (p = .008 and p = .0046). CONCLUSION The SKR is useful for decreasing physical stress incurred by laparoscopic surgeons when working in the standing position.
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Affiliation(s)
- Wataru Nishimoto
- a Graduate School of Medical and Pharmaceutical Science , Chiba University , Chiba , Japan
| | - Hiroshi Kawahira
- b Center for Frontier Medical Engineering , Chiba University , Chiba , Japan
| | - Yoshihiro Shimomura
- c Division of Design Science, Graduate School of Engineering , Chiba University , Chiba , Japan
| | - Yuji Nishizawa
- d Colorectal and Pelvic Surgery Division , National Cancer Center Hospital East , Kashiwa , Japan
| | - Masaaki Ito
- d Colorectal and Pelvic Surgery Division , National Cancer Center Hospital East , Kashiwa , Japan
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Stucky CCH, Cromwell KD, Voss RK, Chiang YJ, Woodman K, Lee JE, Cormier JN. Surgeon symptoms, strain, and selections: Systematic review and meta-analysis of surgical ergonomics. Ann Med Surg (Lond) 2018; 27:1-8. [PMID: 29511535 PMCID: PMC5832650 DOI: 10.1016/j.amsu.2017.12.013] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/26/2017] [Accepted: 12/28/2017] [Indexed: 11/15/2022] Open
Abstract
Background Many surgeons experience work-related pain and musculoskeletal symptoms; however, comprehensive reporting of surgeon ailments is lacking in the literature. We sought to evaluate surgeons' work-related symptoms, possible causes of these symptoms, and to report outcomes associated with those symptoms. Materials and methods Five major medical indices were queried for articles published between 1980 and 2014. Included articles evaluated musculoskeletal symptoms and ergonomic outcomes in surgeons. A meta-analysis using a fixed-effect model was used to report pooled results. Results Forty articles with 5152 surveyed surgeons were included. Sixty-eight percent of surgeons surveyed reported generalized pain. Site-specific pain included pain in the back (50%), neck (48%), and arm or shoulder (43%). Fatigue was reported by 71% of surgeons, numbness by 37%, and stiffness by 45%. Compared with surgeons performing open surgery, surgeons performing minimally invasive surgery (MIS) were significantly more likely to experience pain in the neck (OR 2.77 [95% CI 1.30–5.93]), arm or shoulder (OR 4.59 [2.19–9.61]), hands (OR 2.99 [1.33–6.71], and legs (OR 12.34 [5.43–28.06]) and experience higher odds of fatigue (8.09 [5.60–11.70]) and numbness (6.82 [1.75–26.65]). Operating exacerbated pain in 61% of surgeons, but only 29% sought treatment for their symptoms. We found no direct association between muscles strained and symptoms. Conclusions Most surgeons report work-related symptoms but are unlikely to seek medical attention. MIS surgeons are significantly more likely to experience musculoskeletal symptoms than surgeons performing open surgery. Symptoms experienced do not necessarily correlate with strain. 68% of surveyed surgeons reported experiencing generalized pain from operating. Minimally-invasive surgeons were more likely to report pain, fatigue, and numbness. Only 29% of surgeons reported seeking treatment for symptoms. No association between objective strain on muscles and reported symptoms was found.
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Affiliation(s)
- Chee-Chee H Stucky
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX 77030 USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX 77030 USA
| | - Rachel K Voss
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX 77030 USA
| | - Yi-Ju Chiang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX 77030 USA
| | - Karin Woodman
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 431, Houston, TX 77030 USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX 77030 USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX 77030 USA
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Norheim EP, Black MH, Ngor EW, Shi JM, Safran MR, Navarro RA. Cervical spine disease in surgeons performing arthroscopy or laparoscopy. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 74:206-214. [PMID: 29035681 DOI: 10.1080/19338244.2017.1392277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/06/2017] [Indexed: 06/07/2023]
Abstract
Minimal research exists regarding cervical spine disorders in surgeons who perform endoscopy. A confidential on-line survey regarding neck pain (NP), spine disease (SD), and radiculopathy/myelopathy (R/M) was sent to 722 surgeons from a managed, group-based health care system. 415 responded. 361 had endoscopy experience, of whom 24.4% had NP, 20.8% SD, and 3.9% R/M. Most respondents were less than 50 years of age (62.3%), and male (65.7%). Significant risk factors for NP included older age and female, whereas OB/Gyn specialty, increased age and job stress were for SD. After adjusting for age and gender, significant risk factors for NP and SD included greater surgeon experience. After also adjusting for job stress, significant risk factors for SD included increased surgeon experience and higher frequency of endoscopies. No association was found between use of digital OR. Endoscopy appears to place surgeons at higher risk of cervical disease. Level of Evidence: Level 3.
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Affiliation(s)
- Elizabeth P Norheim
- a Southern California Permanente Medical Group, Kaiser Permanente, Downey Medical Center, Spine Surgery , Downey , California , USA
| | | | - Eunis W Ngor
- b Kaiser Foundation Health Plan , Pasadena , California , USA
| | - Jiaxiao M Shi
- b Kaiser Foundation Health Plan , Pasadena , California , USA
| | - Marc R Safran
- c Stanford Hospital and Clinics , Stanford , California , USA
| | - Ronald A Navarro
- d Southern California Permanente Medical Group, Kaiser Permanente, South Bay Medical Center , Harbor City , California , USA
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31
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Brandt ML. Sustaining a career in surgery. Am J Surg 2017; 214:707-714. [PMID: 28693842 DOI: 10.1016/j.amjsurg.2017.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Abstract
Surgery is a demanding career with great rewards and equally great challenges. In order to sustain our careers as well as the careers of our colleagues, it is important to understand and address the physical, psychological and spiritual challenges of surgery. With rare exception, the majority of surgery residents and practicing surgeons who prematurely leave surgery do so because they find the work to be physically, emotionally or spiritually incompatible with the vision they have for their life. Understanding these issues and providing solutions to improve surgeon wellness can help prevent societal loss of these highly trained professionals and suffering for surgeons and their families.
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Affiliation(s)
- Mary L Brandt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Hallbeck MS, Lowndes BR, Bingener J, Abdelrahman AM, Yu D, Bartley A, Park AE. The impact of intraoperative microbreaks with exercises on surgeons: A multi-center cohort study. APPLIED ERGONOMICS 2017; 60:334-341. [PMID: 28166893 DOI: 10.1016/j.apergo.2016.12.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Abstract
Recent literature has demonstrated ergonomic risk to surgeons in the operating room. One method used in other industries to mitigate these ergonomic risks is the incorporation of microbreaks. Thus, intraoperative microbreaks with exercises in a non-crossover design were studied. Fifty-six attending surgeons from 4 Medical Centers volunteered first in a day of their regular surgeries and then second day where there were microbreaks with exercises that could be performed in the sterile field, answering questions after each case, without significantly increasing the duration of their surgeries. Surgeons self-reported improvement or no change in their mental focus (88%) and physical performance (100%) for the surgical day incorporating microbreaks with exercises. Discomfort in the shoulders was significantly reduced while distractions and flow impact was minimal. Eighty-seven percent of the surgeons wanted to incorporate the microbreaks with exercises into their OR routine. Intraoperative microbreaks with exercises may be a way to mitigate work-related musculoskeletal fatigue, pain and injury.
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Affiliation(s)
- M S Hallbeck
- Mayo Clinic's Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States; Department of Surgery, Mayo Clinic, Rochester, MN, United States.
| | - B R Lowndes
- Mayo Clinic's Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - J Bingener
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - A M Abdelrahman
- Mayo Clinic's Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - D Yu
- Mayo Clinic's Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - A Bartley
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - A E Park
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, United States; Johns Hopkins University School of Medicine, Johns Hopkins, Baltimore, MD, United States
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Dabholkar T, Yardi S, Dabholkar YG, Velankar HK, Ghuge G. A Survey of Work-Related Musculoskeletal Disorders Among Otolaryngologists. Indian J Otolaryngol Head Neck Surg 2017; 69:230-238. [PMID: 28607896 DOI: 10.1007/s12070-017-1106-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/21/2017] [Indexed: 11/29/2022] Open
Abstract
There are increased reports of prevalence of work-related musculoskeletal disorders (WRMSDs) in surgeons performing minimal access surgeries. Due to the nature of the speciality, otolaryngologists spend their work days in performing markedly precise procedures in small workspaces i.e. the patients' ear, nose and throat. Due to this, they frequently adopt awkward neck, back and shoulder postures while using devices like otoscope, endoscope and microscope. The field of otolaryngology has barely received any attention with respect to ergonomic assessment. Thus, the aim of this study was to find out the prevalence of WRMSDs in otolaryngologists in Mumbai and Navi Mumbai. A pre-validated, structured questionnaire was distributed to 150 otolaryngologists. Seventy-three otolaryngologists responded to the questionnaire. The questionnaire comprised of demographic and workload data, report of musculoskeletal symptoms and otolaryngologists' interpretation of casual and preventive factors of symptoms at workplace. Response rate of the survey was 48.6%. The total prevalence of WRMSDs in the otolaryngologists was 87.67%. Majority of those surveyed reported that they suffered from musculoskeletal problems which they attributed to the ergonomic flaws encountered during surgery (60.27%) and OPD (69.86%) respectively. Pain and discomfort during surgery experienced by the surgeons were most frequently attributed to the awkward and sustained postures adopted during surgery. Effective time management, ergonomically apt postures, intermittent change of posture, using back rest and availing skilled assistance during OPD and surgery, were the self-assessed corrective measures suggested by the respondents. The otolaryngologists' job profile puts them at high risk for WRMSDs.
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Affiliation(s)
- Twinkle Dabholkar
- School of Physiotherapy, D. Y. Patil University, 6th Floor, Medical College Building, Sector-5 Nerul, Navi Mumbai, 400706 India
| | - Sujata Yardi
- School of Physiotherapy, D. Y. Patil University, 6th Floor, Medical College Building, Sector-5 Nerul, Navi Mumbai, 400706 India
| | - Yogesh G Dabholkar
- Department of ENT, School of Medicine, D. Y. Patil University, 1st Floor, Hospital Building, Sector-5 Nerul, Navi Mumbai, 400706 India.,B-306, Om Neelkanth CHS, Plot No 31, Sector 42A, Nerul West, Navi Mumbai, 400 706 India
| | - Haritosh K Velankar
- Department of ENT, School of Medicine, D. Y. Patil University, 1st Floor, Hospital Building, Sector-5 Nerul, Navi Mumbai, 400706 India
| | - Gaurav Ghuge
- School of Physiotherapy, D. Y. Patil University, 6th Floor, Medical College Building, Sector-5 Nerul, Navi Mumbai, 400706 India
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Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial. BMC Surg 2017; 17:13. [PMID: 28183345 PMCID: PMC5301379 DOI: 10.1186/s12893-017-0206-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Recent advances in robotic technology suggest that the utilization of the da Vinci Single-Site™ platform for cholecystectomy is safe, feasible and results in a shorter learning curve compared to conventional single-incision laparoscopic cholecystectomy. Moreover, the robot-assisted technology has been shown to reduce the surgeon’s stress load compared to standard single-incision laparoscopy in an experimental setup, suggesting an important advantage of the da Vinci platform. However, the above-mentioned observations are based solely on case series, case reports and experimental data, as high-quality clinical trials to demonstrate the benefits of the da Vinci Single-Site™ cholecystectomy have not been performed to date. Methods This study addresses the question whether robot-assisted Single-Site™ cholecystectomy provides significant benefits over single-incision laparoscopic cholecystectomy in terms of surgeon’s stress load, while matching the standards of the conventional single-incision approach with regard to peri- and postoperative outcomes. It is designed as a single centre, single-blinded randomized controlled trial, which compares both surgical approaches with the primary endpoint surgeon’s physical and mental stress load at the time of surgery. In addition, the study aims to assess secondary endpoints such as operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, costs of procedure, health-related quality of life, cosmesis and complications. Patients as well as ward staff are blinded until the 1st postoperative year. Sample size calculation based on the results of a previously published experimental setup utilizing an estimated effect size of surgeon’s comfort of 0.8 (power of 0.8, alpha-error level of 0.05, error margin of 10–15%) resulted in a number of 30 randomized patients per arm. Discussion The study is the first randomized controlled trial that compares the da Vinci Single Site™ platform to conventional laparoscopic approaches in cholecystectomy, one of the most frequently performed operations in general surgery. Trial registration This trial is registered at clinicaltrials.gov (trial number: NCT02485392). Registered February 19, 2015.
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Affiliation(s)
- Lukasz Filip Grochola
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Christopher Soll
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Adrian Zehnder
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Roland Wyss
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Pascal Herzog
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
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Lee TS, Song MY, Kwon YJ. Activation of back and lower limb muscles during squat exercises with different trunk flexion. J Phys Ther Sci 2017; 28:3407-3410. [PMID: 28174462 PMCID: PMC5276771 DOI: 10.1589/jpts.28.3407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/20/2016] [Indexed: 12/15/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the activation of back and lower
limb muscles in subjects who were performing a squat exercise at different angles of trunk
flexion. [Subjects and Methods] Twenty healthy subjects (age 21.1± 1.8 years, height 168.7
± 8.2 cm, weight 66.1 ± 12.3 kg) volunteered. The activation of the erector spinae muscle,
rectus femoris muscle, gluteus maximus muscle and biceps femoris muscle was observed while
the subjects performed squat exercises with a trunk flexion of 0°, 15°, and 30°. [Results]
The erector spinae muscle, gluteus maximus muscle, and biceps femoris muscle were
activated more during the squat exercise with the trunk flexion at 30° than the exercise
with the trunk flexion at 0°. The rectus femoris muscle showed a tendency to decrease as
the truck flexion increased. [Conclusion] Squat exercise be executed while maintaining an
erect trunk posture if one wishes to strengthen the quadriceps muscle while reducing the
load on the lower back.
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Affiliation(s)
- Tae-Sik Lee
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Min-Young Song
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Yu-Jeong Kwon
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
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Keester DL, Sommerich CM. Investigation of musculoskeletal discomfort, work postures, and muscle activation among practicing tattoo artists. APPLIED ERGONOMICS 2017; 58:137-143. [PMID: 27633206 DOI: 10.1016/j.apergo.2016.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 02/22/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
Tattoo artists are an understudied worker population with respect to investigation of work-related musculoskeletal (MSK) discomfort and associated risk factors. Results from one discomfort survey has been published; no analysis of worker biomechanics has been published. As such, a study was conducted to begin exposure assessment of tattoo artists to work factors that could result in MSK discomfort. Consistent with the prior survey, the current study showed an elevated prevalence of MSK discomfort. Twelve month discomfort prevalence exceeded 50% in the neck, shoulders, hands/wrists, and upper and lower back (range: 53-94%). Seventy-one percent of postures evaluated during 16 h of observation had total RULA scores of 5, 6, or 7 (investigation and changes are required soon or immediately). Static muscle activity levels in the left, right, or both upper trapezius muscles in each study participant exceeded the 2-5% MVE limit recommended in the literature. Intervention concepts are also discussed.
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Affiliation(s)
- Dana L Keester
- Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Carolyn M Sommerich
- Department of Integrated Systems Engineering, The Ohio State University, USA.
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Janki S, Mulder EEAP, IJzermans JNM, Tran TCK. Ergonomics in the operating room. Surg Endosc 2016; 31:2457-2466. [PMID: 27752811 PMCID: PMC5443844 DOI: 10.1007/s00464-016-5247-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
Abstract
Background Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to investigate the current frequency and effects of occupational musculoskeletal injuries on work absence. Methods An online questionnaire was conducted among all surgeons affiliated to the Dutch Society for Endoscopic Surgery, Gastrointestinal Surgery, and Surgical Oncology. In addition, this survey was conducted among surgeons, gynaecologists, and urologists of one cluster of training hospitals in the Netherlands. Results There were 127 respondents. Fifty-six surgeons currently suffer from musculoskeletal complaints, and 30 have previously suffered from musculoskeletal complaints with no current complaints. Frequently reported localizations were the neck (39.5 %), the erector spinae muscle (34.9 %), and the right deltoid muscle (18.6 %). Most of the musculoskeletal complaints were present while operating (41.8 %). Currently, 37.5 % uses medication and/or therapy to reduce complaints. Of surgeons with past complaints, 26.7 % required work leave and 40.0 % made intraoperative adjustments. More surgeons with a medical history of musculoskeletal complaints have current complaints (OR 6.1, 95 % CI 1.9–19.6). There were no significant differences between surgeons of different operating techniques in localizations and frequency of complaints, or work leave. Conclusions Despite previous various ergonomic recommendations in the operating room, the current study demonstrated that musculoskeletal complaints and subsequent work absence are still present among surgeons, especially among surgeons with a positive medical history for musculoskeletal complaints. Even sick leave was necessary to fully recover. There were no significant differences in reported complaints between surgeons of different operating techniques. Almost half of the respondents with complaints made intraoperative ergonomic adjustments to prevent future complaints. The latter would be interesting for future research.
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Affiliation(s)
- Shiromani Janki
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Evalyn E A P Mulder
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - T C Khe Tran
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Alzahrani MM, Alqahtani SM, Tanzer M, Hamdy RC. Musculoskeletal disorders among orthopedic pediatric surgeons: an overlooked entity. J Child Orthop 2016; 10:461-466. [PMID: 27538942 PMCID: PMC5033786 DOI: 10.1007/s11832-016-0767-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/05/2016] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Forceful and repetitive maneuvers constitute the majority of pediatric orthopedic surgical tasks, thus subjecting surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice. The aim of this study was to assess the prevalence, characteristics and impact of MSK disorders among pediatric orthopedic surgeons. METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the Pediatric Orthopedic Society of North America (POSNA) via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. p values of <0.05 were considered statistically significant. RESULTS Of the 402 respondents, 67 % reported that they had sustained a work-related MSK injury, of which the most common diagnoses were low back pain (28.6 %) and lateral elbow epicondylitis (15.4 %). Among those which reported an injury, 26 % required surgical treatment and 31 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (p < 0.001), working in a non-academic institute (p < 0.05), working in more than one institute (p < 0.05), and being in active practice for >21 years (p < 0.05). The need to undergo treatment or take time off due to the injury was associated with increased number of injuries (p < 0.001). In addition, surgeons were more likely to require time off work when they were >56 years of age (p < 0.001), had been in practice for >21 years (p < 0.001), required surgical management of their disorder (p < 0.001), and had experienced an exacerbation of a previous disorder (p < 0.001). DISCUSSION AND CONCLUSION This study is the first of its kind to assess MSK injuries sustained by pediatric orthopedic surgeons. The high incidence of these disorders may place a financial and psychological burden on these surgeons and thus the healthcare system. These results should shed a light on awareness and the need for further studies to prevent and help decrease the incidence of these disorders not only in orthopedic surgeons but also in the surgical population in general.
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Affiliation(s)
- Mohammad M. Alzahrani
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 2000 Drummond, Apt.1203, Montreal, QC H3G 2X1 Canada ,Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada ,Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia
| | - Saad M. Alqahtani
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 2000 Drummond, Apt.1203, Montreal, QC H3G 2X1 Canada ,Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada ,Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada
| | - Reggie C. Hamdy
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 2000 Drummond, Apt.1203, Montreal, QC H3G 2X1 Canada ,Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada
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AlQahtani SM, Alzahrani MM, Harvey EJ. Prevalence of musculoskeletal disorders among orthopedic trauma surgeons: an OTA survey. Can J Surg 2016; 59:42-7. [PMID: 26812408 DOI: 10.1503/cjs.014415] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Occupational injuries and hazards have gained increased attention in the surgical community in general and in the orthopedic literature specifically. The aim of this study was to assess prevalence and characteristics of musculoskeletal disorders among orthopedic trauma surgeons and the impact of these injuries on the surgeons' practices. METHODS We sent a modified version of the physical discomfort survey to surgeon members of the Orthopaedic Trauma Association (OTA) via email. Data were collected and descriptive statistics were analyzed. RESULTS A total of 86 surgeons completed the survey during the period of data collection; 84.9% were men, more than half were 45 years or older and 40.6% were in practice for 10 years or more. More than 66% of respondents reported a musculoskeletal disorder that was related to work; the most common was low back pain (29.3%). The number of body regions involved and disorders diagnosed was associated with increasing age and number of years in practice (p = 0.033). Time off work owing to these disorders was associated with working in a private setting (p = 0.045) and working in more than 1 institute (p = 0.009). CONCLUSION To our knowledge, our study is the first to report a high percentage of orthopedic trauma surgeons sustaining occupational injuries some time in their careers. The high cost of management and rehabilitation of these injuries in addition to the related number of missed work days indicate the need for increased awareness and implementation of preventive measures.
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Affiliation(s)
- Saad M AlQahtani
- From the Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Que. (AlQahtani, Alzahrani, Harvey); and the Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia (AlQahtani, Alzahrani)
| | - Mohammad M Alzahrani
- From the Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Que. (AlQahtani, Alzahrani, Harvey); and the Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia (AlQahtani, Alzahrani)
| | - Edward J Harvey
- From the Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Que. (AlQahtani, Alzahrani, Harvey); and the Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia (AlQahtani, Alzahrani)
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40
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Alqahtani SM, Alzahrani MM, Tanzer M. Adult Reconstructive Surgery: A High-Risk Profession for Work-Related Injuries. J Arthroplasty 2016; 31:1194-1198. [PMID: 26791046 DOI: 10.1016/j.arth.2015.12.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/10/2015] [Accepted: 12/10/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adult reconstructive surgery is an orthopedic subspecialty characterized by surgical tasks that are physical, repetitive, and require some degree of stamina from the surgeon. This can result strain and/or injury of the surgeon's musculoskeletal system. This study investigates the prevalence of work-related injuries among arthroplasty surgeons. METHODS A modified version of the physical discomfort survey was sent to surgeon members of the Hip Society, the International Hip Society, and the Canadian Orthopedic Arthroplasty via email. One hundred and eighty-three surgeons completed the survey. RESULTS Overall, 66.1% of the arthroplasty surgeons reported that they had experienced a work-related injury. The most common injuries that occurred were low back pain (28%), lateral epicondylitis of the elbow (14%), shoulder tendonitis (14%), lumbar disc herniation (13%), and wrist arthritis (12%). Overall, 27% of surgeons took time off from work because of the injury. As the number of disorders diagnosed increased, there was a significant increase in the incidence of requiring time off work because of the disorder (P < .001) and also exacerbation of a previously diagnosed disorder (P < .01). Factors that significantly increased the risk of the surgeon requiring time off because of the disorder were age >55 years, practicing for more than >20 years, and performing >100 total hip arthroplasty procedures per year (P < .05). In addition, 31% of the orthopedic surgeons surveyed required surgery for their injury. CONCLUSION Although most studies concentrate on the importance of patient safety and thus the quality of the health care system, the surgeon's safety is also considered an integral part of this system's quality. This study highlights a high prevalence of musculoskeletal work-related injuries among arthroplasty surgeons and indicates the need for the identification of preventive measures directed toward improving the operative surgical environment and work ergonomics for the surgeons.
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Affiliation(s)
- Saad M Alqahtani
- Division of Orthopaedic Surgery, McGill University, Montreal, Canada; Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia
| | - Mohammad M Alzahrani
- Division of Orthopaedic Surgery, McGill University, Montreal, Canada; Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, Canada
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Abstract
In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy.
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Aitchison LP, Cui CK, Arnold A, Nesbitt-Hawes E, Abbott J. The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments. Surg Endosc 2016; 30:5068-5076. [PMID: 27059965 DOI: 10.1007/s00464-016-4855-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/02/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic surgery presents multiple ergonomic difficulties for the surgeon, requiring awkward body postures and prolonged static muscle loading that increases risk of musculoskeletal strain and injury. This prospective study quantitatively measures the biomechanical movements of surgeons during laparoscopic procedures to determine at-risk movements from prolonged static muscle loading and repetitive motions that may lead to injury. METHODS A total of 150 video recordings of 18 surgeons, standing at the patient's left, were captured from three fixed camera positions during live gynecological laparoscopic surgery. Postoperative processing quantified surgeon movements at the neck, shoulders and elbows using computer software to measure extreme joint angles and time spent within defined joint angle ranges. RESULTS Surgeons spent a median of 98 % (range 77-100 %) of surgical time with their neck rotated at 21° (range 0°-52°). The non-dominant arm was subjected to more extreme positions for significantly longer periods of time compared to the dominant, with shoulder flexion at 45°-90° for 35 vs. 0 % (p < 0.001) and elbow flexion at >120° for 31 vs. 0 % (p < 0.001) of total surgical time. Procedures involving power morcellation required significantly greater number of instrument insertion/removals-119 (range 56-182) compared with 12 (range 2-122) when morcellation was not used (p < 0.001). Shorter surgeons maintained significantly greater degrees of neck rotation when viewing the monitor (p < 0.003) and surgeons with shorter arm lengths spent longer in extreme positions with their non-dominant shoulder at >90° (p = 0.04) and elbow at >120° (p < 0.001) compared with taller surgeons. No significant correlations were found between BMI or surgical experience and more extreme joint positions. CONCLUSIONS Four primary areas have been identified where surgeons are consistently demonstrating movements that increase their risk of harm: (1) extended periods of neck rotation; (2) asymmetrical loading between the dominant and non-dominant shoulders; (3) power morcellation and frequent insertions/removals of laparoscopic instruments resulting in repetitions of the most extreme shoulder positions and (4) a negative correlation between height and percentage time spent in more extreme positions.
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Affiliation(s)
| | | | - Amy Arnold
- University of New South Wales, Sydney, Australia.,The Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia
| | - Erin Nesbitt-Hawes
- University of New South Wales, Sydney, Australia.,The Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia.,Prince of Wales Private Hospital, Sydney, Australia
| | - Jason Abbott
- University of New South Wales, Sydney, Australia. .,The Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia. .,Prince of Wales Private Hospital, Sydney, Australia.
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Gözen AS, Tokas T, Tschada A, Jalal A, Klein J, Rassweiler J. Direct comparison of the different conventional laparoscopic positions with the ethos surgical platform in a laparoscopic pelvic surgery simulation setting. J Endourol 2015; 29:95-9. [PMID: 25112534 DOI: 10.1089/end.2014.0051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Laparoscopic surgery can be harmful to surgeons requiring a prolonged learning curve due to significant ergonomic drawbacks. Based on preliminary clinical experience, we present an experimental evaluation of the second-generation ETHOS™ operating chair by comparing it with two different operating positions of conventional laparoscopic pelvic surgery. MATERIALS AND METHODS The ETHOS operation platform consists of a seat like a saddle and five more parts that can be adjusted individually to support the surgeon's trunk and extremities. This operation platform was tested in 30 trainees who performed three standard suturing exercises in a pelvitrainer, approximating a linear and a U-shaped incision, made on the skin of a chicken leg, and completing an urethrovesical anastomosis, on a pig bladder specimen model, using interrupted sutures. The trainees performed each exercise in standing laterally to pelvitrainer (torero position) vs standing behind pelvi-trainer and sitting on ETHOS. The mean values, from all times and for each exercise and position, were documented, and the participants filled out a validated questionnaire focusing on ergonomic issues. RESULTS There were no significant differences among the different training modalities, in step 1 and step 2. However, in step 3, which mimics the urethrovesical anastomosis, the mean times were statistically significant significantly less by using ETHOS (p<0.0001). The mean times of training in step 3 were 41.2 minutes in the behind the camera position, 49 minutes in torero position, and 39.7 minutes by using ETHOS. The position that was maintained, during the exercises, was mainly responsible for the improvement noted in the ergonomic scores. CONCLUSIONS The new operating platform (ETHOS chair) can significantly improve ergonomics in laparoscopy particularly concerning difficult steps like intracorporeal suturing. This may also improve the urethrovesical anastomosis times in a clinical setting.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany
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Affiliation(s)
- Declan Quinn
- ST7, Altnagelvin Area Hospital; Glenshane Road Londonderry Northern Ireland UK
| | - James Moohan
- Consultant Gynaecologist; Altnagelvin Area Hospital; Glenshane Road Londonderry Northern Ireland UK
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Ramakrishnan VR, Montero PN. Ergonomic considerations in endoscopic sinus surgery: lessons learned from laparoscopic surgeons. Am J Rhinol Allergy 2013; 27:245-50. [PMID: 23710962 DOI: 10.2500/ajra.2013.27.3872] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic sinus procedures are increasingly common, and more technically difficult procedures are being undertaken to provide patients with minimally invasive alternatives to traditional open surgical techniques. However, such endoscopic approaches have increasing physical demands on the surgeon. The aim of this review is to summarize current literature on surgical ergonomic principles as they relate to endoscopic sinus and skull base surgery and focus on future needs for our specialty. METHODS Literature review was performed of surgical ergonomics and, particularly, laparoscopic ergonomic principles. RESULTS Existing ergonomic principles for laparoscopic surgery can be applied to endoscopic sinus and skull base surgery and can be expected to offer benefits in terms of surgeon fatigue, physical discomfort, and task efficiency. CONCLUSION Increasing surgeon awareness will allow for many basic ergonomic principles to be applied to endoscopic sinus and skull base surgery. Although many simple changes can be immediately made, there is a clear need for further study and abundant room for innovation.
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Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
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46
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Liang B, Qi L, Yang J, Cao Z, Zu X, Liu L, Wang L. Ergonomic status of laparoscopic urologic surgery: survey results from 241 urologic surgeons in china. PLoS One 2013; 8:e70423. [PMID: 23936202 PMCID: PMC3729835 DOI: 10.1371/journal.pone.0070423] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/18/2013] [Indexed: 12/23/2022] Open
Abstract
Background The prolonged and frequent use of laparoscopic equipment raises ergonomic risks that may cause physical distress for surgeons. We aimed to assess the prevalence of urologic surgeons’ physical distress associated with ergonomic problems in the operating room (OR) and their awareness of the ergonomic guidelines in China. Methods A sample of 300 laparoscopic urologists in China was assessed using a questionnaire on demographic information, ergonomic issues in the OR, musculoskeletal symptoms, and awareness of the ergonomic guidelines for the OR. Results There were 241 survey respondents (86.7%) with valid questionnaires. Among the respondents, only 43.6% placed the operating table at pubic height during the actual operation. The majority of the respondents (63.5%) used only one monitor during the procedure. Only 29.9% placed the monitor below the eye level. More than half of the respondents (50.6%) preferred to use manual control instead of the foot pedal. Most of the respondents (95.0%) never used the body support. The respondents experienced discomfort in the following regions, in ascending order: leg (21.6%), hand (30.3%), wrist (32.8%), shoulder (33.6%), back (53.1%), and neck (58.1%). The respondents with over 250 total operations experienced less discomfort than those with less than 250 total operations. Most of the respondents (84.6%) were unaware of the ergonomic guidelines. However, almost all of the respondents (98.3%) regarded the ergonomic guidelines to be important in the OR. Conclusions Most of the laparoscopic urologists were not aware of the ergonomic guidelines for the OR; hence, they have been suffering from varying degrees of physical discomfort caused by ergonomic issues. There is an urgent need for education regarding ergonomic guidelines in the OR for laparoscopic urologists in China.
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Affiliation(s)
- Boluo Liang
- Department of Reproductive Center, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinrui Yang
- Department of Urology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenzhen Cao
- Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- * E-mail:
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Indramohan VP, Ashford R, Khan S, Lintern M. Are surgeon's content with the current surgical headgear systems? J Med Eng Technol 2012; 36:366-71. [PMID: 22943636 DOI: 10.3109/03091902.2012.712203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Medical devices such as 'surgical headgears' are used by surgeons during certain micro-surgical applications requiring enhanced vision and magnification. The main aim of the study was to investigate the clinical usability of existing headgear, the prevalence of discomfort experienced by surgeons frequently using such devices and ascertain if the surgeons are content with the existing headgear systems. Online semi-structured questionnaires were sent to 200 surgical consultants hailing from six different sub-specialities currently practicing in various National Health Service (NHS) trusts in the UK. Data collected from the questionnaires were descriptively analysed. Vital issues pertaining to weight (36%), distraction (50%), pain and strain around the areas of head (56%), neck (26%), nose (28%), ears (16%), neck and back muscles (30%) were reported by the surgeons. In conclusion, 70% of surgeons are not content with the current headgear systems. Consequently, they foresee a need for an efficient and improved headgear system.
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Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. Spine surgeon's kinematics during discectomy according to operating table height and the methods to visualize the surgical field. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:2704-12. [PMID: 22772353 DOI: 10.1007/s00586-012-2425-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/24/2012] [Accepted: 06/25/2012] [Indexed: 12/24/2022]
Abstract
PURPOSE The ergonomic problems for surgeons during spine surgery are an awkward body posture, repetitive movements, increased muscle activity, an overflexed spine, and a protracted time in a standing posture. The authors analyzed whole spine angles during discectomy. The objective of this study is to assess differences in surgeon whole spines angles according to operating table height and the methods used to visualize surgical field. MATERIALS AND METHODS A cohort of 12 experienced spine surgeons was enrolled. Twelve experienced spine surgeons performed discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, and out of loupe) and three different operating table heights. Whole spine angles were compared for three different views during discectomy simulation; midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from head to pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared at the different operating table heights, while using the three visualization methods, with natural standing position. RESULTS Whole spine angles were significantly different for visualization methods. Lumbar lordosis, cervical lordosis, and occipital angle were closer to natural standing values when discectomy was performed with a loupe, but most measures differed from natural standing values when performed out of loupe. Thoracic kyphosis was also similar to the natural standing position during discectomy using a loupe, but differed from the natural standing position when performed with naked eye. Whole spine angles were also found to differ from the natural standing position according to operating table height, and became closer to natural standing position values as operating table height increased, when simulation was conducted with loupe. CONCLUSION This study suggests that loupe use and a table height midpoint between the umbilicus and sternum are optimal for reducing surgeon musculoskeletal fatigue.
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Affiliation(s)
- Jeong Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul 135-720, South Korea
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Musculoskeletal disorders among spine surgeons: results of a survey of the Scoliosis Research Society membership. Spine (Phila Pa 1976) 2011; 36:E1715-21. [PMID: 21508887 DOI: 10.1097/brs.0b013e31821cd140] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Survey of surgeon members of the Scoliosis Research Society. OBJECTIVE To assess the prevalence of musculoskeletal disorders (MSDs) among spine surgeons. SUMMARY OF BACKGROUND DATA Spinal deformity surgery is characterized by long duration and repetitive, forceful tasks. The purpose of this study is to describe the type and prevalence of MSDs among orthopedic spine surgeons. METHODS A modified version of the physical discomfort survey was sent to surgeon members of the Scoliosis Research Society via standard mail and e-mail. A total of 3 attempts to contact potential respondents were made, with 62% (561/904 × 100) responding. Mean respondent age was 54 years. Mean annual total caseload was 147, of which 62 were of spinal deformity. A total of 84% of the respondents had an active surgical practice. RESULTS The most common self-reported diagnoses included neck pain/strain/spasm (38%, 215/561), lumbar disc herniation/radiculopathy (31%, 172/561), cervical disc herniation/radiculopathy (28%, 155/561), rotator cuff disease (24%, 134/561), varicose veins or peripheral edema (20%, 112/561), and lateral epicondylitis (18%, 99/561). For lumbar disc disease, 7.1% (40/561 × 100) and for cervical disc disease, 4.6% (26/561 × 100) of spine surgeons underwent surgery. Among active spine surgeons, multiple linear regression analysis revealed that total caseload correlated with neck pain (P = 0.01) and lower extremity edema (P = 0.03), while the number of deformity cases correlated with wrist pain (P = 0.003) and hand pain (P = 0.03). Age was correlated with shoulder (P = 0.03), elbow (P = 0.04), and hand pain (P = 0.02). Number of years in practice did not correlate with MSDs. CONCLUSION Compared with disease estimates in the general population, spine surgeons have a higher prevalence of MSDs. Our cohort underwent surgical intervention for lumbar (7.1%) and cervical (4.6%) disc disease at rates far exceeding disease estimates in the general population. Increased awareness among spine surgeons may lead to earlier treatment and, ultimately, enhanced preventive measures.
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50
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Little RM, Deal AM, Zanation AM, McKinney K, Senior BA, Ebert CS. Occupational hazards of endoscopic surgery. Int Forum Allergy Rhinol 2011; 2:212-6. [DOI: 10.1002/alr.20108] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/30/2011] [Accepted: 11/01/2011] [Indexed: 11/11/2022]
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