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Olig E, Ranieri G, Louie M. Ergonomic considerations for unique surgeon populations. Curr Opin Obstet Gynecol 2024; 36:260-265. [PMID: 38837696 DOI: 10.1097/gco.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Surgeons are rapidly diversifying as a population, introducing new ergonomic challenges. This review describes the challenges that are experienced by special populations of surgeons including small-handed surgeons, pregnant surgeons, and trainees, and evidence-based solutions to overcome them. RECENT FINDINGS Small-handed and female surgeons report more musculoskeletal complaints compared with their male counterparts. Pregnant surgeons frequently report development or worsening of musculoskeletal disorders such as carpal tunnel syndrome and low back pain. Trainees also report high rates of musculoskeletal complaints with minimal autonomy to alter their environment. Limited objective data exists regarding the ideal instruments currently available for special populations. Several small, randomized studies have proposed exercise regimens targeting the upper extremities and pregnancy-related pain syndromes with improvements in symptoms. Various methods of ergonomic education have been studied in trainees with improvements in operating room posture and performance. SUMMARY Limited objective data is available to recommend specific surgical instruments for high-risk surgeon populations. Beneficial exercise regimens have been described for musculoskeletal disorders commonly plaguing surgeons but have yet to be studied explicitly in small-handed or pregnant surgeons and trainees.
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Affiliation(s)
- Emily Olig
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona, USA
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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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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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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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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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Hislop J, Orth D, Tirosh O, Isaksson M, Hensman C, McCormick J. Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis. Surg Endosc 2023; 37:6640-6659. [PMID: 37433911 PMCID: PMC10462557 DOI: 10.1007/s00464-023-10228-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/17/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry. METHODS PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses. RESULTS A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools. CONCLUSIONS The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.
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Affiliation(s)
- Jaime Hislop
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Dominic Orth
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Oren Tirosh
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
- Institute for Health and Sport, Victoria University, Footscray, VIC, Australia.
| | - Mats Isaksson
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Chris Hensman
- Department of Surgery, Monash University,, Melbourne, VIC, Australia
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- LapSurgery Australia, Melbourne, VIC, Australia
| | - John McCormick
- Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, VIC, Australia
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