1
|
Gimpaya N, Tran WT, Grover SC. Ergonomic wellness for the trainee in gastrointestinal endoscopy. Curr Opin Gastroenterol 2024; 40:348-354. [PMID: 38662508 DOI: 10.1097/mog.0000000000001034] [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: 08/09/2024]
Abstract
PURPOSE OF REVIEW Endoscopy-related injuries (ERIs) are prevalent in gastrointestinal endoscopy. The aim of this review is to address the growing concern of ERIs by evaluating the ergonomic risk factors and the efficacy of interventions and educational strategies aimed at mitigating these risks, including novel approaches. RECENT FINDINGS ERIs are highly prevalent, exacerbated by factors such as repetitive strain, nonneutral postures, suboptimal equipment design, and the procedural learning curve. Female sex and smaller hand sizes have been identified as specific risk factors. Recent guidelines underscore the importance of ergonomic education and the integration of ergonomic principles into the foundational training of gastroenterology fellows. Advances in equipment design focus on adaptability to different hand sizes and ergonomic positions. Furthermore, the incorporation of microbreaks and macrobreaks, along with neutral monitor and bed positioning, has shown promise in reducing the incidence of ERIs. Wearable sensors may be helpful in monitoring and promoting ergonomic practices among trainees. SUMMARY Ergonomic wellness is paramount for gastroenterology trainees to prevent ERIs and ensure a sustainable career. Effective strategies include ergonomic education integrated into curricula, equipment design improvements, and procedural adaptations such as scheduled breaks and optimal positioning. Sensor-based and camera-based systems may allow for education and feedback to be provided regarding ergonomics to trainees in the future.
Collapse
Affiliation(s)
| | | | - Samir C Grover
- Scarborough Health Network Research Institute
- Division of Gastroenterology, Scarborough Health Network, Scarborough
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Suhail FK, Luo Y, Williams K, Advani R, Campbell K, Dunleavy K, Rizvi A, Persaud A, Williams RL, Rabinowitz LG. Sex differences impact ergonomic endoscopic training for gastroenterology fellows. Gastrointest Endosc 2024; 99:146-154.e1. [PMID: 37793505 DOI: 10.1016/j.gie.2023.09.028] [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] [Received: 01/19/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIMS Endoscopic-related injuries (ERIs) for gastroenterologists are common and can impact longevity of an endoscopic career. This study examines sex differences in the prevalence of ERIs and ergonomic training during gastroenterology fellowship. METHODS A 56-item anonymous survey was sent to 709 general and advanced endoscopy gastroenterology fellows at 73 U.S. training programs between May and June 2022. Demographic information was collected along with questions related to endoscopic environment, ergonomic instruction, technique, equipment availability, and ergonomic knowledge. Responses of female and male gastroenterology fellows were compared using χ2 and Fisher exact tests. RESULTS Of the 236 respondents (response rate, 33.9%), 113 (44.5%) were women and 123 (52.1%) were men. Female fellows reported on average smaller hand sizes and shorter heights. More female fellows reported endoscopic equipment was not ergonomically optimized for their use. Additionally, more female fellows voiced preference for same-gender teachers and access to dial extenders and well-fitting lead aprons. High rates of postendoscopy pain were reported by both sexes, with significantly more women experiencing neck and shoulder pain. Trainees of both sexes demonstrated poor ergonomic awareness with an average score of 68% on a 5-point knowledge-based assessment. CONCLUSIONS Physical differences exist between male and female trainees, and current endoscopic equipment may not be optimized for smaller hand sizes. This study highlights the urgent need for formal ergonomic training for trainees and trainers with consideration of stature and hand size to enhance safety, comfort, and equity in the training and practice of endoscopy.
Collapse
Affiliation(s)
- Fathima K Suhail
- Division of Gastroenterology, Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Yuying Luo
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kevin Williams
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rashmi Advani
- Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Kirsti Campbell
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katie Dunleavy
- Division of Gastroenterology, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Anam Rizvi
- Division of Gastroenterology, Department of Medicine, Zucker School of Medicine Hofstra University, New York, New York, USA
| | - Alana Persaud
- Division of Gastroenterology, Department of Medicine, SUNY Downstate Medical University, New York, New York, USA
| | - Renee L Williams
- Division of Gastroenterology, NYU Grossman School of Medicine, New York, New York, USA
| | - Loren G Rabinowitz
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Pawa S, Kwon RS, Fishman DS, Thosani NC, Shergill A, Grover SC, Al-Haddad M, Amateau SK, Buxbaum JL, Calderwood AH, Chalhoub JM, Coelho-Prabhu N, Desai M, Elhanafi SE, Forbes N, Fujii-Lau LL, Kohli DR, Machicado JD, Marya NB, Ruan W, Sheth SG, Storm AC, Thiruvengadam NR, Wani S, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on the role of ergonomics for prevention of endoscopy-related injury: methodology and review of evidence. Gastrointest Endosc 2023; 98:492-512.e1. [PMID: 37245721 DOI: 10.1016/j.gie.2023.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Swati Pawa
- Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Richard S Kwon
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Amandeep Shergill
- Division of Gastroenterology, Department of Medicine, University of San Francisco, San Francisco, California, USA
| | - Samir C Grover
- Division of Gastroenterology, Department of Medicine, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart K Amateau
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Jean M Chalhoub
- Department of Gastroenterology and Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | | | - Madhav Desai
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Sherif E Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Divyanshoo R Kohli
- Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Jorge D Machicado
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Neil B Marya
- Division of Gastroenterology and Hepatology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Wenly Ruan
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
4
|
Walsh CM. Enhancing Ergonomics in Pediatric Endoscopy Training and Practice. Gastrointest Endosc Clin N Am 2023; 33:235-251. [PMID: 36948744 DOI: 10.1016/j.giec.2022.12.002] [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] [Indexed: 03/24/2023]
Abstract
Pediatric endoscopists are at risk of work-related injuries from overuse and repetitive motions during endoscopy. Recently, there has been increasing appreciation for the importance of ergonomics education and training to help build long-term habits that prevent injury. This article reviews the epidemiology of endoscopy-related injuries in pediatric practice, describes methods for controlling exposures in the workplace, discusses key ergonomic principles that can be used to mitigate injury risk, and outlines tips for integrating education on endoscopy ergonomics during training.
Collapse
Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the SickKids Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| |
Collapse
|
5
|
Yong V, Kahler D, Schlossberg A, Gilmore K, Zhao H, Philp MM. Controller size matters: User proficiency is affected by endoscopic controller size. Am J Surg 2023; 225:378-382. [PMID: 36182597 DOI: 10.1016/j.amjsurg.2022.09.048] [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: 08/03/2022] [Revised: 09/02/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endoscope controllers are traditionally a one-size-fits-all design. However, this design may not fit the modern workforce in endoscopy-related fields. Our study aims to determine if endoscopic controller size, independent of user dexterity, affects user proficiency. METHODS 54 endoscopically naive participants completed a baseline dexterity test, followed by large-controller endoscopic and small-controller bronchoscopic simulation exercises. Participants were stratified by surgical glove size (≥7.5 and < 7.5) and gender. RESULTS Endoscopy time was longer in participants with <7.5 size gloves (p = 0.01) and in females (p < 0.001). However, participants with glove size <7.5 had better dexterity measures (p = 0.04). There was no difference in bronchoscopy time based on glove size (p = 0.61). CONCLUSIONS Participants with larger hands were more proficient with the larger controller despite being less dexterous than their counterparts. This advantage was less pronounced with the smaller controller. Our findings suggest that endoscopic controllers should be modified in design to accommodate all providers.
Collapse
Affiliation(s)
- Valeda Yong
- Department of Surgery, Temple University Hospital, 3401 N. Broad Street, Zone C, 4th Floor, Philadelphia, PA, 19140, USA.
| | - Dylan Kahler
- Department of Surgery, Temple University Hospital, 3401 N. Broad Street, Zone C, 4th Floor, Philadelphia, PA, 19140, USA
| | - Axel Schlossberg
- Lewis Katz School of Medicine at Temple University, 3500 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Kimberly Gilmore
- William Maul Measey Institute for Clinical Simulation and Patient Safety, Lewis Katz School of Medicine at Temple University, 3500 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, 3500 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Matthew M Philp
- Division of Colorectal Surgery, Department of Surgery, Temple University Hospital, 3401 N. Broad Street, Zone C, 3rd Floor, Philadelphia, PA, 19140, USA
| |
Collapse
|
6
|
Ghasemi MS, Siadat M, Abdulrazak B, Dehghan N, Ibarra-Mejia G, Forogh B. Design and ergonomic evaluation of a new adapted endoscope holder to reduce muscle pressure and discomfort during endoscopy. Work 2023; 76:403-410. [PMID: 36776095 DOI: 10.3233/wor-220185] [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: 02/12/2023] Open
Abstract
BACKGROUND Laparoscopic surgeons who regularly perform endoscopy are more likely to develop musculoskeletal disorders than other internal medicine specialists, a difference that attributed to repetitive movements, poor postures, and sub-optimal equipment design. OBJECTIVE This study aimed to design, build, and evaluate an endoscope holder for reducing the static load applied by the weight of the endoscope, in order to reduce musculoskeletal disorders risk factors in the surgeon's hand, shoulder and back issues regions. METHODS A new endoscope holder was designed according to ergonomic design principles. The designed holder was evaluated by surface electromyography (sEMG) and discomfort assessment including 15 laparoscopic surgeons. The results were analyzed with centrality statistics and compared with the independent t-test using SPSS version 22. RESULTS The evaluation of the new endoscope holder shows a statistical significant decrease in the average electrical activity of biceps brachii, triceps brachii, lateral deltoid, T9 Thoracic erector spinae, L4 Lumbar erector spinae, and external oblique after using the holder (p < 0.05). CONCLUSION The results shows that using the new endoscope holder is associated with a lower level of discomfort, as well as a lower induced muscle activity. The results also highlight the need to upgrade the holder to offer rotability in all directions (perpendicular to the ground) which will be included in the next design.
Collapse
Affiliation(s)
- Mohamad Sadegh Ghasemi
- Department of Ergonomics, Faculty of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Siadat
- Department of Ergonomics, Faculty of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Bessam Abdulrazak
- Ambient Intelligence Laboratory (AMI-Lab), Computer Science Department, Faculty of Science, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Naser Dehghan
- Ambient Intelligence Laboratory (AMI-Lab), Computer Science Department, Faculty of Science, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Gabriel Ibarra-Mejia
- Department of Public Health, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, USA
| | - Bijan Forogh
- Neuromusculoskeletal Research Center, Physical Medicine and Rehabilitation Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Ruan W, Walsh CM, Pawa S, D'Souza SL, Banerjee P, Kothari S, McCreath GA, Fishman DS. Musculoskeletal injury and ergonomics in pediatric gastrointestinal endoscopic practice. Surg Endosc 2023; 37:248-254. [PMID: 35920909 DOI: 10.1007/s00464-022-09455-9] [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: 01/22/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Endoscopy-related musculoskeletal injuries (ERI) are increasingly prevalent in adult endoscopists; however, there are no studies that have evaluated ERI and ergonomic practices among pediatric gastroenterologists and trainees. We aimed to examine the prevalence, nature, and impact of musculoskeletal injuries in pediatric endoscopic practice and assess attitudes towards ergonomic training needs. METHODS Pediatric gastroenterologists and trainees were surveyed to collect information on endoscopist and practice characteristics, the prevalence, nature, and impacts of ERI, ergonomics strategies employed in practice, previous ergonomics training, and perceptions of ergonomics training (elicited using a 1 (strongly disagree) to 5 (strongly agree) Likert scale). Responses were analyzed using descriptive statistics, and bivariate analyses were conducted to explore correlates of ERI. RESULTS Among 146 survey respondents, 50 (34.2%) were trainees and 96 (65.8%) were practicing endoscopists with a mean duration of endoscopic practice of 9.7 ± 9.4 years. Overall, 55.6% (n = 80/144) reported experiencing a musculoskeletal injury, with 34.7% (n = 50/144) reporting an injury attributable to endoscopy. Among those with ERI, the most common sites were the neck/upper back (44.0%), thumb (42.0%), hand/finger (38.0%), and lower back (36.0%). Women were more likely to experience ERI compared to men (43.4% vs. 23.4%; p = 0.013). Only 20.9% of participants had formal training in ergonomics. Respondents reported being motivated to implement practice changes to prevent ERI (4.41 ± 0.95) and perceived ergonomics training as important (4.37 ± 0.96). CONCLUSIONS Pediatric endoscopists, and particularly women, experience significant ERI; however, formal endoscopy ergonomics training is rare. Improved ergonomics training is needed for both practicing pediatric gastroenterologists and trainees.
Collapse
Affiliation(s)
- Wenly Ruan
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, D1010.18, Houston, TX, 77030, USA.
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, and the Research and Learning Institutes, Hospital for Sick Children,, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Swati Pawa
- Section of Gastroenterology and Hepatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.,Bill Hefner VA Healthcare System, Salisbury, NC, USA
| | | | - Promila Banerjee
- Loyola Stritch School of Medicine and Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | | | - Graham A McCreath
- The Hospital for Sick Children, SickKids Research Institute, Toronto, ON, Canada
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, D1010.18, Houston, TX, 77030, USA
| |
Collapse
|
8
|
Miller AT, Herberts MB, Hansel SL, Fox JC, Hallbeck MS, League J, Hinson C, Van Dyke C, Murray JA. Procedural and anthropometric factors associated with musculoskeletal injuries among gastroenterology endoscopists. APPLIED ERGONOMICS 2022; 104:103805. [PMID: 35649298 DOI: 10.1016/j.apergo.2022.103805] [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: 08/13/2021] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS Musculoskeletal (MSK) injuries among gastroenterologists are common. Our study describes risk factors and consequences of injury by comparing provider-specific anthropometric and objective procedural data to self-reported injury patterns. METHODS A validated MSK symptom survey was sent to gastroenterologists to gauge prevalence, distribution, and severity of active injury. Respondents' procedural activities over 7 years were collected via an endoscopic database. RESULTS 64 surveys were completed. 54 respondents had active pain; 53.1% reported activity-limiting injury. Activity-limiting injuries lead to longer colonoscopy times (25.3 vs. 22.1 min, P = 0.03) and lower procedural volumes (532 vs. 807, P = 0.01). Hand/wrist injuries yielded longer colonoscopy insertion times (9.35 vs. 8.21 min, P = 0.03) and less hands-on scope hours (81.2 vs. 111.7 h, P = 0.04). Higher esophagogastroduodenoscopy volume corelated with shoulder injury (336.5 vs. 243.1 EGDs/year, P = 0.04). Females had more foot injuries (P = 0.04). CONCLUSION Activity-limiting MSK symptoms/injuries affect over 50% of endoscopists with negative impact on procedural volume and efficiency.
Collapse
Affiliation(s)
- Alexander T Miller
- Division of Gastroenterology, UC Davis Medical Center, Sacramento, CA, USA
| | - Michelle B Herberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Stephanie L Hansel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jean C Fox
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - John League
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Chadrick Hinson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Carol Van Dyke
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
9
|
Winters C, Subramanian V, Valdastri P. Robotic, self-propelled, self-steerable, and disposable colonoscopes: Reality or pipe dream? A state of the art review. World J Gastroenterol 2022; 28:5093-5110. [PMID: 36188716 PMCID: PMC9516669 DOI: 10.3748/wjg.v28.i35.5093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 02/06/2023] Open
Abstract
Robotic colonoscopes could potentially provide a comfortable, less painful and safer alternative to standard colonoscopy. Recent exciting developments in this field are pushing the boundaries to what is possible in the future. This article provides a comprehensive review of the current work in robotic colonoscopes including self-propelled, steerable and disposable endoscopes that could be alternatives to standard colonoscopy. We discuss the advantages and disadvantages of these systems currently in development and highlight the technical readiness of each system to help the reader understand where and when such systems may be available for routine clinical use and get an idea of where and in which situation they can best be deployed.
Collapse
Affiliation(s)
- Conchubhair Winters
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Venkataraman Subramanian
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Pietro Valdastri
- School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
| |
Collapse
|
10
|
Pawa S, Martindale SL, Gaidos JK, Banerjee P, Kothari S, D’Souza SL, Oxentenko AS, Burke CA. Endoscopy-related injury among gastroenterology trainees. Endosc Int Open 2022; 10:E1095-E1104. [PMID: 36032041 PMCID: PMC9403520 DOI: 10.1055/a-1869-9202] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background and study aims Endoscopy-related injury (ERI) is widespread among practicing gastroenterologists. However, less is known about the incidence among trainees. This study assesses the rate of self-reported ERI occurrence, patterns of injury, and knowledge of preventive strategies in a nationally representative sample of gastroenterology fellows. Methods A 38-item electronic survey was sent to members of the American College of Gastroenterology. One hundred and sixty-eight gastroenterology fellows were included in analyses. Descriptive and univariate analyses evaluated the likelihood of ERI by workload parameters and gender. Results ERI was reported by 54.8 % of respondents. ERI was most common in the thumb (58.7 %), hand/finger (56.5 %), and wrist (47.8 %). There was no significant difference in the reported occurrence of ERI between male and female gastroenterology fellows. However, female fellows were significantly more likely to report a greater number of body areas affected by ERI, and male fellows were more likely to report elbow pain. Most respondents (85.1 %) reported discussion about, or training in, ergonomic strategies during gastroenterology fellowship. Conclusions ERI is reported to occur as early as gastroenterology fellowship. Results of this study support this finding and highlight the need for ongoing implementation and monitoring of a formal ergonomics training program as well as development of ergonomically appropriate instruments. Implications of these findings likely extend to trainees in other procedural related specialties like orthopedics and general surgery, though further research is required. Ergonomics training in gastroenterology fellowship and monitoring of its impact on trainees reported ERI is important due to negative effects on productivity and career longevity.
Collapse
Affiliation(s)
- Swati Pawa
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, United States
| | - Sarah L. Martindale
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, United States
| | | | - Promila Banerjee
- Loyola University Stritch School of Medicine, Maywood, Illinois, United States
- Hines VA Hospital, Hines, Illinois, United States
| | - Shivangi Kothari
- University of Rochester Medical Center, Rochester, New York, United States
| | | | | | | |
Collapse
|
11
|
Turkseven M, De S, Jackson CD, Sawhney MS. Modeling Haptic Interactions in Endoscopic Submucosal Dissection (ESD). IEEE TRANSACTIONS ON HAPTICS 2022; 15:603-612. [PMID: 35881596 PMCID: PMC9652775 DOI: 10.1109/toh.2022.3193982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ability to provide realistic haptic feedback is indispensable for virtual-reality (VR) based endoscopic colorectal surgery simulators. Despite its importance, force feedback is commonly simulated by simplified approximations with parameters manually tuned in preliminary evaluations due to the complexity of the dynamics of haptic interaction in colonoscopy interventions. Endoscopic submucosal dissection (ESD) is a particularly challenging intervention that requires advanced manual skills for endoscopic control. This work proposes a mechanical impedance model for haptic interactions in ESD formulated via an experimental methodology applied to endoscopic colorectal interventions in general. The developed model is shown to capture the variations in the interaction force during two operations performed at distinct locations on a porcine sample. Salient cues in the recorded haptic interaction data are presented, and changes in the impedance characteristics of the tool-tissue interaction between the steps of the operation are analyzed.
Collapse
|
12
|
Abstract
Optimal endoscopic operations incorporate ergonomic principles into the endoscopy environment benefiting endoscopists, endoscopy unit personnel, and patients. A high prevalence of occupational musculoskeletal injuries is well established among endoscopists and gastroenterology nurses. Ergonomics can be integrated into all facets of the endoscopy unit including scheduling, endoscopy unit design, training programs, and investment in technology. Preprocedure, intraprocedure, and postprocedure areas should aim to deliver patient safety, privacy, and comfort, while also supporting endoscopists and staff with adjustable rooms and effective work flows. Team-wide educational initiatives can improve ergonomic awareness. These strategies help mitigate risks for musculoskeletal injuries and can lead to increased productivity. The COVID-19 area brings novel challenges to endoscopy.
Collapse
Affiliation(s)
- Anna M Lipowska
- Division of Gastroenterology and Hepatology, University of Illinois at Chicago, 840 South Wood Street, CSB Suite 741 (MC 716), Chicago, IL 60612, USA.
| | - Amandeep K Shergill
- Division of Gastroenterology and Hepatology, San Francisco Veterans Affairs Medical Center and University of California, 4150 Clement Street, VA 111B/ GI Section, San Francisco, CA 94121, USA
| |
Collapse
|
13
|
Harris-Adamson C, Shergill AK. Endoscopist injury: shifting our focus to interventions. Gastrointest Endosc 2021; 94:260-262. [PMID: 34024633 DOI: 10.1016/j.gie.2021.03.928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/27/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Carisa Harris-Adamson
- Department of Medicine, University of California, San Francisco, California, USA; School of Public Health, University of California, Berkeley, California, USA
| | - Amandeep K Shergill
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, California, USA
| |
Collapse
|
14
|
Walsh CM, Qayed E, Aihara H, Anand GS, Byrne K, Chahal P, Dacha S, James TW, Kowalski TE, Repaka A, Saadi M, Sheth SG, Taylor JR, Williams RL, Wagh MS. Core curriculum for ergonomics in endoscopy. Gastrointest Endosc 2021; 93:1222-1227. [PMID: 33820648 DOI: 10.1016/j.gie.2021.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emad Qayed
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gobind S Anand
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Kathryn Byrne
- Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunil Dacha
- Division of Gastroenterology, Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aparna Repaka
- Division of Gastroenterology, VA Boston Healthcare System and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mohammed Saadi
- Department of Gastroenterology, Hepatology, and Nutrition, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, St Louis University, St Louis, Missouri, USA
| | - Renee L Williams
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
15
|
Matsuzaki I, Ebara T, Tsunemi M, Hatta Y, Yamamoto K, Baba A, Hattori M, Nakamura M, Fujishiro M. Effects of endoscopy-related procedure time on musculoskeletal disorders in Japanese endoscopists: a cross-sectional study. Endosc Int Open 2021; 9:E674-E683. [PMID: 33937507 PMCID: PMC8062226 DOI: 10.1055/a-1352-3850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022] Open
Abstract
Background and study aims There has been little evidence assessing the prevalence of musculoskeletal disorders (MSDs) among endoscopists performing recent diagnostic and therapeutic endoscopic procedures requiring prolonged procedural times. We evaluated the prevalence and identified the risk factors for developing MSDs, focusing on procedural time. Methods An electronic survey of endoscopists (n = 213) employed at the Nagoya University Hospital and its affiliated hospitals was developed by a multidisciplinary group. Results Of the 110 endoscopists (51.6 %) who responded to the survey, eighty-seven endoscopists (79.1 %) had experienced endoscopy-related MSDs during the previous 1 year, and 49 endoscopists (44.5 %) had experienced these MSDs during the previous week. Nineteen endoscopists (17.3 %) reported absence from work due to severe MSDs. The most frequent sites of MSDs were neck, low back, and shoulders. Logistic regression analyses showed that longer upper endoscopic submucosal dissection ESD, (odds ratio: 5.7; 95 %CI: 1.3-25.0), lower ESD (odds ratio 4.9; 95 %CI: 1.1-22.0), and lower gastrointestinal treatment (odds ratio: 5.6; 95 %CI: 2.3-13.3) were significantly associated with the development of MSDs in the low back area. Moreover, longer lower ESD (odds ratio: 5.0; 95 % CI: 1.2-20.2) was a risk factor for symptoms in the left shoulder. Conclusion This study suggests a correlation between the volume of therapeutic endoscopic procedures including ESD and the risk of MSDs mainly low back area and left shoulder. Managing monthly total endoscopic time, in light of organizational ergonomics, could contribute to minimizing such risks of endoscopy-related MSDs.
Collapse
Affiliation(s)
- Ippei Matsuzaki
- Department of Gastroenterology, Yamashita Hospital, Ichinomiya, Japan
| | - Takeshi Ebara
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Mafu Tsunemi
- Department of Nursing, Yamashita Hospital, Ichinomiya, Japan
| | - Yoshifumi Hatta
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Kojiro Yamamoto
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Akemi Baba
- Department of Clinical laboratory, Yamashita Hospital, Ichinomiya, Japan
| | - Masashi Hattori
- Department of Gastroenterology, Yamashita Hospital, Ichinomiya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
16
|
Are All Endoscopy-Related Musculoskeletal Injuries Created Equal? Results of a National Gender-Based Survey. Am J Gastroenterol 2021; 116:530-538. [PMID: 33560650 DOI: 10.14309/ajg.0000000000001136] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Endoscopy-related injury (ERI) is common in gastroenterologists (GI). The study aim was to assess the prevalence of self-reported ERI, patterns of injury, and endoscopist knowledge of preventative strategies in a nationally representative sample. METHODS A 38-item electronic survey was sent to 15,868 American College of Gastroenterology physician members. The survey was completed by 1,698 members and was included in analyses. Descriptive, univariate, and multivariate analyses were conducted to evaluate the likelihood of ERI based on workload parameters and gender. RESULTS ERI was reported by 75% of respondents. ERI was most common in the thumb (63.3%), neck (59%), hand/finger (56.5%), lower back (52.6%), shoulder (47%), and wrist (45%). There was no significant difference in the prevalence of ERI between men and women GI. However, women GI were significantly more likely to report upper extremity ERI while men were more likely to report lower-back pain-related ERI. Significant gender differences were noted in the reported mechanisms attributed to ERI. Most respondents did not discuss ergonomic strategies in their current practice (63%). ERI was less likely to be reported in GI who took breaks during endoscopy (P = 0.002). DISCUSSION ERI is highly prevalent in GI physicians. Significant gender differences regarding specific sites affected by ERI and the contributing mechanisms were observed. Results strongly support institution of training in ergonomics for all GI as a strategy to prevent its impact on providers of endoscopy.
Collapse
|
17
|
Shergill AK, McQuaid KR. Ergonomic endoscopy: An oxymoron or realistic goal? Gastrointest Endosc 2019; 90:966-970. [PMID: 31449788 DOI: 10.1016/j.gie.2019.08.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/18/2019] [Indexed: 02/08/2023]
Abstract
The current endoscope design is not ergonomic. There is a high prevalence of endoscopy-related injury reported in the literature, and studies have demonstrated high-risk biomechanical exposures during the performance of routine colonoscopy. Endoscopy ergonomics focuses on understanding the endoscopist's interaction with the endoscope and the endoscopy unit and re-designing these tasks to minimize the risk of endoscopy-related injury. The discussion to date has focused on what the endoscopist can do to minimize his or her risk of injury. It is imperative that we re-frame that discussion because the implication that physicians are responsible for implementing personal or workplace interventions places an undue burden on physicians and will be the least effective exposure control method. Endoscope companies need to consider the endoscopist in their design process. As a profession, we need to collectively advocate for endoscopist safety. We offer a perspective on how ergonomic endoscopy can become a realistic and achievable goal.
Collapse
Affiliation(s)
- Amandeep K Shergill
- Division of Gastroenterology, Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco, USA
| | - Kenneth R McQuaid
- Division of Gastroenterology, Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco, USA
| |
Collapse
|