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Kang SH, Mirka GA. Effects of a Passive Back-Support Exosuit on Erector Spinae and Abdominal Muscle Activity During Short-Duration, Asymmetric Trunk Posture Maintenance Tasks. HUMAN FACTORS 2024; 66:1830-1843. [PMID: 37635094 DOI: 10.1177/00187208231197264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To examine the effects of asymmetry and lower extremity mobility restrictions on the effectiveness of a passive back-support exosuit in short-duration, static trunk flexion postures. BACKGROUND The effectiveness of trunk exoskeletons/suits for sagittally symmetric trunk posture maintenance has been investigated, but there has been limited study of the effects of asymmetric trunk postures or lower extremity motion restriction. METHOD Sixteen participants held trunk flexion postures involving trunk flexion (20°, 40°, 60°), asymmetry (0°, 30°), and lower extremity mobility (Free, Restricted) for 3 s. Participants held these postures with and without an exosuit while erector spinae and abdominal muscle activities were collected. RESULTS There were no significant interactions between exosuit and asymmetry or exosuit and lower extremity motion restrictions, indicating no significant effects of these factors on the effectiveness of the exosuit at reducing trunk muscle activity. The exosuit was found to be effective at reducing erector spinae muscle activity regardless of asymmetry of posture or lower extremity restrictions (average 21%, from 11.2% MVC to 8.8% MVC). The magnitude of the erector spinae activity at 60° of trunk flexion with the exosuit was similar to that seen at 20° without the exosuit. CONCLUSION The exosuit consistently provided biomechanical benefit through reduced activation of the erector spinae muscles and neither asymmetry of trunk posture nor lower extremity restriction influenced this effectiveness. APPLICATION Trunk exoskeletons/suits can reduce trunk muscle activation and understanding how characteristics of the trunk postures assumed impact these responses may help target tasks wherein these devices may be effective.
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Abolfotouh SM, Alnori O, Choma T, Moore D, Abolfotouh MA. Epidemiology of Work-Related Neck Pain Among Spine Surgeons. Global Spine J 2024; 14:1515-1523. [PMID: 36564909 DOI: 10.1177/21925682221148685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES This study aimed to investigate work-related neck pain among AO spine surgeons in different regions by estimating its prevalence, predictors, consequences, and management methods. METHODS A cross-sectional survey of 411 spine surgeon members of AO spine was conducted during March-May 2021, using the Modified Nordic Questionnaire and the Neck Disability Index. Data on neck pain experience during the last 12 months and its consequences and risk factors were collected. Logistic regression analysis was done to identify significant predictors of neck pain. Significance was set at P < .05. RESULTS The 1-year neck pain was experienced by 66.7% of surgeons. According to the Neck Disability Index, more than one-half (52.8%) experienced disability due to neck pain of mild (45.5%), moderate (6.5%), and severe (.8%) grades. Neck pain was responsible for stopping work in 17.5% of surgeons, with a median of 3.5 (IQR, 2-7.8) days off work. One-half of the participants (56.3%) were treated by medical care, 31.5% by physiotherapy, and 16.5% requested rest days and sick leave. Physical stress (P < .001) and non-exercising (P = .04) were the significant predictors of neck pain. CONCLUSION The 12-month prevalence of neck pain was high among spine surgeons, with an impact on activities of daily living, mainly of a mild degree, reported by one-half of surgeons. Physical stress was the only significant predictor, while sports practice was a protective factor against neck pain. Medication was the primary management adopted-an increased focus on pain prevention through improved workplace ergonomics and sports activity programs is recommended.
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Affiliation(s)
- Sameh M Abolfotouh
- Orthopedics Department, Medcare Hospital, Dubai, UAE
- OrthoCure Medical Center, Dubai, UAE
| | - Omar Alnori
- Orthopedics Department, Hamad General Hospital, Doha, Qatar
| | | | - Don Moore
- Spine Unit, University of Missouri, MO, USA
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center(KAIMRC)/ King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS)/ King Abdulaziz Medical City (KAMC), Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia
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Cha JS, Athanasiadis DI, Asadi H, Stefanidis D, Nussbaum MA, Yu D. Evaluation of a passive arm-support exoskeleton for surgical team members: Results from live surgeries. JOURNAL OF SAFETY RESEARCH 2024; 89:322-330. [PMID: 38858056 DOI: 10.1016/j.jsr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/16/2023] [Accepted: 02/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Musculoskeletal symptoms and injuries adversely impact the health of surgical team members and their performance in the operating room (OR). Though ergonomic risks in surgery are well-recognized, mitigating these risks is especially difficult. In this study, we aimed to assess the impacts of an exoskeleton when used by OR team members during live surgeries. METHODS A commercial passive arm-support exoskeleton was used. One surgical nurse, one attending surgeon, and five surgical trainees participated. Twenty-seven surgeries were completed, 12 with and 15 without the exoskeleton. Upper-body postures and muscle activation levels were measured during the surgeries using inertial measurement units and electromyography sensors, respectively. Postures, muscle activation levels, and self-report metrics were compared between the baseline and exoskeleton conditions using non-parametric tests. RESULTS Using the exoskeleton significantly decreased the percentage of time in demanding postures (>45° shoulder elevation) for the right shoulder by 7% and decreased peak muscle activation of the left trapezius, right deltoid, and right lumbar erector spinae muscles, by 7%, 8%, and 12%, respectively. No differences were found in perceived effort, and overall scores on usability ranged from "OK" to "excellent." CONCLUSIONS Arm-support exoskeletons have the potential to assist OR team members in reducing musculoskeletal pain and fatigue indicators. To further increase usability in the OR, however, better methods are needed to identify the surgical tasks for which an exoskeleton is effective.
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Affiliation(s)
| | | | - Hamed Asadi
- Purdue University, West Lafayette, IN, United States
| | | | | | - Denny Yu
- Purdue University, West Lafayette, IN, United States
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Chan C, Tan YC, Lim EW, Teo JY, Lin J, Tan WJ, Tay GCA, Tan EKW, Seow-En I. Evaluating the surgical trainee ergonomic experience during minimally invasive abdominal surgery (ESTEEMA study). Sci Rep 2024; 14:12502. [PMID: 38822017 PMCID: PMC11143188 DOI: 10.1038/s41598-024-63516-8] [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: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
Minimally invasive abdominal surgery (MAS) can exert a physical cost. Surgical trainees spend years assisting minimally-invasive surgeries, increasing the risk of workplace injury. This prospective questionnaire-based cohort study was conducted amongst general surgery residents in Singapore. Residents assisting major MAS surgery were invited to complete anonymous online survey forms after surgery. The Phase 1 survey assessed physical discomfort scores and risk factors. Intraoperative measures to improve ergonomics were administered and evaluated in Phase 2. During Phase 1 (October 2021 to April 2022), physical discomfort was reported in at least one body part in 82.6% (n = 38) of respondents. Over a third of respondents reported severe discomfort in at least one body part (n = 17, 37.0%). Extremes of height, training seniority, longer surgical duration and operative complexity were significant risk factors for greater physical discomfort. In Phase 2 (October 2022 to February 2023), the overall rate of physical symptoms and severe discomfort improved to 81.3% (n = 52) and 34.4% (n = 22) respectively. The ergonomic measure most found useful was having separate television monitors for the primary surgeon and assistants, followed by intraoperative feedback on television monitor angle or position. Close to 20% of survey respondents felt that surgeon education was likely to improve physical discomfort.
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Affiliation(s)
- Cassandra Chan
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Ying Ching Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ee Wen Lim
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jinlin Lin
- Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Winson JianHong Tan
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Gerald Ci An Tay
- Department of Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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Wong SW, Parkes A, Crowe P. Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review. J Robot Surg 2024; 18:224. [PMID: 38801617 PMCID: PMC11130008 DOI: 10.1007/s11701-024-01992-w] [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: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.
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Affiliation(s)
- Shing Wai Wong
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Allan Parkes
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Philip Crowe
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
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Saikali S, Patel E, Mascarenhas A, Jaber A, Gamal A, Moschovas MC, Cui L, Li X, Patel V. Assessing Muscular Pain and Ergonomics Among Robotic Surgeons in China: A Validation. Surg Innov 2024:15533506241255766. [PMID: 38780068 DOI: 10.1177/15533506241255766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Robotic surgery has transformed minimally invasive procedures, offering precision and efficiency. However, the ergonomic aspects of robotic consoles and their impact on surgeon health remain understudied. This review investigates the burden of ergonomics and muscle fatigue among robotic surgeons in China, comparing the findings to a multinational study. METHODOLOGY A literature review identified themes related to physical discomfort in robotic surgery. A questionnaire was administered to Chinese robotic surgeons, yielding 40 responses. The study assessed demographic characteristics, surgeon experience, ergonomic practices, reported discomfort, and pain-relief mechanisms. RESULTS The study revealed that most surgeons experienced shoulder and neck pain, with mixed opinions on whether robotic surgery was the primary cause. Stretching exercises were commonly used for pain relief. Surgeons believed that case volume and surgery duration contributed to discomfort. Comparisons with a multinational study suggested potential demographic and experience-related differences. CONCLUSION While the study has limitations, including a small sample size and potential translation issues, it underscores the importance of addressing ergonomic concerns and providing proper training to robotic surgeons to ensure their well-being and longevity in the field. Further research with larger cohorts and platform-specific analyses is warranted.
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Affiliation(s)
- Shady Saikali
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Ela Patel
- Stanford University, Stanford, CA, USA
| | | | | | - Ahmad Gamal
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Marcio Covas Moschovas
- Advent Health Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Liang Cui
- Department of Urology, Peking University First Hospital. Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Vipul Patel
- Advent Health Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
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Jacovides CL, Guetter CR, Crandall M, McGuire K, Slama EM, Plotkin A, Kashyap MV, Lal G, Henry MC. Overcoming Barriers: Sex Disparity in Surgeon Ergonomics. J Am Coll Surg 2024; 238:971-979. [PMID: 38511681 DOI: 10.1097/xcs.0000000000001043] [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: 03/22/2024]
Abstract
BACKGROUND Musculoskeletal discomfort is widely experienced by surgeons across multiple surgical specialties. Developing technologies and new minimally invasive techniques add further complexity and ergonomic stressors. These stressors differentially affect male and female surgeons, but little is known about the role these sex disparities play in surgical ergonomic stress. We reviewed existing literature to better understand how ergonomic stress varies between male and female surgeons. STUDY DESIGN A literature search was performed via PubMed including but not limited to the following topics: ergonomics, surgeons, female surgeons, women surgeons, pregnancy, and operating room. A review of available quantitative data was performed. RESULTS Female surgeons endure more pronounced ergonomic discomfort than their male counterparts, with added ergonomic stress associated with pregnancy. CONCLUSIONS A 4-fold method is proposed to overcome ergonomic barriers, including (1) improved education on prevention and treatment of ergonomic injury for active surgeons and trainees, (2) increased departmental and institutional support for ergonomic solutions for surgeons, (3) partnerships with industry to study innovative ergonomic solutions, and (4) additional research on the nature of surgical ergonomic challenges and the differential effects of surgical ergonomics on female surgeons.
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Affiliation(s)
- Christina L Jacovides
- From the Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, Temple University Hospital, Philadelphia, PA (Jacovides)
| | - Camila R Guetter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Guetter)
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Guetter)
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL (Crandall)
| | - Kandace McGuire
- Department of Surgery, Virginia Commonwealth University, Richmond, VA (McGuire)
| | - Eliza M Slama
- Sentara Northern Virginia Medical Center, Woodbridge, VA (Slama)
| | - Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA (Plotkin)
| | - Meghana V Kashyap
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE (Kashyap)
| | - Geeta Lal
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA (Lal)
| | - Marion C Henry
- Division of Pediatric Surgery, Department of Surgery, University of Chicago, Chicago, IL (Henry)
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Tsumanuma FK, Hembecker PK, Claus CMP, Loureiro MDP, Reinert F, Abreu de Souza M. Effect of laparoscopic handle size on surgical performance: A randomized crossover trial. Med Eng Phys 2024; 127:104165. [PMID: 38692768 DOI: 10.1016/j.medengphy.2024.104165] [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: 10/25/2023] [Revised: 03/02/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
Laparoscopic instrument handles design and dimensions are crucial to determine the configuration of surgeons' hand grip and, therefore, can have a deleterious effect on overall surgical efficiency and surgeons' comfort. The aim of this study is to investigate the impact of laparoscopic handle size and hand surface area on surgical task performance. A single-blind, randomized crossover trial was carried out with 29 novice medical students. Participants performed three simulated tasks in "black box" simulators using two scissor-type handles of different sizes. Surgical performance was assessed by the number of errors and time required to complete each task. Hand anthropometric data were measured using a 3D scanner. Execution time was significantly higher when cutting and suturing tasks were performed with the smaller handle. In addition, hand surface area was positively correlated with peg transfer task time when performed with the standard handle and was correlated with cutting task time in small and standard handle groups. We also found positive correlations between execution time and the number of errors executed by larger-handed participants. Our findings indicate that laparoscopic handle size and hand area influence surgical performance, highlighting the importance of considering hand anthropometry variances in surgical instrument design.
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Affiliation(s)
- Fernanda Keiko Tsumanuma
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná (PUC-PR), Imaculada Conceição St., 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Paula Karina Hembecker
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná (PUC-PR), Imaculada Conceição St., 1155, Curitiba, Paraná, 80215-901, Brazil.
| | - Christiano Marlo Paggi Claus
- Department of Surgery, Nossa Senhora das Graças Hospital, Alcides Munhoz St., 433, Curitiba, Paraná, 80810-040, Brazil
| | - Marcelo de Paula Loureiro
- Graduate Program in Industrial Biotechnology, Positivo University, Prof. Pedro Viriato Parigot de Souza St., 5.300, Curitiba, Paraná, 80740-050, Brazil
| | - Fabíola Reinert
- Department of Design and Graphic Expression, Federal University of Santa Catarina (UFSC), Campus Universitário Reitor João David Ferreira Lima, s/n, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Mauren Abreu de Souza
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná (PUC-PR), Imaculada Conceição St., 1155, Curitiba, Paraná, 80215-901, Brazil
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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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Lurie B, Albanese J, Allenback G, Elliott I, Nelson K. Small Glove Size and Female Gender Are Associated with Greater Reported Difficulty Using Orthopaedic Instruments Among Residents. JB JS Open Access 2024; 9:e23.00151. [PMID: 38779173 PMCID: PMC11108343 DOI: 10.2106/jbjs.oa.23.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Introduction Smaller hand size has been shown to affect ease of instrument use and surgeon injury rates in multiple surgical subspecialties. Women have a smaller average hand size and are more often affected by this issue than men. The goal of this resident survey was to investigate whether hand size and gender impact self-reported difficulty with instrument use among orthopaedic surgery residents. Methods Residents were surveyed about how often they experience difficulty using common orthopaedic instruments. Self-reported difficulty using surgical instruments was compared between residents with small glove (SG, outer ≤7.0) vs. large glove (LG, ≥ 7.5) sizes and between male and female residents. Results One hundred forty-five residents (118 males and 27 females) completed the survey for a response rate of 3.7%. The SG group contained 35 residents, with 26 females and 9 males. The LG group contained 110 residents, with 1 female and 109 males. The SG group reported more difficulty than the LG group when using 3/6 instruments: the wire-cutting pliers (71.4% vs. 25.5%), universal T-handle chuck (65.7% vs. 21.4%), and large wire driver (60.0% vs. 24.8%). Female residents reported more difficulty than males for 5/6 instruments. Within the SG group, however, there was no difference in self-reported difficulty between female SG and male SG residents for 4/6 instruments. Conclusions The predominantly male LG group reported significantly less difficulty than the more gender mixed though still predominantly female SG group. A subanalysis comparing males and females within the SG group found that there was no difference between SG female and SG male residents for 4/6 of the instruments, suggesting that glove size might impact reported difficulty independently from gender. Although the effect of glove size vs. gender is difficult to differentiate in this study, the high rate of difficulty experienced by male and female residents in the SG group should be considered by residency programs, surgeon educators, and instrument manufacturers as the field of orthopaedic surgery continues to become more diverse. Level of Evidence III.
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Affiliation(s)
- Benjamin Lurie
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jessica Albanese
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Gayle Allenback
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Iain Elliott
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Karen Nelson
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
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11
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Smith MR, Buote NJ, Sumner JP, Freeman LJ. Variables affecting surgeons' use of, and preferences for, instrumentation in veterinary laparoscopy. Vet Surg 2024; 53:513-523. [PMID: 37485785 DOI: 10.1111/vsu.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 05/16/2023] [Accepted: 06/25/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To investigate the impact of variables on use and preference of common laparoscopic instruments. STUDY DESIGN Online survey. SAMPLE POPULATION Surgeons (n = 140) with 3 years or more laparoscopic experience. METHODS Electronic survey distributed via specialty group LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, preferences, and surgical practice data. Statistical analysis was performed using Fishers exact, ANOVA, Tukey Kramer honestly significant difference (HSD) test, linear regression, and logistic regression. RESULTS Ninety-eight of 140 respondents answered instrument-related questions and the completion rate of these questions was 76%: 48% of females and 49% of males responded to the survey. The median glove size of respondents was size 7 (range, 5.5 to 8.5). Closing laparoscopic Babcock forceps (p = .018), rotating cup biopsy forceps (p = .003), and manipulating endoscopic staplers (p < .001) were more difficult for surgeons with smaller glove sizes. The median difficulty score for the endoscopic stapler was 4/10 and the median percentage of time this was found difficult was 25%. Reusable instruments were preferred over disposable single-use instruments. The pistol grip was preferred for grasping and retracting (54/98, 55%) and fine dissection (46/96, 48%), while the axial grip was preferred for suturing and knot tying (61/98, 62%). CONCLUSION Surgeons with smaller glove sizes (<6.5) experience more difficulty when using common laparoscopic instruments. The endoscopic stapler was the most difficult to use. CLINICAL SIGNIFICANCE When purchasing laparoscopic instrumentation, surgeons should review all available options in handle size and design to improve ergonomics during minimally invasive procedures.
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Affiliation(s)
- Meghan R Smith
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Nicole J Buote
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Julia P Sumner
- Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Lynetta J Freeman
- Emeritus Professor, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
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12
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Bonsch R, Seibt R, Krämer B, Rieger MA, Steinhilber B, Luger T. Influence of Intraoperative Active and Passive Breaks in Simulated Minimally Invasive Procedures on Surgeons' Perceived Discomfort, Performance, and Workload. Life (Basel) 2024; 14:426. [PMID: 38672698 PMCID: PMC11051257 DOI: 10.3390/life14040426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Laparoscopic surgeons are at high risk of experiencing musculoskeletal discomfort, which is considered the result of long-lasting static and awkward body postures. We primarily aimed to evaluate whether passive and active work breaks can reduce ratings of perceived discomfort among laparoscopic surgeons compared with no work breaks. We secondarily aimed to examine potential differences in performance and workload across work break conditions and requested the surgeons evaluate working with passive or active work breaks. Following a balanced, randomized cross-over design, laparoscopic surgeons performed three 90 min laparoscopic simulations without and with 2.5 min passive or active work breaks after 30 min work blocks on separate days. The simulation included the following tasks: a hot wire, peg transfer, pick-and-place, pick-and-tighten, pick-and-thread, and pull-and-stick tasks. Ratings of perceived discomfort (CR10 Borg Scale), performance per subtask, and perceived workload (NASA-TLX) were recorded, and the break interventions were evaluated (self-developed questionnaire). Statistical analyses were performed on the rating of perceived discomfort and a selection of the performance outcomes. Twenty-one participants (9F) were included, with a mean age of 36.6 years (SD 9.7) and an average experience in laparoscopies of 8.5 years (SD 5.6). Ratings of perceived musculoskeletal discomfort slightly increased over time from a mean level of 0.1 to 0.9 but did not statistically significantly differ between conditions (p = 0.439). Performance outcomes of the hot wire and peg transfer tasks did not statistically significantly differ between conditions. The overall evaluation by the participants was slightly in favor regarding the duration and content of active breaks and showed a 65% likelihood of implementing them on their own initiative in ≥90 min-lasting laparoscopic surgeries, compared with passive breaks. Both passive and active breaks did not statistically significantly influence ratings of perceived discomfort or perceived workload in a 90 min simulation of laparoscopic surgery, with an overall low mean level of perceived discomfort of 0.9 (SD 1.4). As work breaks do not lead to performance losses, rest breaks should be tested in real-life situations across a complete working shift, where perceived discomfort may differ from this laboratory situation. However, in this respect, it is crucial to investigate the acceptance and practicality of intraoperative work breaks in feasibility studies in advance of assessing their effectiveness in follow-up longitudinal trials.
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Affiliation(s)
- Rosina Bonsch
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
- Clinic for Hand, Plastic, Reconstructive and Burn Surgery, BG Clinic Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Bernhard Krämer
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
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13
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Amirthanayagam A, O'Neill S, Goss C, Moss EL. Physical and psychological impact of surgery on the operating surgeon. Int J Gynecol Cancer 2024; 34:459-467. [PMID: 38438178 DOI: 10.1136/ijgc-2023-004594] [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: 03/06/2024] Open
Abstract
The impact of surgery on the surgeon's well-being encompasses both physical and psychological aspects. Physically, surgeons are at risk of work-related musculoskeletal symptoms due to the nature of their work, and this risk can be impacted by theater environment, equipment design, and workload. Many symptoms will be self-limiting, but work related musculoskeletal symptoms can lead to the development of an injury, which can have far reaching effects, including the need for medical or surgical treatment, time away from work, or a change in clinical duties. Additionally, surgery can place a significant cognitive workload on the lead operator and this can be exacerbated, or alleviated, by the surgical environment, experience of the assistance, surgical modality, and case complexity. Measuring and quantifying the impact of surgery on the surgeon is a challenging undertaking. Tools such as motion capture, physiological markers, including heart rate variability and salivary cortisol, and questionnaires can provide insights into understanding the overall impact of surgery on the surgeon. A holistic approach that incorporates injury prevention strategies, communication, and support, is vital in assessing and mitigating risk factors. Injury prevention assessment tools and interventions that can be used within the busy surgical environment are needed, alongside increased ergonomic awareness. Addressing the impact of surgery on the surgeon is a multifaceted challenge, and long term positive changes can only be sustained with the support of the whole surgical team and healthcare organizations by developing and maintaining a supportive working environment.
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Affiliation(s)
| | - Seth O'Neill
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Charles Goss
- Department of Occupational Health, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Esther L Moss
- College of Life Sciences, University of Leicester, Leicester, UK
- Department of Gynaecological Oncology, University of Leicester, Leicester, UK
- Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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14
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Hilt L, Sherman B, Tan WH, Lak K, Gould JC, Kindel TL, Higgins RM. Bariatric Surgeon Ergonomics: A Comparison of Laparoscopy and Robotics. J Surg Res 2024; 295:864-873. [PMID: 37968140 DOI: 10.1016/j.jss.2023.08.045] [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: 02/28/2023] [Revised: 07/24/2023] [Accepted: 08/27/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Bariatric surgery is routinely performed using laparoscopic and robotic approaches. Musculoskeletal injuries are prevalent among both robotic and laparoscopic bariatric surgeons. Studies evaluating ergonomic differences between laparoscopic and robotic bariatric surgery are limited. This study aims to analyze the ergonomic, physical, and mental workload differences among surgeons performing robotic and laparoscopic bariatric surgery. MATERIALS AND METHODS All primary laparoscopic and robotic bariatric surgeries, Roux-en-Y gastric bypass, and sleeve gastrectomy between May and August 2022 were included in this study. Objective ergonomic analysis was performed by an observer evaluating each surgeon intraoperatively according to the validated Rapid Entire Body Assessment tool, with a higher score indicating more ergonomic strain. After each operation, surgeons subjectively evaluated their physical workload using the body part discomfort scale, and their mental workload using the surgery task load index. RESULTS Five bariatric surgeons participated in this study. In total, 50 operative cases were observed, 37 laparoscopic and 13 robotic. The median total Rapid Entire Body Assessmentscore as a primary surgeon was significantly higher in laparoscopic (6.0) compared to robotic (3.0) cases (P < 0.01). The laparoscopic and robotic approaches had no significant differences in the surgeons' physical (body part discomfort scale) or mental workload (surgery task load index). CONCLUSIONS This study identified low-risk ergonomic stress in surgeons performing bariatric surgery robotically compared to medium-risk stress laparoscopically. Since ergonomic stress can exist even without the perception of physical or mental stress, this highlights the importance of external observations to optimize ergonomics for surgeons in the operating room.
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Affiliation(s)
- Lauren Hilt
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brianne Sherman
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wen Hui Tan
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen Lak
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tammy L Kindel
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rana M Higgins
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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15
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Morse E, Tai K, Harpel L, Born H, Krishna P, Rameau A. Female Surgical Ergonomics in Otolaryngology: A National Survey Study. Otolaryngol Head Neck Surg 2024; 170:788-794. [PMID: 37890071 PMCID: PMC10922095 DOI: 10.1002/ohn.568] [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: 07/03/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To assess the nature and impact surgical ergonomic challenges experienced by female otolaryngologists. STUDY DESIGN National survey study. SETTING Female otolaryngology residents, fellows and attendings recruited via social media posting and email distribution. METHODS We distributed a survey study to female otolaryngologists throughout the United States. The height and glove size of participants reporting difficulties with equipment and instruments were compared to those not reporting difficulties. RESULTS Ninety-six female otolaryngologists participated in our study, comprised of 43% residents, 10% fellows, and 47% attendings. Ninety percent of participants reported difficulties using equipment and 77% of participants reported difficulty with instruments, the most common being nasal endoscopic instruments (28%). The vast majority of participants reported pain during and (or) after the operation (92%). Head and neck (53%) and rhinology (44%) were identified as particularly challenging specialities, but only 25% of participants reported that ergonomics affected their career plans. Participants felt that adjustable equipment (60%), a variety of sizes of instruments (43%), and more discussion around ergonomics (47%) would help. Respondents reported adjusting the operating room to accommodate their size took extra time (44%) and was a mental burden (39%). Participants reporting difficulties with operating room equipment were significantly shorter than those without difficulties (64 inches vs 67 inches, P = .037), and those reporting difficulties with instruments had a smaller median glove size (6 vs 6.5, P = .018). CONCLUSION Surgical ergonomics represent a challenge for female otolaryngologists, particularly those with smaller hands and shorter height. Partnering with industry, we must address the needs of an increasingly diverse workforce to ensure that all surgeons can operate effectively and comfortably.
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Affiliation(s)
- Elliot Morse
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Katherine Tai
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Lexa Harpel
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Hayley Born
- Department of Otolaryngology, Columbia University Medical Center, New York, New York, USA
| | - Priya Krishna
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, California, USA
| | - Anaïs Rameau
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
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16
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Lomanto D, Tan L, Lee S, Wijerathne S. Robotic Platform: What It Does and Does Not Offer in Hernia Surgery. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12701. [PMID: 38425788 PMCID: PMC10899468 DOI: 10.3389/jaws.2024.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Davide Lomanto
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Lydia Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sujith Wijerathne
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
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17
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Yeung TM, Larkins KM, Warrier SK, Heriot AG. The rise of robotic colorectal surgery: better for patients and better for surgeons. J Robot Surg 2024; 18:69. [PMID: 38329595 DOI: 10.1007/s11701-024-01822-z] [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: 07/27/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
Robotic colorectal surgery represents a major technological advancement in the treatment of patients with colorectal disease. Several recent randomized controlled trials comparing robotic colorectal surgery with laparoscopic surgery have demonstrated improved short-term patient outcomes in the robotic group. Whilst the primary focus of research in robotic surgery has been on patient outcomes, the robotic platform also provides unparalleled benefits for the surgeon, including improved ergonomics and surgeon comfort, with the potential to reduce occupational injuries and prolong career longevity. It is becoming clear that robotic surgical systems improve patient outcomes and may provide significant benefits to the surgical workforce.
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Affiliation(s)
- Trevor M Yeung
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia.
- Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Kirsten M Larkins
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - Satish K Warrier
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - Alexander G Heriot
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
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18
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Bosco JA, Papalia A, Zuckerman JD. Surgery and the Aging Orthopaedic Surgeon. J Bone Joint Surg Am 2024; 106:241-246. [PMID: 38127852 DOI: 10.2106/jbjs.23.00653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
➤ Aging is associated with well-documented neurocognitive and psychomotor changes.➤ These changes can be expected to impact the skill with which orthopaedic surgeons continue to perform surgical procedures.➤ Currently, there is no standardized approach for assessing the changes in surgical skills and clinical judgment that may occur with aging.➤ Oversight by the U.S. Equal Employment Opportunity Commission, the impact of the Age Discrimination in Employment Act, and the current legal climate make it difficult to institute a mandatory assessment program.➤ The regularly scheduled credentialing process that occurs at each institution can be the most effective time to assess for these changes because it utilizes an established process that occurs at regularly scheduled intervals.➤ Each department of orthopaedic surgery and institution should determine an approach that can be utilized when there is concern that a surgeon's surgical skills have shown signs of deterioration.
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Affiliation(s)
- Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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19
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Basager A, Williams Q, Hanneke R, Sanaka A, Weinreich HM. Musculoskeletal disorders and discomfort for female surgeons or surgeons with small hand size when using hand-held surgical instruments: a systematic review. Syst Rev 2024; 13:57. [PMID: 38326919 PMCID: PMC10848514 DOI: 10.1186/s13643-024-02462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WMSDs), also referred to as work-related musculoskeletal injuries (MSKIs), cause surgeons pain and discomfort. Implementing ergonomics in the operating room has helped reduce such symptoms. However, there are still many issues that surgeons face when dealing with medical instruments, especially among female surgeons or surgeons with smaller hands. METHODS The Cochrane methodology for performing a systematic review was utilized to search five databases for pertinent literature based on the study question "Do female surgeons or surgeons with smaller hand size, who use surgical instruments have an increased risk of musculoskeletal disorders and discomfort compared to male or larger handed surgeons?". The literature search strategy was designed around the three conceptual domains of surgeons/surgery, smaller hand size, and instrumentation. We searched PubMed, Embase.com, CINAHL Plus with Full Text (EBSCOhost), Scopus, and Web of Science Core Collection. This exploration identified 2165 research publications, and after specific inclusion and exclusion criteria, 19 studies were included in the systematic review. Risk of bias analysis was conducted to assess the quality of the included studies. After conducting a heterogeneity test, a meta-analysis was not performed due to high heterogeneity. RESULTS Using certain surgical instruments presents challenges in the form of MSKIs for female and smaller-handed surgeons. Studies showed that 77% of females and 73% of surgeons who wear < 6.5 glove size report musculoskeletal issues ranging from difficulty of use to pain. Difficulties using surgical instruments and reported injuries have a greater impact on surgical trainees which might deter interest in surgical fields for future proceduralists. Recommendations for improved ergonomic tool design are suggested by some of the included studies to help tackle the MSKIs that surgeons face when performing operations. CONCLUSIONS The number of female surgeons has increased substantially in the last decade. Hence, there exists an urgent need to address the major challenges they encounter by focusing on this specific aspect of workplace safety and health to mitigate injury. Doing so will yield a productive environment while simultaneously protecting the health and safety of both surgeons and patients. SYSTEMATIC REVIEW REGISTRATION The study protocol was registered on PROSPERO (ID: CRD42022283378).
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Affiliation(s)
- Ahmed Basager
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, 842 West Taylor Street, Chicago, IL, 60607, USA.
- Department of Industrial Engineering, University of Jeddah, Jeddah, Saudi Arabia.
| | - Quintin Williams
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, 842 West Taylor Street, Chicago, IL, 60607, USA
| | - Rosie Hanneke
- Library of the Health Sciences-Chicago, University of Illinois at Chicago, 1750 W. Polk St, Chicago, IL, 60612, USA
| | - Aishwarya Sanaka
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, 842 West Taylor Street, Chicago, IL, 60607, USA
| | - Heather M Weinreich
- Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, 1009 S. Wood St, Chicago, IL, 60612, USA
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20
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Liu S, Li YY, Li D, Wang FY, Fan LJ, Zhou LX. Advances in objective assessment of ergonomics in endoscopic surgery: a review. Front Public Health 2024; 11:1281194. [PMID: 38249363 PMCID: PMC10796503 DOI: 10.3389/fpubh.2023.1281194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Background Minimally invasive surgery, in particular endoscopic surgery, has revolutionized the benefits for patients, but poses greater challenges for surgeons in terms of ergonomics. Integrating ergonomic assessments and interventions into the multi-stage endoscopic procedure contributes to the surgeon's musculoskeletal health and the patient's intraoperative safety and postoperative recovery. Objective The purpose of this study was to overview the objective assessment techniques, tools and assessment settings involved in endoscopic procedures over the past decade and to identify the potential factors that induce differences in high workloads in endoscopic procedures and ultimately to design a framework for ergonomic assessment in endoscopic surgery. Methods Literature searches were systematically conducted in the OVID, pubmed and web of science database before October 2022, and studies evaluating ergonomics during the process of endoscopic procedures or simulated procedures were both recognized. Results Our systematic review of 56 studies underscores ergonomic variations in endoscopic surgery. While endoscopic procedures, predominantly laparoscopy, typically incur less physical load than open surgery, extended surgical durations notably elevate ergonomic risks. Surgeon characteristics, such as experience level and gender, significantly influence these risks, with less experienced and female surgeons facing greater challenges. Key assessment tools employed include electromyography for muscle fatigue and motion analysis for postural evaluation. Conclusion This review aims to provide a comprehensive analysis and framework of objective ergonomic assessments in endoscopic surgery, and suggesting avenues for future research and intervention strategies. By improving the ergonomic conditions for surgeons, we can enhance their overall health, mitigate the risk of WMSDs, and ultimately improve patient outcomes.
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Affiliation(s)
- Shuang Liu
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yuan-you Li
- Department of neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Dan Li
- College of Computer Science, Sichuan University, Chengdu, China
| | - Feng-Yi Wang
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Ling-Jie Fan
- Department of rehabilitation medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Liang-xue Zhou
- Department of neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- The Fifth People’s hospital of Ningxia, Ningxia, China
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21
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Shah M, Gross K, Wang C, Kurlansky P, Krishnamoorthy S. Working Through the Pain: A Cross-Sectional Survey on Musculoskeletal Pain Among Surgeons and Residents. J Surg Res 2024; 293:335-340. [PMID: 37806219 DOI: 10.1016/j.jss.2023.08.021] [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: 03/09/2023] [Revised: 07/16/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION While prior studies have reported that over 80% of surgeons report musculoskeletal pain, to our knowledge, the degree of care required to manage these symptoms has not been discussed. Here, we present granular data on musculoskeletal treatment modalities used by surgeons and residents at a single institution. METHODS We distributed a survey to assess the prevalence of musculoskeletal pain and treatment utilization to surgery attending and residents at a single institution. RESULTS Fifty-five out of 115 residents and attending (47.8%) responded to our survey. Among the respondents, 87.3% reported pain within the past week and 76.4% (42/55) of respondents required treatment for musculoskeletal pain and injuries: 63.6% had taken over the counter pain medication, 10.9% had taken prescription pain medication, 25.5% required physical therapy, 14.5% required orthopedic surgery, 23.6% made an appointment with a specialist, and 21.8% required additional testing (i.e., imaging, labs). Interestingly, treatment utilization overall and by modality was similar between residents and attending surgeons. CONCLUSIONS Our study mirrors the high prevalence of musculoskeletal pain in surgeons that has been previously reported in the literature. Among survey respondents, 76.5% of surgeons and 76.2% of residents required some form of treatment. These findings suggest a significant burden of musculoskeletal disorders of likely multifactorial etiologies including operating room ergonomics. Therefore, comprehensive ergonomics programs to measure, prevent, and treat musculoskeletal injury may help to fulfill a compelling need to ensure health and career longevity of the surgical workforce.
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Affiliation(s)
- Meghal Shah
- Department of Surgery, Columbia University, New York, New York.
| | - Karlie Gross
- Columbia University Programs in Physical Therapy, New York, New York
| | - Chunhui Wang
- Data Science Institute, Columbia University, New York, New York
| | - Paul Kurlansky
- Department of Surgery, Columbia University, New York, New York; Data Science Institute, Columbia University, New York, New York
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22
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Lobo D, Sancibrian R, Mesones A, Llata JR, Williams M, Viera-Artiles J. Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery. Laryngoscope 2024; 134:79-86. [PMID: 37255028 DOI: 10.1002/lary.30790] [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: 12/21/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The main objective of this study was to develop and evaluate the feasibility and effectiveness of a novel exoskeleton system designed to provide ergonomic assistance to surgeons while preserving or improving the quality of endoscopic sinus and skull base surgical procedures. METHODS To evaluate the functionality and ergonomic characteristics of the device, five experiments were conducted in different and increasingly realistic scenarios: silicone model of the nasal cavity, freshly frozen cadavers and finally in a real surgery. Each volunteer's task was recorded and timed. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) rating scale was used to estimate the surgeons' workload while performing the tasks. RESULTS Twenty-five volunteers took part in the experiments. Volunteers perceived more comfort and less fatigue and pain when using the armrest than when not using the device (3.3, SD 1.75 vs. 5.9 SD 1.49; p = 0.02). Participants found the device intuitive, comfortable, and improving accuracy and stability with endoscope use. CONCLUSION A new system that provides ergonomic assistance to surgeons was tested in simulation surgery with acceptable usability. Initial results in terms of pain and fatigue reduction and efficiency were excellent, justifying further research into this technology. LEVEL OF EVIDENCE NA Laryngoscope, 134:79-86, 2024.
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Affiliation(s)
- David Lobo
- Otolaryngology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Valdecilla Biomedical Research Institute, Santander, Spain
| | - Ramon Sancibrian
- Department of Structural and Mechanical Engineering, Universidad de Cantabria, Santander, Spain
| | - Angela Mesones
- Department of Structural and Mechanical Engineering, Universidad de Cantabria, Santander, Spain
| | - José Ramón Llata
- Department of Electronic Technology, Systems Engineering and Automatic Control, Universidad de Cantabria, Santander, Spain
| | - Monica Williams
- Anaesthesiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jaime Viera-Artiles
- Otolaryngology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
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Koo YE, Allen C, Ballantyne A, Yassaie E. Androcentric bias in surgical equipment - What challenges do women face? Am J Surg 2024; 227:106-110. [PMID: 37805302 DOI: 10.1016/j.amjsurg.2023.09.049] [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: 06/29/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Increasing diversity amongst surgeons results in a wide range of sizes and strengths. There are many types of biases affecting women surgeons. This study evaluates what challenges women surgeons may have with surgical equipment. METHODS An online survey was distributed to Women in Surgery social media groups in North America and Australasia between April 2022-July 2022. RESULTS There were 480 respondents across the range of specialties. 453 surgeons were included. Median glove size was 6.5. Difficulty with use of surgical instruments due to size was reported by 89% of surgeons and 71% reported difficulty due to the required grip strength. One hundred and twelve different tools were reported to be problematic. CONCLUSIONS This study highlights a potential source of androcentric bias which could be addressed to improve equity for women surgeons.
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Affiliation(s)
- Young Eun Koo
- Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Charlotte Allen
- Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Angela Ballantyne
- Department of Primary Health Care and General Practice, University of Otago, New Zealand
| | - Emily Yassaie
- Wellington Regional Plastic, Maxillofacial and Burns Unit, New Zealand.
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Norasi H, Hallbeck MS, Elli EF, Tollefson MK, Harold KL, Pak R. Impact of preferred surgical modality on surgeon wellness: a survey of workload, physical pain/discomfort, and neuromusculoskeletal disorders. Surg Endosc 2023; 37:9244-9254. [PMID: 37872425 PMCID: PMC10709269 DOI: 10.1007/s00464-023-10485-0] [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: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND We compared surgeons' workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems). METHODS An electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions including: (I) Demographics and anthropometrics; (II) The percentage of the procedural time that the surgeon spent on performing each surgical modality; (III) Physical and mental demand and physical discomfort; (IV) Neuromusculoskeletal symptoms including body part pain and NMSDs. RESULTS Seventy-nine out of 245 surgeons completed the survey (32.2%) and 65 surgeons (82.2%) had a dominant surgical modality: 10 endoscopic, 15 laparoscopic, 26 open, and 14 robotic surgeons. Physical demand was the highest for open surgery and the lowest for endoscopic and robotic surgeries, (all p < 0.05). Open and robotic surgeries required the highest levels of mental workload followed by laparoscopic and endoscopic surgeries, respectively (all p < 0.05 except for the difference between robotic and laparoscopic that was not significant). Body part discomfort or pain (immediately after surgery) were lower in the shoulder for robotic surgeons compared to laparoscopic and open surgeons and in left fingers for robotic surgeons compared to endoscopic surgeons (all p < 0.05). The prevalence of NMSD was significantly lower in robotic surgeons (7%) compared to the other surgical modalities (between 60 and 67%) (all p < 0.05). CONCLUSIONS The distribution of NMSDs, workload, and physical discomfort varied significantly based on preferred surgical approach. Although robotic surgeons had fewer overall complaints, improvement in ergonomics of surgery are still warranted.
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Affiliation(s)
- Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew K Tollefson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Raymond Pak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Chávez-Saavedra G, Espinosa-Hinojosa A, Colonna-Márquez LE, Hidalgo-Valadez C, Díaz-Martínez DA, González-Sandoval BV. Surgical fatigue syndrome and EDiS3 intervention, should every surgeon need to know how to mitigate muscle skeletal discomfort? Surg Open Sci 2023; 16:184-191. [PMID: 38035222 PMCID: PMC10684824 DOI: 10.1016/j.sopen.2023.10.014] [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: 06/20/2023] [Revised: 10/03/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
Background Surgical fatigue syndrome (SFS) is a frequent, but underestimated, entity that occurs during laparoscopic surgeries. It could impair surgical outcomes, patient safety, and surgeon health. Furthermore, current surgical education lacks effective interventions to avoid it. Discomfort represents the most common manifestation and includes musculoskeletal fatigue, numbness, or frank pain. The most common affected sites are the back neck, dominant hand shoulder, and high or low back. We propose an integral intervention (surgeon posture, instruments/devices design & use and discomfort improvement) that prevents or mitigates SFS. Methods An experimental study was conducted on 57 general surgery residents and general surgeons. Participants in the experimental and control group executed standardized laparoscopic knots in a simulator and knowledge, body discomfort, and posture/ergonomic risk was evaluated before and after intervention application. Results A statistically significant decrease in discomfort intensity was found in the experimental group. Also, discomfort presentation by the anatomic site diminishes and surgical performance improves. Conclusions Intervention prevents or mitigates discomfort associated with muscle-skeletal component of SFS. ACGME competency Practice Based-Learning and Improvement.
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Affiliation(s)
- Gerardo Chávez-Saavedra
- Medicine and Nutrition Department, University of Guanajuato, Av. Puente del Millenio 1001 Fracc, San Carlos León, Guanajuato 37670, Mexico
| | - Angélica Espinosa-Hinojosa
- Regional General Hospital "María Ignacia Gandulfo”, Novena Calle Sur Oriente 11 Barrio, San Sebastián, Comitán de Domínguez, Chiapas 30029, Mexico
| | - Luis Enrique Colonna-Márquez
- Regional General Hospital 58, Mexican Institute of Social Security, Blvd. Juan Alonso de Torres Pte. 2125, San Miguel, 37268 León, Guanajuato, Mexico
| | - Carlos Hidalgo-Valadez
- Medicine and Nutrition Department, University of Guanajuato, Av. Puente del Millenio 1001 Fracc, San Carlos León, Guanajuato 37670, Mexico
| | - Daniel Alberto Díaz-Martínez
- Instituto de Salud Pública del Estado de Guanajuato. Tamazuca No. 4 Zona Centro, Guanajuato, Guanajuato. CP 36000
| | - Beatriz Verónica González-Sandoval
- Medicine and Nutrition Department, University of Guanajuato, Av. Puente del Millenio 1001 Fracc, San Carlos León, Guanajuato 37670, Mexico
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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 2023:S0002-9610(23)00589-5. [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] [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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Villarreal RT, Kim SY, Yu D. Worker and work-related factors influence on musculoskeletal symptoms among veterinary surgeons. ERGONOMICS 2023:1-16. [PMID: 37938127 DOI: 10.1080/00140139.2023.2280830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
Worker and work-related musculoskeletal symptoms are prevalent among surgeons operating on human patients. Despite incidence rates for accidents among veterinarians and their staff being 2.9 times higher than that of general practitioners of human medicine, little is known about musculoskeletal symptoms among veterinary surgeons. In this study, 212 board-certified members of the American College of Veterinary Surgeons responded to a survey regarding various work-related activities and their experience with musculoskeletal symptoms in 10 different body regions. Across all body regions, reported pain increased from before to after a typical day of surgery (p <.01). Gender, weight, age, and years performing surgery were worker factors that were related to pain (p <.05), while number of procedures, practice focus, and proportion of minimally invasive surgery were work factors related to pain (p <.05). Our findings suggest that musculoskeletal symptoms are prevalent among veterinary surgeons and may help provide evidence for guidelines for minimising musculoskeletal injuries in veterinary surgery.Practitioner summary: Little is known about the risk factors for musculoskeletal symptoms (MSS) among veterinary surgeons. This cross-sectional survey of veterinary surgeons investigates worker and work factors related to MSS. We show that MSS are prevalent and identify key factors providing evidence that MSS are a concern in veterinary surgery.
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Affiliation(s)
| | - Sun Young Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
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28
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Dixon F, Vitish-Sharma P, Khanna A, Keeler BD. Work-related musculoskeletal pain and discomfort in laparoscopic surgeons: an international multispecialty survey. Ann R Coll Surg Engl 2023; 105:734-738. [PMID: 37128858 PMCID: PMC10618035 DOI: 10.1308/rcsann.2023.0024] [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: 05/03/2023] Open
Abstract
INTRODUCTION As laparoscopic surgery is used more widely across the globe and within multiple surgical specialties the potential impact on surgeons is yet to be fully quantified. Maintenance of uncomfortable body positions may lead to work-related musculoskeletal disorders (WMSD) in surgeons, with potential knock-on effects. METHODS An international open online survey of multispecialty laparoscopic surgeons was carried out, designed and reported in accordance with the CHERRIES checklist for internet e-survey research. There was no paid advertising and no incentives offered. RESULTS A total of 259 surgeons from 9 specialties and 32 countries answered the survey, with 90% reporting pain attributable to performing laparoscopic surgery. All training grades were represented. Longer average operative duration and a greater number of years in practice were both associated with a significantly higher prevalence of pain. Surgeons with a pre-existing injury were significantly more likely to report pain than those without. Twenty per cent of surgeons would consider early retirement owing to pain. CONCLUSIONS The impact on surgeons of performing laparoscopic surgery is significant, even given the limitations of an open survey. Innovations such as robotic surgery and improved ergonomic education may reduce the incidence of WMSD in surgeons, to mitigate both the personal effects on surgeons and the wider effect on the future surgical workforce.
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Affiliation(s)
- F Dixon
- Milton Keynes University Hospital NHS Foundation Trust, UK
| | | | - A Khanna
- Milton Keynes University Hospital NHS Foundation Trust, UK
| | - B D Keeler
- Milton Keynes University Hospital NHS Foundation Trust, UK
- University of Buckingham, UK
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29
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Maskal S, Beffa L. The Role of Robotics in Abdominal Wall Reconstruction. Surg Clin North Am 2023; 103:977-991. [PMID: 37709400 DOI: 10.1016/j.suc.2023.04.007] [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: 09/16/2023]
Abstract
Robotic abdominal wall reconstruction is becoming an accepted technique to approach complex hernias in a minimally invasive fashion. There remain a deficit of high-quality data to suggest significant clinical benefit but current randomized trials are ongoing. Robotic surgery can be applied to a range of abdominal wall defects safely and with positive outcomes which are at least equivocal to open abdominal wall techniques.
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Affiliation(s)
- Sara Maskal
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lucas Beffa
- Lerner College of Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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30
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Green SV, Morris DE, Naumann DN, Rhodes HL, Burns JK, Roberts R, Lang AR, Morris L. One size does not fit all: Impact of hand size on ease of use of instruments for minimally invasive surgery. Surgeon 2023; 21:267-272. [PMID: 36513570 DOI: 10.1016/j.surge.2022.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Consideration of ergonomic factors is important for the practice of safe and efficient minimally invasive surgery (MIS). Surgeons with smaller glove sizes have previously been reported to have increased difficulties with some minimally invasive instruments. We aim to investigate hand anthropometrics and their relationship to surgeon comfort when using MIS instruments. METHODS Male and female surgeons from two centres were surveyed on their experience of handling MIS instruments and images obtained of the dorsal and palmar aspects of their dominant hand. Photographs of hands were transformed to calibrated coordinates to enable anthropometric measurements of finger length and width as well as palm width and hand span photogrammetrically. Surgeon-perceived discomfort, fatigue, pressure points and techniques to mitigate difficulty handling instruments were compared to hand measurements. RESULTS Questionnaires were completed by 58 surgeons; 20 (34%) were consultants, 17 (29%) were women. Glove size ranged from 6 to 8 (median 7.5). Male participants had significantly larger hands than females in all measured dimensions. Female surgeons and those with smaller finger and hand dimensions were significantly more likely to experience difficulty or discomfort across a range of variables when using MIS instruments. CONCLUSIONS Surgeons with smaller hands reported increased problems handling MIS instruments. This represents an issue of equity in surgery, with women being more significantly affected than men. Hand size varies greatly between surgeons and anthropometric variability should be considered in design of MIS instruments.
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Affiliation(s)
- Sophie V Green
- Department of Paediatric Surgery, Nottingham University Hospitals, Nottingham, UK
| | - David E Morris
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK.
| | - David N Naumann
- East Midlands Major Trauma Centre, Nottingham University Hospitals, Nottingham, UK
| | - Hannah L Rhodes
- Department of Paediatric Surgery, Bristol Children's Hospital, Bristol, UK
| | - J Kate Burns
- Department of Paediatric Surgery, Bristol Children's Hospital, Bristol, UK
| | - Rebecca Roberts
- Department of Paediatric Surgery, Bristol Children's Hospital, Bristol, UK
| | - Alexandra R Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Louise Morris
- East Midlands Major Trauma Centre, Nottingham University Hospitals, Nottingham, UK
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Liu J, Qiao X, Xiao Y, Deng Z, Cui J, Wu M, Zhang H, Ran K, Luo H, Tang B. Physical and mental health impairments experienced by operating surgeons and camera-holder assistants during laparoscopic surgery: a cross-sectional survey. Front Public Health 2023; 11:1264642. [PMID: 37744484 PMCID: PMC10512950 DOI: 10.3389/fpubh.2023.1264642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Surgeons may experience physical and mental health problems because of their jobs, which may lead to chronic muscle damage, burnout, or even withdrawal. However, these are often ignored in camera-holder assistants during laparoscopic surgery. We aimed to analyze the differences between operating surgeons and camera-holder assistants. Methods From January 1, 2022, to December 31, 2022, a cross-sectional survey was conducted to evaluate the muscle pain, fatigue, verbal scolding, and task load for operating surgeons and camera-holder assistants. The Nordic Musculoskeletal Questionnaire, the Space Administration Task Load Index, and the Surgical Task Load Index (SURG-TLX) were combined in the questionnaire. Results 2,184 operations were performed by a total of 94 operating surgeons and 220 camera assistants. 81% of operating surgeons and 78% of camera-holder assistants reported muscle pain/discomfort during the procedure. The most affected anatomic region was the shoulders for operating surgeons, and the lower back for camera-holder assistants. Intraoperative fatigue was reported by 41.7% of operating surgeons and 51.7% of camera-holder assistants. 55.2% of camera-holder assistants reported verbal scolding from the operating surgeons, primarily attributed to lapses in laparoscope movement coordination. The SURG-TLX results showed that the distributions of mental, physical, and situational stress for operating surgeons and camera-holder assistants were comparable. Conclusion Like operating surgeons, camera-holder assistants also face similar physical and mental health impairments while performing laparoscopic surgery. Improvements to the working conditions of the camera-holder assistant should not be overlooked.
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Affiliation(s)
- Junjie Liu
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Qiao
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Municipality Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Yi Xiao
- Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuofan Deng
- Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ji Cui
- Obstetrics & Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingdong Wu
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haolong Zhang
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Ran
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hailong Luo
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Tang
- Hernia and Abdominal Wall Surgery, The Fourth Clinical College of Chongqing Medical University, Chongqing, China
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Vörös V, De Smet J, Ourak M, Poliakov V, Deprest J, Kimpe T, Vander Poorten E. Comparison of 2D and autostereoscopic 3D visualization during mixed reality simulation. Int J Comput Assist Radiol Surg 2023; 18:1679-1686. [PMID: 36995512 DOI: 10.1007/s11548-023-02876-4] [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: 01/11/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE In general minimally invasive surgical procedures, surgeons are tied to 2D visualization, leading to the loss of depth perception. This can lead to large mental load for the surgeons and may be responsible for the long learning curve. To restore the sense of depth, this study investigated the use and benefits of an autostereoscopic (3D) display during a simulated laparoscopic task. METHODS A mixed reality simulator was developed for comparing the performance of participants while using 2D and autostereoscopic 3D visualization. An electromagnetic sensor was mounted on a physical instrument, and its pose was mapped to the virtual instrument. The virtual scene was developed using Simulation Open Framework Architecture (SOFA). Finite element modeling was used to calculate interaction forces, which were then mapped to visual soft tissue deformation. RESULTS Ten non-expert participants completed a virtual laparoscopic task, where the subjects were asked to contact eighteen target areas distributed on the surface of the vagina, both in 2D and 3D. Results showed an improvement with 3D vision in task completion time (-16%), total traveled distance (-25%) and errors made (-14%). There was no difference in the average contact forces between the vagina and the instrument. Only the difference in time and forces were shown to be statistically significant. CONCLUSION Overall, autostereoscopic 3D showed superiority over conventional 2D visualization. The traveled trajectory increased in 2D as the instrument was retracted more between the targets to avoid contact. The 2D and 3D deformation upon contact seems not to contribute differently to force perception. However, the participants only had visual feedback, but no haptic feedback. Therefore, it could be interesting to include haptic feedback in a future study.
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Affiliation(s)
- Viktor Vörös
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium.
- Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium.
| | - Jef De Smet
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Vladimir Poliakov
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Tom Kimpe
- Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium
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Hosoya K, Maeda Y, Komachi T, Sato K, Okubo K. AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery. Braz J Otorhinolaryngol 2023; 89:101292. [PMID: 37579570 PMCID: PMC10448402 DOI: 10.1016/j.bjorl.2023.101292] [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: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE After Endoscopic Sinus Surgery (ESS), packing plays an important role in wound healing and hemostasis. However, the effect of the packing removal procedure on physician stress has not been evaluated. The purpose of this study was to evaluate physician stress during packing removal for patients treated with AQUACEL® Ag Advantage versus KALTOSTAT®. METHODS This retrospective study included 15 patients who underwent packing with ESS for chronic rhinosinusitis performed at two centers; 9 were treated with AQUACEL® Ag Advantage and 6 were treated with KALTOSTAT®. Physician stress during packing removal was evaluated with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). The time required to remove the packing and the number of instruments used in the procedure were recorded. Postoperative bleeding (Boezaart bleeding score) and wound healing were graded. Patient symptoms on the day after surgery and pain during packing removal were assessed using a visual analog scale. RESULTS Computed tomography scores, asthma complications, and blood eosinophil counts were significantly higher in the AQUACEL® Ag Advantage group. Patient symptoms on the day after surgery were not significantly different between the two groups. Physician stress during the task of packing removal was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (35.5 vs. 81.0, p=0.016) according to the NASA-TLX scores. The number of instruments used in the procedure was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (3.0 vs. 6.0, p=0.015). There were no significant differences in procedure time for packing removal, postoperative bleeding, wound healing, or patient pain at the time of packing removal between the groups. CONCLUSION Physicians feel stressed about packing removal. In addition, AQUACEL® Ag Advantage is useful for packing after ESS, requiring fewer instruments for the procedure than KALTOSTAT® and reducing physician stress about the procedure. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Kei Hosoya
- Musashi Kosugi Hospital, Nippon Medical School, Department of Otolaryngology, Nakahara-Ku, Kawasaki, Japan; Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan
| | - Yohei Maeda
- Japan Community Health Care Organization Osaka Hospital, Department of Otorhinolaryngology, Fukushima, Osaka, Japan; Osaka University, Department of Otorhinolaryngology-Head and Neck Surgery, Suita, Japan.
| | - Taro Komachi
- Chiba Hokusoh Hospital, Nippon Medical School, Department of Otolaryngology, Inzai, Japan
| | - Kazuki Sato
- Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan
| | - Kimihiro Okubo
- Nippon Medical School Hospital, Department of Otolaryngology, Head and Neck Surgery, Bunkyo-Ku, Tokyo, Japan
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Mathey-Andrews CA, Venkateswaran S, McCarthy ML, Potter AL, Copeland J, Panda N, Colson YL, Jeffrey Yang CF. A national survey of occupational musculoskeletal injuries in cardiothoracic surgeons. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00749-3. [PMID: 37659461 DOI: 10.1016/j.jtcvs.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE There is growing concern that surgeons are at increased risk for work-related orthopedic injuries due to poor ergonomics. We conducted a survey of North American cardiothoracic surgeons to evaluate the prevalence of occupational injury, as well as perceptions and use of ergonomic techniques. METHODS Cardiothoracic surgeons identified through the Cardiothoracic Surgery Network were asked to complete a 33-question survey assessing their musculoskeletal health, as well as their perceptions and use of ergonomic techniques in the operating room and office. RESULTS Among 600 cardiothoracic surgeons, the prevalence of occupational musculoskeletal injuries was 64%, with 30% of affected surgeons requiring time away from work and 20% requiring surgery or the use of narcotics. Cervical spine injury (35%, n = 216) was the most common injury due to operating, followed by lumbar spine injury (30%, n = 180). In multivariable-adjusted analysis, cardiac surgeons were more likely than thoracic surgeons to experience occupational musculoskeletal injuries (adjusted odds ratio, 1.8 [1.2-2.8], P < .01). Notably, 90% of surgeons (n = 536) reported thinking that their institution did not provide sufficient ergonomics education or support, and only 35% (n = 205) thought that the cardiothoracic surgical community is supportive of implementing ergonomics techniques in the operating room and office. CONCLUSIONS In this survey analysis, cardiothoracic surgeons reported experiencing work-related orthopedic injuries at an alarmingly high rate, leading to significant time away from work and for many to retire from surgery over a decade early. These findings underline a critical need for institutions to prioritize ergonomics education and implement ergonomics-directed techniques in the operating room and office.
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Affiliation(s)
| | | | - Meghan L McCarthy
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alexandra L Potter
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Jessica Copeland
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Nikhil Panda
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Yolonda L Colson
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Chi-Fu Jeffrey Yang
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
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Buddle V, Nugent R, Jack RA, DeLuca P. Orthopedists Report High Prevalence of Work-Related Pain and Low Ergonomic Awareness. Orthopedics 2023; 46:280-284. [PMID: 36853949 DOI: 10.3928/01477447-20230224-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The purpose of this study was to determine the prevalence of work-related pain among practicing orthopedic surgeons, quantify knowledge of operating room (OR) and clinic ergonomics, and examine the use of occupational health resources. A survey was distributed, which included orthopedic surgeons from four states and five institutions. Data collected included years in practice, practice setting, orthopedic subspecialty, hours operating per week, days per week exercising, location and significance of pain, occupational health awareness, and use of OR/clinic ergonomics. One hundred ten of 194 surveys (56.7%) were completed, representing all orthopedic subspecialties. Eighty-three surgeons (75.5%) experienced pain because of occupational responsibilities. The lumbar spine, neck, and shoulders were the most affected areas. Seventeen (20.5%) identified this pain as significant. Ten (12.0%) stated that the pain did subjectively affect their OR performance. Hand surgeons had a statistically significant decreased risk of musculoskeletal pain (P=.007), whereas spine surgeons had a statistically significant increased risk of musculoskeletal pain (P=.028). Forty-nine (44.5%) were not aware of any institutional resources available if an injury was sustained at work. Forty-eight (43.6%) were aware of OR ergonomics, with 34 (30.9%) taking steps to make their OR more ergonomic. The vast majority of orthopedic surgeons experience pain as a result of occupational responsibilities. A clear lack of knowledge regarding institutional resources as well as OR ergonomics implementation was identified. Education in training, at the institutional and national levels, would expand surgeon knowledge and promote surgeon health. [Orthopedics. 2023;46(5):280-284.].
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Fang C, Mo P, Chan H, Cheung J, Wong JSH, Wong TM, Mak YK, Ching K, Ho G, Leung F. Can a Wireless Full-HD Head Mounted Display System Improve Knee Arthroscopy Performance? - A Randomized Study Using a Knee Simulator. Surg Innov 2023; 30:477-485. [PMID: 36448618 PMCID: PMC10403956 DOI: 10.1177/15533506221142960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Our prototype wireless full-HD Augmented Reality Head-Mounted Display (AR-HMD) aims to eliminate surgeon head turning and reduce theater clutter. Learning and performance versus TV Monitors (TVM) is evaluated in simulated knee arthroscopy. METHODS 19 surgeons and 19 novices were randomized into either the control group (A) or intervention group (B) and tasked to perform 5 simulated loose-body retrieval procedures on a bench-top knee arthroscopy simulator. A cross-over study design was adopted whereby subjects alternated between devices during trials 1-3, deemed the "Unfamiliar" phase, and then used the same device consecutively in trials 4-5, to assess performance in a more "Familiarized" state. Measured outcomes were time-to-completion and incidence of bead drops. RESULTS In the unfamiliar phase, HMD had 67% longer mean time-to-completion than TVM (194.7 ± 152.6s vs 116.7 ± 78.7s, P < .001). Once familiarized, HMD remained inferior to TVM, with 48% longer completion times (133.8 ± 123.3s vs 90.6 ± 55s, P = .052). Cox regression revealed device type (OR = 0.526, CI 0.391-0.709, P < .001) and number of procedure repetitions (OR = 1.186, CI 1.072-1.311, P = .001) are significantly and independently related to faster time-to-completion. However, experience is not a significant factor (OR = 1.301, CI 0.971-1.741, P = .078). Bead drops were similar between the groups in both unfamiliar (HMD: 27 vs TVM: 22, P = .65) and familiarized phases (HMD: 11 vs TVM: 17, P = .97). CONCLUSION Arthroscopic procedures continue to be better performed under conventional TVM. However, similar quality levels can be reached by HMD when given more time. Given the theoretical advantages, further research into improving HMD designs is advocated.
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Affiliation(s)
- Christian Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Pinky Mo
- The University of Hong Kong, Hong Kong
| | - Holy Chan
- The University of Hong Kong, Hong Kong
| | - Jake Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Janus Siu Him Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Tak-Man Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Yan-Kit Mak
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Kathine Ching
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Grace Ho
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Tahermanesh K, Maleki M, Rezaei Moghaddam F, Nejati P, Shahriyari R, Fazel Anvari-Yazdi A, Rahnama Moghadam A, Salehiniya H, Falahatinodeh P, Allahqoli L, Alkatout I. Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study. JOURNAL OF SURGICAL EDUCATION 2023; 80:1121-1128. [PMID: 37355402 DOI: 10.1016/j.jsurg.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/24/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. METHODS In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire (NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. RESULTS One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). CONCLUSIONS This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.
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Affiliation(s)
- Kobra Tahermanesh
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Maleki
- School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | | | - Parisa Nejati
- Department of Sports and Exercise Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Shahriyari
- Department of Obstetrics and Gynecology, Bank-e-Melli Iran Hospital, Tehran, Iran
| | - Abbas Fazel Anvari-Yazdi
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Leila Allahqoli
- Midwifery department, Ministry of Health and Medical Education, Tehran, Iran.
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Gorce P, Jacquier-Bret J. Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6419. [PMID: 37510651 PMCID: PMC10379148 DOI: 10.3390/ijerph20146419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I2 statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.
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Affiliation(s)
- Philippe Gorce
- International Institute of Biomechanics and Occupational Ergonomics, ErBio, Avenue du Dr Marcel Armanet, 83400 Hyères, France
- Université de Toulon, CS60584, CEDEX 9, 83041 Toulon, France
| | - Julien Jacquier-Bret
- International Institute of Biomechanics and Occupational Ergonomics, ErBio, Avenue du Dr Marcel Armanet, 83400 Hyères, France
- Université de Toulon, CS60584, CEDEX 9, 83041 Toulon, France
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Schupper AJ, Hrabarchuk EI, McCarthy L, Hadjipanayis CG. Improving Surgeon Well-Being: Ergonomics in Neurosurgery. World Neurosurg 2023; 175:e1220-e1225. [PMID: 37427701 DOI: 10.1016/j.wneu.2023.04.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Musculoskeletal disorders are common among surgeons, and affect most neurosurgeons over the course of their career. Although all subspecialist neurosurgeons may be affected by physical strain, spine surgeons and skull base surgeons have a high propensity for workplace injury as a result of long procedures with repetitive movements in strained physical positions. METHODS In this review, the prevalence of musculoskeletal disorders in neurosurgery, the state of innovation to improve ergonomics in the operating room for neurosurgeons, and potential limitations in advancing technology with the goal of maximizing neurosurgeon longevity are discussed. RESULTS Innovations such as robotics, the exoscope, and handheld devices with more degrees of freedom have allowed surgeons to maneuver instruments without exerting excessive effort, all while maintaining neutral body positioning, avoiding joint and muscle strain. CONCLUSIONS As new technology and innovation in the operating room develop, there has been a larger emphasis placed on maximizing surgeon comfort and neutral positioning, by minimizing force exertion and fatigue.
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Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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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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Shugaba A, Subar DA, Slade K, Willett M, Abdel-Aty M, Campbell I, Heywood N, Vitone L, Sheikh A, Gill M, Zelhof B, Nuttall HE, Bampouras TM, Gaffney CJ. Surgical stress: the muscle and cognitive demands of robotic and laparoscopic surgery. ANNALS OF SURGERY OPEN 2023; 4:e284. [PMID: 37342254 PMCID: PMC7614670 DOI: 10.1097/as9.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Introduction Surgeons are among the most at-risk professionals for work-related musculoskeletal decline and experience high mental demands. This study examined the electromyographic (EMG) and electroencephalographic (EEG) activities of surgeons during surgery. Methods Surgeons who performed live laparoscopic (LS) and robotic (RS) surgeries underwent EMG and EEG measurements. Wireless EMG was used to measure muscle activation in four muscle groups bilaterally (biceps brachii, deltoid, upper trapezius, and latissimus dorsi), and an 8-channel wireless EEG device was used to measure cognitive demand. EMG and EEG recordings were completed simultaneously during (i) noncritical bowel dissection, (ii) critical vessel dissection, and (iii) dissection after vessel control. Robust ANOVA was used to compare the %MVCRMS and alpha power between LS and RS. Results Thirteen male surgeons performed 26 laparoscopic surgeries (LS) and 28 robotic surgeries (RS). Muscle activation was significantly higher in the right deltoid (p = 0.006), upper trapezius (left, p = 0.041; right, p = 0.032), and latissimus dorsi (left, p = 0.003; right, p = 0.014) muscles in the LS group. There was greater muscle activation in the right biceps than in the left biceps in both surgical modalities (both p = 0.0001). There was a significant effect of the time of surgery on the EEG activity (p <0.0001). A significantly greater cognitive demand was observed in the RS than in the LS with alpha, beta, theta, delta, and gamma (p = 0.002 - p <0.0001). Conclusion These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in robotic surgery.
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Affiliation(s)
- Abdul Shugaba
- Lancaster Medical School, Lancaster University, UK
- BRIDGES Research Group, Department of General Surgery, Royal Blackburn Teaching Hospitals NHS Trust
| | - Daren A. Subar
- East Lancashire NHS Hospitals Trust, UK
- BRIDGES Research Group, Department of General Surgery, Royal Blackburn Teaching Hospitals NHS Trust
| | - Kate Slade
- Department of Psychology, Lancaster University, UK
| | | | | | | | | | | | | | - Mike Gill
- East Lancashire NHS Hospitals Trust, UK
| | - Bachar Zelhof
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
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Lim C, Barragan JA, Farrow JM, Wachs JP, Sundaram CP, Yu D. Physiological Metrics of Surgical Difficulty and Multi-Task Requirement during Robotic Surgery Skills. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094354. [PMID: 37177557 PMCID: PMC10181544 DOI: 10.3390/s23094354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Previous studies in robotic-assisted surgery (RAS) have studied cognitive workload by modulating surgical task difficulty, and many of these studies have relied on self-reported workload measurements. However, contributors to and their effects on cognitive workload are complex and may not be sufficiently summarized by changes in task difficulty alone. This study aims to understand how multi-task requirement contributes to the prediction of cognitive load in RAS under different task difficulties. Multimodal physiological signals (EEG, eye-tracking, HRV) were collected as university students performed simulated RAS tasks consisting of two types of surgical task difficulty under three different multi-task requirement levels. EEG spectral analysis was sensitive enough to distinguish the degree of cognitive workload under both surgical conditions (surgical task difficulty/multi-task requirement). In addition, eye-tracking measurements showed differences under both conditions, but significant differences of HRV were observed in only multi-task requirement conditions. Multimodal-based neural network models have achieved up to 79% accuracy for both surgical conditions.
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Affiliation(s)
- Chiho Lim
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | | | | | - Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | | | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
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Luger T, Bonsch R, Seibt R, Krämer B, Rieger MA, Steinhilber B. Intraoperative active and passive breaks during minimally invasive surgery influence upper extremity physical strain and physical stress response-A controlled, randomized cross-over, laboratory trial. Surg Endosc 2023:10.1007/s00464-023-10042-9. [PMID: 37084097 PMCID: PMC10120511 DOI: 10.1007/s00464-023-10042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/25/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Investigate the effect of passive, active or no intra-operative work breaks on static, median and peak muscular activity, muscular fatigue, upper body postures, heart rate, and heart rate variability. BACKGROUND Although laparoscopic surgery is preferred over open surgery for the benefit of the patient, it puts the surgeons at higher risk for developing musculoskeletal disorders especially due to the less dynamic and awkward working posture. The organizational intervention intraoperative work break is a workplace strategy that has previously demonstrated positive effects in small-scale intervention studies. METHODS Twenty-one surgeons were exposed to three 90-min conditions: no breaks, 2.5-min passive (standing rest) or active (targeted stretching and mobilization exercises) breaks after 30-min work blocks. Muscular activity and fatigue of back, shoulder and forearm muscles were assessed by surface electromyography; upper body posture, i.e., spinal curvature, by inclination sensors; and heart rate and variability (HRV) by electrocardiography. Generalized estimating equations were used for statistical analyses. This study (NCT03715816) was conducted from March 2019 to October 2020. RESULTS The HRV-metric SDNN tended to be higher, but not statistically significantly, in the intervention conditions compared to the control condition. No statistically significant effects of both interventions were detected for muscular activity, joint angles or heart rate. CONCLUSION Intraoperative work breaks, whether passive or active, may counteract shoulder muscular fatigue and increase heart rate variability. This tendency may play a role in a reduced risk for developing work-related musculoskeletal disorders and acute physical stress responses.
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Affiliation(s)
- Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Rosina Bonsch
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
- Plastic, Reconstructive and Burn Surgery, Clinic for Hand, BG Clinic Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Bernhard Krämer
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
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Hamza H, Baez VM, Al-Ansari A, Becker AT, Navkar NV. User interfaces for actuated scope maneuvering in surgical systems: a scoping review. Surg Endosc 2023:10.1007/s00464-023-09981-0. [DOI: 10.1007/s00464-023-09981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
A variety of human computer interfaces are used by robotic surgical systems to control and actuate camera scopes during minimally invasive surgery. The purpose of this review is to examine the different user interfaces used in both commercial systems and research prototypes.
Methods
A comprehensive scoping review of scientific literature was conducted using PubMed and IEEE Xplore databases to identify user interfaces used in commercial products and research prototypes of robotic surgical systems and robotic scope holders. Papers related to actuated scopes with human–computer interfaces were included. Several aspects of user interfaces for scope manipulation in commercial and research systems were reviewed.
Results
Scope assistance was classified into robotic surgical systems (for multiple port, single port, and natural orifice) and robotic scope holders (for rigid, articulated, and flexible endoscopes). Benefits and drawbacks of control by different user interfaces such as foot, hand, voice, head, eye, and tool tracking were outlined. In the review, it was observed that hand control, with its familiarity and intuitiveness, is the most used interface in commercially available systems. Control by foot, head tracking, and tool tracking are increasingly used to address limitations, such as interruptions to surgical workflow, caused by using a hand interface.
Conclusion
Integrating a combination of different user interfaces for scope manipulation may provide maximum benefit for the surgeons. However, smooth transition between interfaces might pose a challenge while combining controls.
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Li S, Liu Y, Li K, Cao G, Li S, Mao Y, Wang Y, Feng J, Tang ST. Validation and effect of the NASA-TLX score on the assessment of the workload of pediatric robotic operations. Surg Endosc 2023:10.1007/s00464-023-09959-y. [PMID: 36917343 DOI: 10.1007/s00464-023-09959-y] [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: 08/29/2022] [Accepted: 02/12/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE The objective of the study was to assess the validity of the NASA-TLX score in rating the workload of pediatric robotic operations. METHODS The workload of 230 pediatric gastrointestinal and thoracic robotic operations was rated using the NASA-TLX score. The difference between the high workload group and the low workload group in each subscale of the NASA-TLX score was analyzed. The correlation of each subscale with the total workload score in the high workload group and low workload group was also analyzed. A logistic regression analysis was subsequently conducted to assess the effects of different factors (sex, age, weight, procedure duration, procedure specialties, combined malformation and blood loss) on the workload. RESULTS The average NASA-TLX score was 56.5 ± 5.1 for the total group, 56.9 ± 5.0 for the gastrointestinal group and 54.6 ± 4.8 for the thoracic group, p = 0.007. The score of the high workload group was 62.7 ± 3.2, while it was 50.6 ± 2.7 for the low workload group (p < 0.001). The score on each subscale was also significantly different between the high and low workload groups. In the high workload group, a stronger correlation was observed between the total score and TD and Fr and a lower correlation with MD and Pe. In the low workload group, all six subscales showed a moderate correlation with the total score. A multivariate logistic regression analysis revealed that the procedure duration was an independent influencing factor for a higher workload score. CONCLUSIONS NASA-TLX is a valid tool to rate the surgeon's workload in pediatric robotic surgery. A longer operative time contributes to a higher workload.
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Affiliation(s)
- Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yuan Liu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Kang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Shiwang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yongzhong Mao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yong Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jianjun Feng
- Department of Pediatric Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, China.
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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Amirthanayagam A, Zecca M, Barber S, Singh B, Moss EL. Impact of minimally invasive surgery on surgeon health (ISSUE) study: protocol of a single-arm observational study conducted in the live surgery setting. BMJ Open 2023; 13:e066765. [PMID: 36882245 PMCID: PMC10008445 DOI: 10.1136/bmjopen-2022-066765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION The rapid evolution of minimally invasive surgery has had a positive impact on patient outcomes; however, it is reported to be associated with work-related musculoskeletal symptoms (WMS) in surgeons. Currently there is no objective measure to monitor the physical and psychological impact of performing a live surgical procedure on the surgeon. METHODS AND ANALYSIS A single-arm observational study with the aim of developing a validated assessment tool to quantify the impact of surgery (open/laparoscopic/robotic-assisted) on the surgeon. Development and validation cohorts of major surgical cases of varying levels of complexity performed by consultant gynaecological and colorectal surgeons will be recruited. Recruited surgeons wear three Xsens DOT monitors (muscle activity) and an Actiheart monitor (heart rate). Salivary cortisol levels will be taken and questionnaires (WMS and State-Trait Anxiety Inventory) completed by the participants preoperatively and postoperatively. All the measures will be incorporated to produce a single score that will be called the 'S-IMPACT' score. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the East Midlands Leicester Central Research Ethics Committee REC ref 21/EM/0174. Results will be disseminated to the academic community through conference presentations and peer-reviewed journal publications. The S-IMPACT score developed within this study will be taken forward for use in definitive multicentre prospective randomised control trials.
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Affiliation(s)
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, Leicestershire, UK
- NIHR Research Design Service East Midlands, Leicester, UK
| | - Baljit Singh
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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A Call to Action for Ergonomic Surgical Devices Designed for Diverse Surgeon End Users. Obstet Gynecol 2023; 141:463-466. [PMID: 36735398 DOI: 10.1097/aog.0000000000005068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
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Ryan MT, Montgomery EA, Fryer J, Yang AW, Mills C, Watson N, Noller M, Riley CA, Tolisano AM. Ergonomics in Otolaryngology: A Systematic Review and Meta-analysis. Laryngoscope 2023; 133:467-475. [PMID: 35575629 DOI: 10.1002/lary.30216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To determine the proportion of otolaryngologists with work-related musculoskeletal discomfort (WRMD) and to review objective ergonomic data that contribute to WRMD. STUDY DESIGN Systematic review and meta-analysis. METHODS A comprehensive search of the literature identified 1121 articles for initial review of which 19 (3563 participants) met criteria for qualitative discussion and eight (2192 participants) met criteria for meta-analysis. Random effects meta-analyses were used to estimate the proportion of otolaryngologists reporting WRMD. RESULTS The overall proportion (95% confidence intervals [CI]) of general otolaryngologists reporting WRMD was 0.79 (0.66, 0.88) for any symptoms; 0.54 (0.40, 0.67) for neck symptoms; 0.33 (0.20, 0.49) for shoulder symptoms; and 0.49 (0.40, 0.59) for back symptoms. Surgeons performing primarily subspecialty cases had a lower estimated overall prevalence of WRMD versus those performing general ENT cases, however the odds ratio (OR) was not statistically significant (OR [95% confidence interval] 0.53 [0.22, 1.25]). 23%-84% of otolaryngologists underwent medical treatment for WRMD. 5%-23% took time off work and 1%-6% stopped operating completely as a result of WRMD. 23%-62.5% of otolaryngologists believed WRMD negatively impacted their quality of life. Objective measures of ergonomic posture indicate moderate to severe risk of injury during the routine clinic and surgical procedures with none found to be low risk. CONCLUSIONS Ergonomic stressors among otolaryngologists contribute to a high rate of WRMD across all subspecialties with notable impact on productivity, longevity, and quality of life. Laryngoscope, 133:467-475, 2023.
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Affiliation(s)
- Matthew T Ryan
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Emily A Montgomery
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Jacob Fryer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Alex W Yang
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Channah Mills
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Nora Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Michael Noller
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Charles A Riley
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Anthony M Tolisano
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
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Shiang A, Wang JS, Cho DH, Kushner B, Panahi AK, Awad MM. Patient Factors Affect Ergonomic Strain of Endoscopists During Colonoscopy. Dig Dis Sci 2023; 68:736-743. [PMID: 36352078 DOI: 10.1007/s10620-022-07721-3] [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: 03/08/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Endoscopic procedures place a great deal of muscular strain on providers, especially over the span of their careers. In this study we quantitatively analyzed the effects of patient factors such as age, body mass index, and sex on the ergonomics of endoscopists performing colonoscopies. METHODS Surface electromyography (sEMG) was used to measure ergonomic strain of physicians while performing colonoscopies in several key muscle groups. The percent of the maximum voluntary contraction (%MVC) was used as a measure of muscular strain. Data was then analyzed based on the patient characteristics above. RESULTS Endoscopists performing colonoscopies on female patients (n = 47) experienced significantly higher ergonomic strain in their right trapezius and right posterior forearm muscle groups when compared to colonoscopies performed on males (n = 35) (%MVC R-trapezius: Male: 8.2; Female: 8.9; p = 0.048); (%MVC R-posterior forearm: Male: 10.4; Female: 11.6; p = 0.0006). Operators experienced greater strain in the same muscle groups when performing colonoscopies on patients with BMI ≤ 25 (n = 25) when compared to patients with BMI > 25 (n = 57) (%MVC R-trapezius: BMI < 25: 9.7; BMI ≥ 25: 8.2; p = 0.0002); (%MVC R-posterior forearm: BMI < 25: 11.9; BMI ≥ 25: 10.8; p = 0.0001). CONCLUSION Physicians experienced greater ergonomic strain when performing colonoscopies on female patients and on patients with a BMI < 25. We believe that these factors potentially impact the tortuosity of the colon and therefore influence the difficulty of navigating the endoscope. These results may aid physicians in gauging the anticipated difficulty of colonoscopies based on patient factors. Increased awareness of their posturing and ergonomics during challenging cases will alleviate musculoskeletal injuries in the long run.
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Affiliation(s)
- Alexander Shiang
- Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8077, St. Louis, MO, 63110, USA.
| | - Jean S Wang
- Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8077, St. Louis, MO, 63110, USA
| | | | - Bradley Kushner
- Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8077, St. Louis, MO, 63110, USA
| | - Ali K Panahi
- Nova Southeastern University, Fort Lauderdale, USA
| | - Michael M Awad
- Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8077, St. Louis, MO, 63110, USA
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Rampp N, Sudan R. Robotic Bariatric Surgery: An Update. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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