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Olig E, Ranieri G, Louie M. Ergonomic considerations for unique surgeon populations. Curr Opin Obstet Gynecol 2024; 36:260-265. [PMID: 38837696 DOI: 10.1097/gco.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Surgeons are rapidly diversifying as a population, introducing new ergonomic challenges. This review describes the challenges that are experienced by special populations of surgeons including small-handed surgeons, pregnant surgeons, and trainees, and evidence-based solutions to overcome them. RECENT FINDINGS Small-handed and female surgeons report more musculoskeletal complaints compared with their male counterparts. Pregnant surgeons frequently report development or worsening of musculoskeletal disorders such as carpal tunnel syndrome and low back pain. Trainees also report high rates of musculoskeletal complaints with minimal autonomy to alter their environment. Limited objective data exists regarding the ideal instruments currently available for special populations. Several small, randomized studies have proposed exercise regimens targeting the upper extremities and pregnancy-related pain syndromes with improvements in symptoms. Various methods of ergonomic education have been studied in trainees with improvements in operating room posture and performance. SUMMARY Limited objective data is available to recommend specific surgical instruments for high-risk surgeon populations. Beneficial exercise regimens have been described for musculoskeletal disorders commonly plaguing surgeons but have yet to be studied explicitly in small-handed or pregnant surgeons and trainees.
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Affiliation(s)
- Emily Olig
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona, USA
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Venkateswaran S, Wang D, Potter AL, Jeffrey Yang CF. Safety and Optimizing Ergonomics for Cardiothoracic Surgeons. Thorac Surg Clin 2024; 34:197-205. [PMID: 38944446 DOI: 10.1016/j.thorsurg.2024.04.007] [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] [Indexed: 07/01/2024]
Abstract
Cardiothoracic surgery, demanding in nature, often results in surgeons suffering from musculoskeletal injuries, causing chronic pain and leading to premature retirement. A significant majority report experiencing pain, exacerbated by minimally invasive techniques such as video-assisted thoracoscopic surgery. Despite this, many surgeons delay seeking medical assistance. To mitigate these risks, preventative strategies such as strength exercises, stretching during operations, and taking brief breaks are crucial. However, the surgical community faces a shortage of institutional support and comprehensive ergonomic education. Advancements in technology, including artificial intelligence and virtual reality, could offer future solutions.
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Affiliation(s)
- Shivaek Venkateswaran
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Danny Wang
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Alexandra L Potter
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Dixon F, Vitish-Sharma P, Khanna A, Keeler BD. Robotic assisted surgery reduces ergonomic risk during minimally invasive colorectal resection: the VOLCANO randomised controlled trial. Langenbecks Arch Surg 2024; 409:142. [PMID: 38676748 PMCID: PMC11055713 DOI: 10.1007/s00423-024-03322-y] [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: 01/31/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Minimally invasive surgery benefits patients but poor operating ergonomics causes musculoskeletal injuries in surgeons. This randomised controlled trial aims to assess whether robotic-assisted surgery with the open-console Versius® system can reduce surgeons' ergonomic risks during major colorectal resections. METHODS Prospectively registered at ClinicalTrials.gov (NCT05262296) in March 2022. Adult patients requiring a minimally invasive colorectal resection were potentially eligible. Photographs taken at 2-min intervals were analysed using the objective Rapid Entire Body Assessment (REBA) posture analysis scale to calculate intraoperative surgeon ergonomic risk. Secondary outcomes included team communication (Oxford NOTECHS II), surgeon cognitive strain (modified NASA-TLX scale), and clinical outcomes. RESULTS Sixty patients were randomised in a 2:1 ratio (40 robot, 20 laparoscopic). Mean age was 65yrs and 34 (57%) were male. Body Mass Index did not differ between the 2 groups (overall mean 29.0 ± 5) and there were equal proportions of left and right-colonic resections. REBA was significantly lower in the robotic arm (median robot REBA score 3 vs lap REBA 5 [p < 0.001]), equating to an injury risk category drop from "medium" to "low risk". There were no significant differences in team communication, operative duration, or patient outcomes. Surgeon cognitive strain was lower in robotic cases (mean robot 32.4 ± 10.3 vs lap 45.6 ± 14.3 [p < 0.001]). CONCLUSIONS This trial demonstrates that robotic surgery with an open-console system reduces ergonomic risk scores and cognitive strain during colorectal resections, with no apparent detriment to team communication. This may therefore be a safe & feasible solution to the increasing problem of work-related musculoskeletal injuries in surgeons.
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Affiliation(s)
- Frances Dixon
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK.
- University of Buckingham, Buckingham, MK18 1EG, UK.
| | - Parveen Vitish-Sharma
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK
- University of Buckingham, Buckingham, MK18 1EG, UK
| | - Achal Khanna
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK
| | - Barrie D Keeler
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK
- University of Buckingham, Buckingham, MK18 1EG, UK
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Sathe TS, Sorrentino TA, Drapeau S, Soriano IS, Lee H. A novel ergonomic simulator for laparoscopic surgery. Am J Surg 2024:S0002-9610(24)00197-1. [PMID: 38670837 DOI: 10.1016/j.amjsurg.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Despite the importance of laparoscopic skill development to General Surgery trainees, current laparoscopic simulators are either too expensive or suffer from poor portability or low video quality. Moreover, several trainers without height adjustable platforms and screens do not promote optimal ergonomics. In this paper, we present the design process and initial prototype of a novel ergonomic laparoscopic simulator that addresses these limitations.
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Affiliation(s)
- Tejas S Sathe
- University of California San Francisco, San Francisco, USA
| | | | - Scott Drapeau
- University of California San Francisco, San Francisco, USA
| | - Ian S Soriano
- University of California San Francisco, San Francisco, USA
| | - Hanmin Lee
- University of California San Francisco, San Francisco, USA
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Bhethanabotla RM, Ledgister K, Soriano IS, O'Sullivan P, Bigelow E, Knott PD, Park AM. Ergonomic Assessment of Septorhinoplasty Maneuvers During Simulated Pregnancy. OTO Open 2024; 8:e126. [PMID: 38577238 PMCID: PMC10988238 DOI: 10.1002/oto2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Objective Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact of pregnancy on surgeon posture and ergonomics. We piloted the use of a pregnancy simulation suit (Empathy Belly) to assess the risk of ergonomic compromise when performing open septorhinoplasty. Study Design Surgical simulation. Setting Single session, training simulation lab at academic medical center. Methods Medical students and surgical residents performed the initial steps of a rhinoplasty procedure without and with a pregnancy simulation suit and were filmed with an artificial intelligence-based video analysis app from Kinetica Labs that calculates joint angles and categorizes the ergonomic risk factors. Still images from videos were taken and analyzed using validated posture-based analysis rubrics. Participants were asked to complete a qualitative questionnaire after the session. Results Twelve medical students and surgical residents participated in the study. Posture-based analysis indicated increased ergonomics risk factors among trainees when performing a rhinoplasty while wearing the pregnancy suit. Video analysis indicated trends of worsening back angle and shoulder postures. Trainees reported experiencing pain in the neck, suprapubic area, and lower back. They acknowledged the importance of ergonomics in otolaryngology and desired further education about workplace injury risk mitigation. Conclusion Pregnancy impacts the ergonomics of performing septorhinoplasty and further investigation is required into interventions to reduce risk of WRMSDs.
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Affiliation(s)
- Rohith M. Bhethanabotla
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Kaye Ledgister
- Department of Environment, Health, and SafetyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Ian S. Soriano
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Patricia O'Sullivan
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Elaine Bigelow
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Philip Daniel Knott
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Andrea M. Park
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
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Taje R, Peer M, Gallina FT, Ambrogi V, Sharbel A, Melis E, Elia S, Idit M, Facciolo F, Patirelis A, Sorge R, Pompeo E. Ergonomic Assessment of Robotic versus Thoracoscopic Thymectomy. J Clin Med 2024; 13:1841. [PMID: 38610606 PMCID: PMC11012820 DOI: 10.3390/jcm13071841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Robotic and thoracoscopic surgery are being increasingly adopted as minimally invasive alternatives to open sternotomy for complete thymectomy. The superior maneuverability range and three-dimensional magnified vision are potential ergonomical advantages of robotic surgery. To compare the ergonomic characteristics of robotic versus thoracoscopic thymectomy, a previously developed scoring system based on impartial findings was employed. The relationship between ergonomic scores and perioperative endpoints was also analyzed. Methods: Perioperative data of patients undergoing robotic or thoracoscopic complete thymectomy between January 2014 and December 2022 at three institutions were retrospectively retrieved. Surgical procedures were divided into four standardized surgical steps: lower-horns, upper-horns, thymic veins and peri-thymic fat dissection. Three ergonomic domains including maneuverability, exposure and instrumentation were scored as excellent(score-3), satisfactory(score-2) and unsatisfactory(score-1) by three independent reviewers. Propensity score matching (2:1) was performed, including anterior mediastinal tumors only. The primary endpoint was the total maneuverability score. Secondary endpoints included the other ergonomic domain scores, intraoperative adverse events, conversion to sternotomy, operative time, post-operative complications and residual disease. Results: A total of 68 robotic and 34 thoracoscopic thymectomies were included after propensity score matching. The robotic group had a higher total maneuverability score (p = 0.039), particularly in the peri-thymic fat dissection (p = 0.003) and peri-thymic fat exposure score (p = 0.027). Moreover, the robotic group had lower intraoperative adverse events (p = 0.02). No differences were found in residual disease. Conclusions: Robotic thymectomy has shown better ergonomic maneuverability compared to thoracoscopy, leading to fewer intraoperative adverse events and comparable early oncological results.
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Affiliation(s)
- Riccardo Taje
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michael Peer
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Filippo Tommaso Gallina
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Azzam Sharbel
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Enrico Melis
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Stefano Elia
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Matot Idit
- Department of Anaesthesia and Intensive Care, Ichilov Medical Center, Tel Aviv 6423906, Israel;
| | - Francesco Facciolo
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Alexandro Patirelis
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Roberto Sorge
- Department of Biostatistics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Eugenio Pompeo
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
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Tsai AY, Carter SR, Greene AC. Artificial intelligence in pediatric surgery. Semin Pediatr Surg 2024; 33:151390. [PMID: 38242061 DOI: 10.1016/j.sempedsurg.2024.151390] [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] [Indexed: 01/21/2024]
Abstract
Artificial intelligence (AI) is rapidly changing the landscape of medicine and is already being utilized in conjunction with medical diagnostics and imaging analysis. We hereby explore AI applications in surgery and examine its relevance to pediatric surgery, covering its evolution, current state, and promising future. The various fields of AI are explored including machine learning and applications to predictive analytics and decision support in surgery, computer vision and image analysis in preoperative planning, image segmentation, surgical navigation, and finally, natural language processing assist in expediting clinical documentation, identification of clinical indications, quality improvement, outcome research, and other types of automated data extraction. The purpose of this review is to familiarize the pediatric surgical community with the rise of AI and highlight the ongoing advancements and challenges in its adoption, including data privacy, regulatory considerations, and the imperative for interdisciplinary collaboration. We hope this review serves as a comprehensive guide to AI's transformative influence on surgery, demonstrating its potential to enhance pediatric surgical patient outcomes, improve precision, and usher in a new era of surgical excellence.
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Affiliation(s)
- Anthony Y Tsai
- Division of Pediatric Surgery, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA 17033, United States.
| | - Stewart R Carter
- Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY, United States
| | - Alicia C Greene
- Division of Pediatric Surgery, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA 17033, United States
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Chen H. From the Editor - In - Chief: Featured papers in the November 2023 issue. Am J Surg 2023; 226:567-568. [PMID: 37858515 DOI: 10.1016/j.amjsurg.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
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