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Lakomek A, Eichler T, Meyer M, Höing B, Dudda M, Lang S, Arweiler-Harbeck D. Muscular tension in ear surgeons during cochlear implantations: does a new microscope improve musculoskeletal complaints? Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08899-0. [PMID: 39174680 DOI: 10.1007/s00405-024-08899-0] [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: 05/20/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Musculoskeletal complaints and fatigue are commonly described symptoms in daily work of ear nose and throat surgeons using a microscope. Long ear surgical procedures are associated with prolonged microscope use, which can lead to unconsciously tense and uncomfortable body posture. The digital microscope RoboticScope® allows visualization of surgical site through a Head-Mounted Display, independent from camera head and is therefore much easier on the back, as the sitting position can be adjusted flexibly. Aim of the prospective study was to investigate to what extent the use of a RoboticScope® changes the tension of neck and shoulder muscles of the surgeons in comparison to a conventional tripod microscope. METHODS For this purpose, the electric activity of neck and shoulder muscles of surgeons was recorded using surface electromyography during cochlear implantations. Electrical potentials were derived via electrodes on neck and shoulder muscles. The basic tension of those muscles was measured in relaxed position before and after surgery. During microscope use the tension was continued to be measured. A questionnaire recorded parameters such as level of difficulty of operation as well as patient data. RESULTS Results from 58 operations, 33 of which were performed using a conventional microscope and 25 using a Head-Mounted Display, show a significant reduction in muscular tension during surgery by 40% (p < 0.001) in experienced ear surgeons when using a RoboticScope®, regardless of the surgeon. CONCLUSION Our results are in line with the relevance of preventive measures to avoid acute and chronic work-related illnesses/symptoms described in literature.
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Affiliation(s)
- Antonia Lakomek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Theda Eichler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Moritz Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Marcel Dudda
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- Department of Orthopaedics and Trauma Surgery, BG Klinikum Duisburg, Duisburg, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
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Campbell RG, Zadro JR, Gamble AR, Chan CL, Mackey MG, Osie G, Png LH, Douglas RG, Pappas E. Work-Related Musculoskeletal Disorders in Endoscopic Sinus and Skull Base Surgery: A Systematic Review With Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38971976 DOI: 10.1002/ohn.892] [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: 04/22/2024] [Revised: 06/06/2024] [Accepted: 06/22/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Endoscopic sinus and skull base surgery has led to significant improvements in patient outcomes, yet may have come at a cost to surgeons' musculoskeletal (MSK) health. We aimed to determine the prevalence and characteristics of work-related MSK disorders (WRMDs) in endoscopic sinus and skull base surgeons; to investigate contributing factors for WRMD in this population; and to evaluate the effectiveness of ergonomic interventions on the severity or prevalence of WRMD in this population. DATA SOURCES Medline, Embase, CINAHL, Web of Science, and Scopus from inception to April 2, 2024. A bibliographic examination was performed for further papers. REVIEW METHODS Inclusion criteria included original peer-reviewed papers with work-related MSK outcomes (prevalence, contributing factors, and interventions) relating to endoscopic sinus and/or skull base surgeons in any language. RESULTS Of 25,772 unique citations, 37 studies met the inclusion criteria. The pooled lifetime, point, and 12-month prevalences of WRMD were 75.9% (95% confidence interval; I2, 67.2%-83.6%, I2 95.6%), 80.8% (77.0%-84.3%, I2 98.0%), and 82.0% (71.8%-90.3%, I2 60.96%) respectively. The neck, lumbar spine, and thoracic spine were the most commonly involved areas. One of 9 studies on contributing factors investigated discomfort as an outcome. The remainder focussed on surrogate outcomes (eg, posture, hand dysfunction). Two of the 13 intervention studies investigated pain or fatigue as an outcome. The remainder targeted posture, muscle activity, or workload. CONCLUSION WRMDs are highly prevalent in endoscopic sinus and skull base surgeons. Further studies focusing on the direct outcomes of WRMD such as pain are needed.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Joshua R Zadro
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew R Gamble
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Cliffton L Chan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Martin G Mackey
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Gabriel Osie
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Lu Hui Png
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Richard G Douglas
- Faculty of Medical and Health Sciences, Surgery, University of Auckland, Auckland, New Zealand
| | - Evangelos Pappas
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Smith JD, Sridharan SS, Contrera KJ, Richmon JD, Feng AL, Chinn SB, Heft-Neal ME, Spector ME. Use of the spider limb positioner for fibular free flap reconstruction of head and neck bony defects. Oral Oncol 2024; 152:106757. [PMID: 38520757 DOI: 10.1016/j.oraloncology.2024.106757] [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: 01/11/2024] [Revised: 02/24/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Osseous and osteocutaneous fibular free flaps are the workhorse of maxillomandibular reconstruction over 30 years after the initial description. Since 2019, we have routinely used the Spider Limb Positioner, adapted from its use in shoulder orthopedic procedures, for fibular free flap harvest. Herein, we describe this novel technique in our cohort. METHODS We describe our intraoperative setup and endorse the versatility and utility of this technique in comparison to other reported fibular free flap harvest techniques. RESULTS The Spider Limb Positioner was used 61 times in 60 different patients to harvest osseous or osteocutaneous fibular free flaps. Median (range) tourniquet time for flap harvest was 90 (40-124) minutes. No iatrogenic nerve compression injuries or complications related to lower extremity positioning occurred. CONCLUSION We describe a novel approach to fibular free flap harvest utilizing the Spider Limb Positioner, which affords optimal ergonomics, visibility, and patient repositioning. There were no nerve injuries or complications related to positioning in our series.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin J Contrera
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeremy D Richmon
- Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Molly E Heft-Neal
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Bhethanabotla RM, Ledgister K, Soriano IS, O'Sullivan P, Bigelow E, Knott PD, Park AM. Ergonomic Assessment of Septorhinoplasty Maneuvers During Simulated Pregnancy. OTO Open 2024; 8:e126. [PMID: 38577238 PMCID: PMC10988238 DOI: 10.1002/oto2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Objective Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact of pregnancy on surgeon posture and ergonomics. We piloted the use of a pregnancy simulation suit (Empathy Belly) to assess the risk of ergonomic compromise when performing open septorhinoplasty. Study Design Surgical simulation. Setting Single session, training simulation lab at academic medical center. Methods Medical students and surgical residents performed the initial steps of a rhinoplasty procedure without and with a pregnancy simulation suit and were filmed with an artificial intelligence-based video analysis app from Kinetica Labs that calculates joint angles and categorizes the ergonomic risk factors. Still images from videos were taken and analyzed using validated posture-based analysis rubrics. Participants were asked to complete a qualitative questionnaire after the session. Results Twelve medical students and surgical residents participated in the study. Posture-based analysis indicated increased ergonomics risk factors among trainees when performing a rhinoplasty while wearing the pregnancy suit. Video analysis indicated trends of worsening back angle and shoulder postures. Trainees reported experiencing pain in the neck, suprapubic area, and lower back. They acknowledged the importance of ergonomics in otolaryngology and desired further education about workplace injury risk mitigation. Conclusion Pregnancy impacts the ergonomics of performing septorhinoplasty and further investigation is required into interventions to reduce risk of WRMSDs.
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Affiliation(s)
- Rohith M. Bhethanabotla
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Kaye Ledgister
- Department of Environment, Health, and SafetyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Ian S. Soriano
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Patricia O'Sullivan
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Elaine Bigelow
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Philip Daniel Knott
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Andrea M. Park
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
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Gidumal S, Saade M, Schwam ZG, Govindan A, Mavrommatis M, Wong K, Perez ER, Wanna GB, Cosetti MK. Use of Soft Cervical Collar Improves Surgeon Ergonomics During Simulated Otologic Surgery. Otol Neurotol 2024; 45:266-272. [PMID: 38238911 DOI: 10.1097/mao.0000000000004097] [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: 02/17/2024]
Abstract
OBJECTIVE To determine whether surgeon use of a soft cervical collar during endoscopic and microscopic otologic surgery is feasible and impacts surgeon ergonomics as measured by inertial sensors. STUDY DESIGN Prospective crossover trial. SETTING US-based otolaryngology training program. PATIENTS Otolaryngology residents and fellows. INTERVENTIONS Therapeutic-use of a soft cervical collar during simulated otologic surgery. MAIN OUTCOME MEASURES Time spent in high-risk angles of neck and back flexion and extension; average angle of neck flexion, extension, rotation, and lateral bending; validated assessment of neck pain; average daily phone use. RESULTS Fifteen subjects met criteria for inclusion. Ten of 15 (67%) were male. Seven of 15 (47%) were postgraduate year 1-2. Seven of 15 (47%) reported a history of neck pain. None reported prior spinal steroid injections or surgery. Across all subjects, use of the soft cervical collar significantly reduced time spent in high-risk angles of neck flexion/extension during both endoscopic (56% vs. 35%, p < 0.05) and microscopic (60% vs. 32%, p < 0.05) otologic surgery. There was no effect on back flexion or extension. There was no difference in time spent in high-risk neck or back angles between endoscopic and microscopic surgery. Average angles of neck or back flexion, extension, lateral bending, and rotation were not significantly different for subgroups with more operative experience, increased phone use, perception of good posture, or history of neck pain. CONCLUSIONS Use of a soft cervical collar during simulated otologic surgery significantly reduced time spent in high-risk neck positions. These data support feasibility of soft collar use during otologic surgery and hold promise for reduction in the high rates of neck pain reported by neurotologists. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED Improving surgeon ergonomics for otologic surgery. LEARNING OBJECTIVE To identify a therapeutic intervention to mitigate neck pain in surgeons caused by assumption of high-risk cervical neck flexion and extension. DESIRED RESULT To demonstrate that use of a readily available soft cervical collar reduces risk of neck pain in otologic surgeons. LEVEL OF EVIDENCE II. INDICATE IRB OR IACUC Exempt.
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Affiliation(s)
- Sunder Gidumal
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Ibrahim ME, El-Zoghby SM, Zaghloul NM, Shehata SA, Farghaly RM. Musculoskeletal pain among medical residents: role of workplace safety climate and sexual harassment. BMC Musculoskelet Disord 2024; 25:167. [PMID: 38388888 PMCID: PMC10882788 DOI: 10.1186/s12891-024-07272-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Workplace factors are important predictors of occurrence of musculoskeletal pain among different occupational populations. In healthcare, a psychologically unsafe work environment can negatively affect the emotional, physical and psychological well-being of physicians. This study aimed to examine the relationship between workplace violence, sexual harassment and musculoskeletal pain among Egyptian physicians in their years of residency. METHODS We distributed an online self-administered questionnaire to 101 residents working in various healthcare sectors in Egypt. It included sections on demographic data, working conditions, widespread pain index (WPI), pain interference short-form, workplace violence and harassment questionnaire, psychosocial safety climate questionnaire (PSC) and sexual harassment climate questionnaire. RESULTS All residents had at least one painful site on the WPI (range 1-11). The mean WPI was 3.5 ± 2.4, and 39.6% satisfied the criteria of having widespread pain by having at least 4 pain sites. Widespread pain index showed a weak statistically significant negative correlation with workplace PSC score (rho = - 0.272, p = 0.006), and a statistically significant weak positive correlation with the calculated total abuse index (rho = 0.305, p = 0.002). Workplace violence and abuse, as measured by a calculated abuse index was the only significant predictors of widespread pain among residents. CONCLUSION WPV was found to be a predictor of musculoskeletal pain among medical residents. Healthcare organizations need to address WPV by employing preventive strategies to minimize its hazardous effects and ensure a safe working environment for physicians.
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Affiliation(s)
- Maha E Ibrahim
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Safaa M El-Zoghby
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Nancy M Zaghloul
- Department of Forensic Medicine and Clinical Toxicology, Misr University for Science and Technology, Cairo, Egypt
| | - Shaimaa A Shehata
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Rasha M Farghaly
- Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
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Gabrielson AT, Wei J. Assessment of musculoskeletal pain and surgical ergonomic parameters among members of the American Society of Pediatric Otolaryngology. Int J Pediatr Otorhinolaryngol 2024; 176:111765. [PMID: 37980843 DOI: 10.1016/j.ijporl.2023.111765] [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: 06/07/2023] [Revised: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To assess rates of self-reported work-related pain and knowledge of ergonomic principles among fellowship trained pediatric otolaryngologists within the American Society of Pediatric Otolaryngology (ASPO). We hypothesized that pediatric otolaryngologists experience rates of musculoskeletal pain and injury similar to what has been reported among adult otolaryngologists and other surgical subspecialties. METHODS An IRB-approved survey was distributed to members of ASPO through email listserv. Collected variables included surgeon demographic information, practice settings, surgical volume, procedure types, work-related musculoskeletal pain-related metrics, modifying factors, and knowledge/attitudes on surgical ergonomics. RESULTS A total of 685 ASPO members were approached via email, of which 435 opened the survey email and 118 attending pediatric otolaryngologists completed the survey (response rate 27%). In all, 78% of respondents reported current or prior pain and/or injury attributed to performing surgery, 20% higher than that reported in the previous ergonomics survey of ASPO members in 2012. The most affected areas were neck/cervical spine (63%), shoulders/arms (44%), lower back/lumbar spine (36%), and hands/wrist (31%). Half of the respondents were diagnosed with musculoskeletal condition(s) attributed to performing surgery. Two-thirds required treatment (62% pharmacologic only, 9% pharmacologic and surgical intervention) for their work-related pain. Leveraging intermittent pauses during surgical procedures to adjust body position was the most reported method of addressing pain in the operating room. Only 21% report ever having received ergonomic training during their training or career. CONCLUSION Musculoskeletal pain associated with performing pediatric otolaryngology procedures is highly prevalent and has not attenuated despite increased awareness of surgical ergonomics. Results from this study underscore the need to develop standardized surgical ergonomics curricula for pediatric otolaryngologists and trainees.
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Affiliation(s)
| | - Julie Wei
- University of Central Florida College of Medicine, Orlando, FL, USA.
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Yadav SK, Lal G, Jain SB, Jha CK, Corwin C, Van Gorp B, Sharma CK, Kumar A, Sinha DK. Indian surgery Trainee's perspective on surgical ergonomics principles and education: A long road ahead. Am J Surg 2023; 226:735-740. [PMID: 37308348 DOI: 10.1016/j.amjsurg.2023.05.037] [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: 01/17/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aimed to determine the baseline knowledge and beliefs, along with the impact of incorporating surgical ergonomics lectures during a residency. METHODS A cohort of 123 Indian surgical residents participated in this educational intervention, which consisted of two educational webinars on ergonomics. Both pre- and post-intervention surveys were electronically sent to the participants. These included questions related to their demographics, prevalence of musculoskeletal (MSK) symptoms, and factors affecting participant awareness of ergonomic recommendations. RESULTS Seventy-one residents responded to the pre-webinar survey. Eighty-five percent of respondents reported MSK symptoms, with the most common being pain (70%) and stiffness (40%), which the residents attributed to their surgical training. Forty-six residents completed the post-webinar survey. The majority of respondents strongly agreed or agreed that surgical ergonomic educational sessions improved their understanding of the fundamental causes of MSK symptoms and increased their awareness of options available for prevention MSK injuries. CONCLUSION The rate of MSK symptoms and/or injury was high among this cohort of surgical residents. These surveys and educational session demonstrated there is limited awareness of the comprehension of ergonomics related to surgical procedures. Our study shows that a simple surgical ergonomic educational intervention can lead to improved understanding of prevention and ergonomic changes.
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Affiliation(s)
| | - Geeta Lal
- Adult Inpatient, Division of Surgical Oncology and Endocrine Surgery, University of Iowa, USA
| | - Sapana Bothra Jain
- Consultant (Endocrine and Breast Surgery), Mahatma Gandhi Institute of Medical Sciences, Jaipur, India
| | - Chandan Kumar Jha
- Department of Surgery, All India Institute of Medical Sciences, Patna, India
| | - Claudia Corwin
- Department of Internal Medicine, Carver College of Medicine, University of Iowa Employee Health, University of Iowa Hospitals and Clinics, USA
| | - Barbara Van Gorp
- Iowa Orthopedic Sports Medicine and Rehabilitation, Iowa Carver College of Medicine, Dept of Physical Therapy and Rehabilitation Science, University of Iowa, USA
| | - Chitresh Kumar Sharma
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, India
| | - Amit Kumar
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India
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Larkin R, Langlie J, Roldan LP, Thielhelm T, Mahfood C, Chiossone JA. Binocular microscopes versus exoscopes: Experiences and performance in simulated otologic surgery. Laryngoscope Investig Otolaryngol 2023; 8:1337-1344. [PMID: 37899868 PMCID: PMC10601593 DOI: 10.1002/lio2.1114] [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: 03/07/2023] [Revised: 06/11/2023] [Accepted: 06/30/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Exoscopes represent a promising alternative to conventional binocular microscopes (OM) in otology offering potential advantages such as enhanced ergonomics and a more compact device design. While previous research has demonstrated the effectiveness of exoscopes in various surgical specialties, their objective assessment in the field of otology remains limited. Therefore, this investigation aims to assess task-based efficiency associated with exoscopes in the field of otology by use of simulated surgical models. Methods A prospective cross-over study design was used to compare an OM to an exoscope in otolaryngology residents and medical students. Participants performed five tasks on 3D-printed ear models using both the exoscope and OM. Data collection included completion time, frequency of predefined errors, mental effort, and user experience. Subgroup analysis was performed based on level of experience. Results Fourteen students and fifteen residents participated. Participants completed four of five tasks faster with the OM and there was no difference in number of errors committed. When separated by surgical experience, residents performed four of five tasks faster using the OM while students completed one of five tasks faster with the OM. Students committed more errors with the exoscope for one task with no difference in errors for residents. There was no difference in perceived difficulty performing tasks with either visualization system. Exit survey results showed more favorable opinions of the OM among residents and more favorable opinions of the exoscope among students. Conclusions The exoscope permits successful performance in simulated otologic tasks. Task performance and user experience between operative microscopes and exoscopes differ based on level of surgical experience. Level of Evidence 2.
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Affiliation(s)
- Riley Larkin
- University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jake Langlie
- University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Luis Pablo Roldan
- Department of OtolaryngologyJackson Memorial Health SystemMiamiFloridaUSA
- Department of OtolaryngologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Torin Thielhelm
- Department of OtolaryngologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Department of OtolaryngologyMount Sinai Health SystemNew York CityNew YorkUSA
| | | | - Juan A. Chiossone
- Department of OtolaryngologyJackson Memorial Health SystemMiamiFloridaUSA
- Department of OtolaryngologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
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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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Haupt TL, Wadley A, Hayden J, Harley EH. Quantitative Ergonomic Comparison of Traditional Versus Endoscopic-Assisted Tonsillectomies: A Prospective Case-Control Study. Indian J Otolaryngol Head Neck Surg 2023; 75:784-788. [PMID: 37275117 PMCID: PMC10235283 DOI: 10.1007/s12070-022-03440-3] [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: 11/21/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
Objective: Quantitatively compare the ergonomics of traditional tonsillectomy versus an endoscopic-assisted tonsillectomy. Methods: The physical positioning of the senior author was studied during a simulation of two different operative approaches to tonsillectomy: one using an endoscope and one using direct visualization without the aid of an endoscope. Whole-body postural data was collected and analyzed using the validated Rapid Upper Limb Assessments (RULA) tool to calculate the risk of musculoskeletal injuries. Results: Severe neck and trunk flexion are high-risk postures unique to the traditional approach. The RULA score for the traditional, non-endoscopic approach was 5, with a Neck, Trunk, and Leg Score of 6 and a Wrist/Arm score of 1. The RULA score for the endoscopic-assisted approach was 3, with a Neck, Trunk, and Leg score of 4 and a Wrist/Arm score of 1. The difference between the two approaches narrowed down to the effect on neck positioning (angle decreased from > 20 degrees with traditional to nearly 0 degrees with endoscopic) and trunk positioning (angle decreased from 20 to 60 degrees with traditional to 0 degrees with endoscopic). Conclusion: An endoscopic-assisted approach to tonsillectomy allowed for a lower RULA score compared to the traditional tonsillectomy. This study suggests that an endoscopic approach may decrease the potential for musculoskeletal strain and reduce occupational-related pain and injury seen in practicing otolaryngologists.
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Affiliation(s)
- Thomas L. Haupt
- Howard University College of Medicine, 520 W St NW, 20059 Washington, DC USA
| | - Andrew Wadley
- Howard University College of Medicine, 520 W St NW, 20059 Washington, DC USA
| | - Jamil Hayden
- Georgetown University School of Medicine, Washington, DC USA
| | - Earl H. Harley
- Georgetown University School of Medicine, Washington, DC USA
- Department of Otolaryngology - Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC USA
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12
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Walters ZA, Chang KY, Cervenka B, Collar R, Hsieh TY. Ergonomics in Otolaryngologic Surgery: A State of the Art Review. Otolaryngol Head Neck Surg 2023; 168:330-338. [PMID: 35943813 DOI: 10.1177/01945998221117095] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Otolaryngology is a surgical field with a high degree of ergonomic risk. The use of head-mounted lighting, loupe magnification, endoscopes, and microscopes is inherent to the field, coupled with repetitive fine motor movements in a constrained anatomic field as well as static, ergonomically unfavorable postures. We seek to review the otolaryngologic literature on ergonomics, including prevalence, severity, and interventions in decreasing work-related musculoskeletal pain. DATA SOURCES Data were derived from clinical peer-reviewed primary literature as well as information provided by residency programs and presented at national and international meetings. REVIEW METHODS A comprehensive review was performed by 3 independent reviewers utilizing an electronic database literature search through PubMed, Embase, and Cochrane Library. Search terms included combinations and variations of the following concepts: ergonomics, surgery, otolaryngology, work related musculoskeletal disorders, chronic cervical pain, musculoskeletal, posture, surveys, microsurgery, endoscopic surgery. Strict objective criteria for inclusion were not used due to the inherent heterogeneity in articles and lack of rigorous empirical evidence. CONCLUSIONS Chronic musculoskeletal pain is prevalent among otolaryngologic surgeons, with many procedures producing high ergonomic risk. Most studies evaluating interventions to decrease ergonomic risks demonstrate promising results, but standardization in methods and outcome reporting is needed. IMPLICATIONS FOR PRACTICE Literature shows that musculoskeletal pain begins in training, and there is a paucity of information related to ergonomic risk in otolaryngology residency curriculums. Work-related musculoskeletal disorders related to poor workplace ergonomics have the potential to limit career longevity and lead to physician burnout. Interventions to mitigate this risk are effective and tend to be well received by physicians.
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Affiliation(s)
- Zoe A Walters
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Katie Y Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Ryan Collar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Tsung-Yen Hsieh
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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13
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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: 9] [Impact Index Per Article: 9.0] [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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14
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Joo H, Lin Z, Yesantharao L, Formeister E, Razavi C, Patel M, Carey J, Taylor R, Galaiya D. Intraoperative Neck Angles in Endoscopic and Microscopic Otologic Surgeries. Otolaryngol Head Neck Surg 2023; 168:1494-1501. [PMID: 36794784 DOI: 10.1002/ohn.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/19/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To quantitatively compare the ergonomic risk of otologic surgeries performed with endoscopes and microscopes. STUDY DESIGN Observational cross-sectional study. SETTING Operating room of a tertiary academic medical center. METHODS Intraoperative neck angles of otolaryngology attendings, fellows, and residents were assessed during 17 otologic surgeries using inertial measurement unit sensors. Sensors were attached midline between the shoulder blades and on the posterior scalp of participants and were calibrated just prior to beginning each case. Quaternion data were used to calculate neck angles during periods of active surgery. RESULTS Endoscopic and microscopic cases included similar percentages of time in high-risk neck positions, 75% and 73%, respectively, according to a validated ergonomic risk assessment tool, the Rapid Upper Limb Assessment. However, microscopic cases included a higher percentage of time spent in extension (25%) compared to endoscopic cases (12%) (p < .001). When examining the magnitude of average flexion and extension angles, endoscopic and microscopic cases were not significantly different. CONCLUSION Utilizing intraoperative sensor data, we found that both endoscopic and microscopic approaches in otologic surgery were associated with high-risk neck angles, which can result in sustained neck strain. These results suggest that optimal ergonomics may be better achieved by the consistent application of basic ergonomic principles than by changing the technology in the operating room.
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Affiliation(s)
- Hyonoo Joo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zihao Lin
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lekha Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eric Formeister
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Christopher Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Millan Patel
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - John Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Russ Taylor
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deepa Galaiya
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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15
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Aaronson NL, Reilly JS. Common Pediatric Otolaryngology Procedures: Ergonomic Considerations. Cureus 2023; 15:e34678. [PMID: 36909121 PMCID: PMC9994041 DOI: 10.7759/cureus.34678] [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: 12/30/2022] [Accepted: 02/05/2023] [Indexed: 02/09/2023] Open
Abstract
Background Otolaryngologists in high-volume children's hospitals developed their operating room workflow practices based on the factors of safety, efficiency, and surgeon preference. Recent data show important benefits and potential reduced risks of proper ergonomic positioning for surgeons to prevent injury. These data suggest that the current operating room workflow practices, in addition to prior training, should be monitored and hopefully improved for surgeons' health. Surprisingly, recent studies have suggested the benefits of standing versus sitting on cognitive function. Objective This study reports the workflow norms for seven operating procedures in pediatric otolaryngology. We seek to identify 1) surgeon preferences, 2) when practices become norms, and 3) whether procedure positions are associated with surgeon discomfort or injury. Methods The Otolaryngology Section of the American Academy of Pediatrics was queried employing a 23-question survey. We included demographic information, reasons for preferences, and surgeon-reported pain. We focused on three workflow issues: 1) length of procedures, 2) site selection (operating room bed vs. transport stretcher), and 3) position of the surgeon (sitting vs. standing). Results Sixty-nine American Academy of Pediatrics members completed the survey. The length of the procedure had minimal effect, with 90% sitting for short procedures such as bilateral myringotomy with tubes, myringoplasty, tonsillectomy, and adenoidectomy. All sit for direct laryngoscopy and bronchoscopy. Most stand for the removal of nasal foreign bodies, drainage of neck abscess procedures, and thyroglossal duct cyst excision. Residency training (75%) and personal comfort (81%) were the more frequently cited reasons for preference. Fewer than one in five (16%) reported preexisting neck or back pain, but this doubled (35%) throughout their otolaryngology practice. Conditional distributions of pain showed reports of pain were greater for individuals in practice for over 20 years. Conclusions Pediatric otolaryngologists develop their operating room preferences early during residency training. High rates of neck and back pain (35%) may develop during a surgeon's career. We suggest improved understanding of ergonomics in concert with operating room workflow should be considered during otolaryngology residency training since recent data suggest potential benefits of standing on cognitive function.
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Affiliation(s)
- Nicole L Aaronson
- Department of Surgery, Section of Otolaryngology, Nemours Children's Health, Wilmington, USA.,Department of Otolaryngology, Department of Pediatrics, Thomas Jefferson University Sidney Kimmel School of Medicine, Philadelphia, USA
| | - James S Reilly
- Department of Surgery, Section of Otolaryngology, Nemours Children's Health, Wilmington, USA.,Department of Otolaryngology, Department of Pediatrics, Thomas Jefferson University Sidney Kimmel School of Medicine, Philadelphia, USA
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16
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Gold BS, Oh SJ, Varelas EA, Arrighi-Allisan AE, Kominsky ES, Perez ER, Cosetti MK. Does “Just in Time” teaching of ergonomic principles improve posture of trainees during otologic microscopic surgery? Am J Otolaryngol 2023; 44:103682. [DOI: 10.1016/j.amjoto.2022.103682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
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17
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Alaseem AM, Turcotte RE, Ste-Marie N, Alzahrani MM, Alqahtani SM, Goulding KA. Occupational injuries and burn out among orthopedic oncology surgeons. World J Orthop 2022; 13:1056-1063. [PMID: 36567863 PMCID: PMC9782546 DOI: 10.5312/wjo.v13.i12.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures. These types of surgeries increase the risk of physical and psychological stressors, which may in turn make these physicians prone to work-related occupational injuries.
AIM The aim of this study was to explore in orthopedic oncologists, the prevalence of work-related physical injuries and psychological disturbances.
METHODS A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society, the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies. The survey was sent by email, and it explored musculoskeletal complaints, psychological disturbances, treatment required for these complaints and the requirement of time off work.
RESULTS A total of 67 surgeon responses were collected. A high number of orthopedic oncologists (84%) reported an occupational injury. Low back pain (39%) was the most prevalent musculoskeletal condition, followed by lumbar disk herniation (16%), shoulder tendinitis (15%) and lateral epicondylitis (13%). Of the cohort, 46% required surgery and 31% required time off work due to their injury. Thirty-three respondents reported a psychological disorder. Burnout (27%), anxiety (20%) and insomnia (20%) were the most commonly reported. Time required off work due to injury was associated with old age and years in practice.
CONCLUSION Orthopedic oncology surgeons report a high prevalence of work-related disorders. Lower back related injury and burnout were the most reported disorders. Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.
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Affiliation(s)
- Abdulrahman M Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Robert E Turcotte
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal H4A3J1, Canada
| | - Nathalie Ste-Marie
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal H4A3J1, Canada
| | - Mohammad M Alzahrani
- Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam 34212, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam 34212, Saudi Arabia
| | - Krista A Goulding
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona 85054, USA
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18
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Fan X, Forsman M, Yang L, Lind CM, Kjellman M. Surgeons' physical workload in open surgery versus robot-assisted surgery and nonsurgical tasks. Surg Endosc 2022; 36:8178-8194. [PMID: 35589973 PMCID: PMC9613719 DOI: 10.1007/s00464-022-09256-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are common among surgeons, and its prevalence varies among surgical modalities. There are conflicting results concerning the correlation between adverse work exposures and MSD prevalence in different surgical modalities. The progress of rationalization in health care may lead to job intensification for surgeons, but the literature is scarce regarding to what extent such intensification influences the physical workload in surgery. The objectives of this study were to quantify the physical workload in open surgery and compare it to that in (1) nonsurgical tasks and (2) two surgeon roles in robot-assisted surgery (RAS). METHODS The physical workload of 22 surgeons (12 performing open surgery and 10 RAS) was measured during surgical workdays, which includes trapezius muscle activity from electromyography, and posture and movement of the head, upper arms and trunk from inertial measurement units. The physical workload of surgeons in open surgery was compared to that in nonsurgical tasks, and to the chief and assistant surgeons in RAS, and to the corresponding proposed action levels. Mixed-effects models were used to analyze the differences. RESULTS Open surgery constituted more than half of a surgical workday. It was associated with more awkward postures of the head and trunk than nonsurgical tasks. It was also associated with higher trapezius muscle activity levels, less muscle rest time and a higher proportion of sustained low muscle activity than nonsurgical tasks and the two roles in RAS. The head inclination and trapezius activity in open surgery exceeded the proposed action levels. CONCLUSIONS The physical workload of surgeons in open surgery, which exceeded the proposed action levels, was higher than that in RAS and that in nonsurgical tasks. Demands of increased operation time may result in higher physical workload for open surgeons, which poses an increased risk of MSDs. Risk-reducing measures are, therefore, needed.
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Affiliation(s)
- Xuelong Fan
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mikael Forsman
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 14157 Huddinge, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, 113 65 Stockholm, Sweden
| | - Liyun Yang
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Carl M. Lind
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus Kjellman
- Department of Molecular Medicine and Surgery, Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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19
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Leung KL, Segal RM, Bernstein JD, Orosco RK, Reid CM. Surgical ergonomics: Assessment of surgeon posture and impact of training device during otolaryngology procedures. Laryngoscope Investig Otolaryngol 2022; 7:1351-1359. [PMID: 36258864 PMCID: PMC9575056 DOI: 10.1002/lio2.901] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To identify factors associated with cervical-thoracic spine posture in otolaryngology surgeries and evaluate the efficacy of a commercially available posture-training device in enhancing surgeon ergonomics. Methods Over 3 months, neck and spine posture from individuals performing otolaryngology surgeries was recorded using UpRight Go 2™. Average baseline posture was first recorded and biofeedback was later introduced to attempt to correct posture. The proportion of time spent in upright/neutral cervical-thoracic spine posture was correlated with surgeon and procedure characteristics and compared to proportion of upright posture time after biofeedback intervention. Results The proportion of upright operating time was significantly different between procedure subtypes and surgical approaches with best performance in rhinology procedures and worst performance in head and neck surgeries (90% vs. 62%; both p < .001). Female gender, shorter stature, and use of sitting stools were associated with greater proportion of surgery spent upright (all p < .05). Loupes use was associated with less time in upright posture (p < .001). With biofeedback intervention, 8 of 10 subjects demonstrated an average of 5% improvement in operating upright, with most improvement found when performing laryngology procedures (7%) and least improvement in head and neck procedures (2%). Conclusions While surgeon posture varies across otolaryngology surgeries, sitting and minimizing the use of loupes may help promote a more ergonomic operating environment and improve surgeon posture. Although the efficacy of biofeedback intervention from a commercially available posture-training device differs among otolaryngologists, exploration of alternative interventions and incorporation of an ergonomics curriculum is warranted to address postural issues experienced by many surgeons. Level of Evidence 3.
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Affiliation(s)
| | | | - Jeffrey D. Bernstein
- Department of Otolaryngology ‐ Head & Neck Surgery, Department of SurgeryUC San Diego HealthSan DiegoCaliforniaUSA
| | - Ryan K. Orosco
- Department of Otolaryngology ‐ Head & Neck Surgery, Department of SurgeryUC San Diego HealthSan DiegoCaliforniaUSA
| | - Chris M. Reid
- Division of Plastic Surgery, Department of SurgeryUC San Diego HealthSan DiegoCaliforniaUSA
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20
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Elzomor A, Tunkel A, Lee E, Jaamour F, Davidson L, Shaver TB, Niermeyer W, Benito D, Cole K, Zapanta P. Intraoperative stretching microbreaks reduce surgery-related musculoskeletal pain in otolaryngologists. Am J Otolaryngol 2022; 43:103594. [PMID: 36029617 DOI: 10.1016/j.amjoto.2022.103594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/07/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the role intraoperative otolaryngology stretching microbreak (OSMB) has on musculoskeletal (MSK) pain and discomfort in otolaryngologists. BACKGROUND Otolaryngology procedures subject surgeons to significant amounts of pain and strain over their years of training. MSK pain is a serious concern for otolaryngologists' career longevity as well as their general wellbeing. METHODS Participants from two different hospitals and one private practice were recruited to participate in this study. An initial ergonomic survey was obtained to assess baseline MSK pain, and its subjective impact on operative performance. The participants then completed three control days without OSMB exercises, followed by three intervention days with OSMB exercises which were completed at 20-40 minute intervals. Preoperative and postoperative pain rating surveys were completed before and after each procedure and at the end of the day to determine changes in pain and/or discomfort. RESULTS Ten otolaryngologists (50 % men, 50 % women; mean age 35.6 years) participated in this study. Half of the participants indicated that they were concerned their pain would limit their ability to operate in the future. 70 % of participants indicated that they have not attempted to treat this pain and 60 % did not try any stretching exercises outside the operating room (OR) to mitigate their symptoms. Participants reported neck, upper back, and lower back to be the primary MSK discomfort. OSMB improved participants' pain scores in neck, shoulders, hands, and lower back pain (p < 0.05). CONCLUSION MSK pain has shown to be a serious concern for the ability of otolaryngologists to continue performing surgery in the future. OSMB may be an effective strategy that can be implemented by otolaryngologists intraoperatively to improve MSK pain and overall well being.
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Affiliation(s)
- Amir Elzomor
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Alexandra Tunkel
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Esther Lee
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Farris Jaamour
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lauren Davidson
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Timothy Brandon Shaver
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Weston Niermeyer
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Daniel Benito
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Keith Cole
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University School of Health Sciences, Washington, DC, USA
| | - Philip Zapanta
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Otolaryngology - Head and Neck Surgery, Sovah Health, Danville, VA, USA
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21
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Reducing musculoskeletal pain in the operating theatre. BJA Educ 2022; 22:154-159. [PMID: 35531080 PMCID: PMC9073315 DOI: 10.1016/j.bjae.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
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22
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Kelly N, Mousset M, Althubaiti A, Agarwal R, Onwuka A, Chiang T. Using the Craniovertebral Angle to Quantify Intraoperative Ergonomic Risk. Otolaryngol Head Neck Surg 2022; 167:664-668. [PMID: 35041547 DOI: 10.1177/01945998211068726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To measure the craniovertebral angle during tonsillectomy, assess the interrater reliability of our methodology, and investigate the correlations of the Rapid Upper Limb Assessment and the craniovertebral angle to quantify ergonomic risk. STUDY DESIGN Prospective, observational study. SETTING Tertiary care pediatric institution. METHODS Neck posture was evaluated for 92 images with 7 surgeons. Lateral images of the surgeon were captured every minute in a standardized method. Images were assessed by 3 raters, measuring the craniovertebral angle, defined as the angle between a horizontal line through the C7 vertebrae and another line through C7 and the tragus of the ear. Interrater reliability of the craniovertebral angle was evaluated using the κ statistic. Per prior publications, reports of neck pain were frequent when the craniovertebral angle value was <50°; thus, we defined an abnormal posture if the craniovertebral angle was <50°. RESULTS Mean (SD) craniovertebral angle during tonsillectomy was 26.0° (11.3°). One hundred percent of procedures had at least 1 assessment of abnormal posture. The lowest interrater reliability was 0.77 (CI: 0.67-0.87). Rapid Upper Limb Assessment and craniovertebral angle (CA) correlation was -0.12 (P = .27) and, therefore, null. CONCLUSION Poor posture during tonsillectomy places otolaryngologists at intraoperative ergonomic risk. The craniovertebral angle is a predictor of future neck pain, and a pathologic neck position during tonsillectomy was identified. Given the high interrater reliability, our approach to assessing intraoperative surgical ergonomics was validated. Overall, RULA and the CA are not a substitute for one another but complementary.
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Affiliation(s)
- Natalie Kelly
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marike Mousset
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Abdulrahman Althubaiti
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Riddhima Agarwal
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tendy Chiang
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Holm TM. Endocrine surgery: A pain in the neck? Am J Surg 2022; 224:313-314. [DOI: 10.1016/j.amjsurg.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/01/2022]
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Jensen MJ, Pagedar NA, Sugg SL, Lal G. Endocrine surgeons have high rates of work-related musculoskeletal (MSK) injury and symptoms. Am J Surg 2021; 224:315-318. [PMID: 34863525 DOI: 10.1016/j.amjsurg.2021.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/28/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Work-related injury and musculoskeletal (MSK) symptoms are common among surgeons, however data for endocrine surgeons (ES) are lacking. METHODS A survey was distributed to American Association of Endocrine Surgeons (AAES) and Endocrine section of American Head and Neck Society (AHNS) members. RESULTS MSK symptoms were present in 199 (90%) of 220 respondents, most notably pain (91%) and stiffness (81%). The most common locations were neck (87%) and shoulders (55%). Women were more likely to be symptomatic (98.6% versus 86.4%, p = 0.004). Although 67% of respondents reported awareness of ergonomic principles, only 19% had learned about them during training. The most common ergonomic adjustments were stretching, use of microbreaks and headlight/loupe adjustments. CONCLUSION The vast majority of ES surgeons suffer MSK symptoms that could potentially impact their quality of life and career length. Effective strategies are needed to protect this highly trained workforce.
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Affiliation(s)
- Megan J Jensen
- Department of Otolaryngology, Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nitin A Pagedar
- Department of Otolaryngology, Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sonia L Sugg
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Geeta Lal
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Sarwal G, Tobias G, Taylor DC, Misskey JD, Hsiang YN. Survey of Canadian vascular surgeons and trainees finds work-related musculoskeletal pain and discomfort is common. J Vasc Surg 2021; 75:1431-1436. [PMID: 34718100 DOI: 10.1016/j.jvs.2021.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Occupational injuries and disability are a source of surgeon morbidity. The purpose of this study was to assess the physical toll of working in operating rooms by Canadian vascular surgeons. OBJECTIVE To assess work-place musculoskeletal (MSK) complaints and challenges faced by Canadian vascular surgeons and trainees and its implications on surgical practice and occupational longevity. METHODS An online survey was distributed to resident and surgeon members of the Canadian Society of Vascular Surgery. The survey collected data on demographics, operative volume, and work-related MSK symptoms. RESULTS The survey was distributed to 188 surgeons and trainees. After three e-mailings, 109 surveys were returned (58% response rate). Of the responders, 87% were male, 51% were 45 years or older, and 56% had been in practice for ten or more years. Workplace MSK symptoms was reported by 83% of the responders. The most common locations were the low back (78%), neck (74%), and shoulder (30%). Most responders (83%) believed that these symptoms were related to their operative environment. Almost half (48%) sought medical care. As a result of these MSK symptoms, 25% experience chronic pain with 8% reporting time off work as a consequence. Another 11% reported an impact on their operative performance with 14% considering early retirement. A lack of operating room system changes to prevent workplace injury and disability was noted by 85% of the responders although only 3% reported their disability to their department. CONCLUSION Occupational MSK symptoms and disability is common amongst Canadian vascular surgeons. Further research is needed to create programs to improve surgeon morbidity.
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Affiliation(s)
- Gautamn Sarwal
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - Gabriel Tobias
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - David C Taylor
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - Jonathan D Misskey
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - York N Hsiang
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C..
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A systematic review of interventions to prevent work-related musculoskeletal disorders in ENT surgeons. The Journal of Laryngology & Otology 2021; 136:622-627. [PMID: 34583792 DOI: 10.1017/s0022215121002590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Arrighi-Allisan AE, Garvey KL, Wong A, Filip P, Shah J, Spock T, Del Signore A, Cosetti MK, Govindaraj S, Iloreta AM. Ergonomic Analysis of Functional Endoscopic Sinus Surgery Using Novel Inertial Sensors. Laryngoscope 2021; 132:1153-1159. [PMID: 34355793 DOI: 10.1002/lary.29796] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/07/2021] [Accepted: 07/17/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS Suboptimal ergonomics during endoscopic sinus surgery can lead to considerable physical discomfort and fatigue for the surgeon. The purpose of this pilot study is to objectively evaluate the ergonomic positions of trainee and attending surgeons while performing functional endoscopic sinus surgery (FESS). STUDY DESIGN Pilot prospective trial. METHODS Six surgeons (two attendings and four trainees) performed FESS while wearing 11 inertial measurement units (IMUs) affixed to either side of each major joint. Screen placement was standardized to be 1 m directly in front of the surgeon and on the patient's left, 0-15° declined from the surgeons' eyes. Bed height was standardized such that the workspace was 0 to 10 cm below the elbows. IMU data were analyzed to calculate joint angles. Ideal joint angles (i.e., <10° for neck and trunk) were determined by the validated Rapid Entire Body Assessment tool. Subjects subsequently completed a modified National Aeronautics and Space Administration Task Load Index to assess cognitive and physical burden and pain. Student's t-test was employed to detect differences between groups. RESULTS Trainees adopted positions involving significantly greater neck flexion (9.90° vs. -6.48°, P = .03) and reported significantly higher frustration levels (3.04 vs. 1.33, P = .02) while operating than attendings. For both cohorts, increased operative time was significantly correlated with greater back flexion (r = 0.90, P = .02; r = 0.55, P = .04, respectively). CONCLUSIONS Our data suggest that trainees operate with higher risk neck postures than do attendings. These data indicate high-risk operative postures may be borne of inexperience and present an opportunity for postural interventions at an early stage of training. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Annie E Arrighi-Allisan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Katherine L Garvey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Anni Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Peter Filip
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Janki Shah
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Todd Spock
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Anthony Del Signore
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Maura K Cosetti
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Alfred Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Maxner A, Gray H, Vijendren A. A systematic review of biomechanical risk factors for the development of work-related musculoskeletal disorders in surgeons of the head and neck. Work 2021; 69:247-263. [PMID: 33998586 DOI: 10.3233/wor-213474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Previous studies have shown high rates (47-72%) of self-reported work-related musculoskeletal disorders (WRMDs) in surgeons of the head and neck. Physical requirements in the workplace, individual factors (e.g. poor posture, obesity) and psychosocial factors have been identified as risk factors. Establishing biomechanical risk factors may help prevent further development of WRMDs in this population. OBJECTIVE The purpose of this critical review was to source studies that identified the biomechanical risk factors for WRMDs in this surgical sub-specialty. METHODS Searches were conducted of Medline, CINAHL, and AMED databases from 1980 until September 2018. RESULTS A total of 182 article were identified. Exclusion criteria lead to 163 full-text articles being screened, generating a total of 6 articles for review. The aims of the included studies varied significantly. Surgeons spend the majority of operating time in static, asymmetrical positions. Surgical loupes/headlamps significantly increased cervical spine loading. Articulated surgical arm supports provided optimal ergonomic conditions. Performing surgical operations with the surgeon in standing or sitting had no effect on task performance or demand. Physical fatigue was also measured in both positions. CONCLUSIONS A combination of equipment-based and patient/surgeon position-based factors predispose surgeons to biomechanical risk factors. Studies of greater methodological quality are required.
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Affiliation(s)
- Andrew Maxner
- Department of Physiotherapy & Paramedicine, Glasgow Caledonian University, Glasgow, UK
| | - Heather Gray
- Department of Physiotherapy & Paramedicine, Glasgow Caledonian University, Glasgow, UK
| | - Ananth Vijendren
- ENT Department, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
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Boyle S, Fitzgerald C, Conlon BJ, Vijendren A. A national survey of workplace-related musculoskeletal disorder and ergonomic practices amongst Irish otolaryngologists. Ir J Med Sci 2021; 191:623-628. [PMID: 33963514 PMCID: PMC8105144 DOI: 10.1007/s11845-021-02642-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022]
Abstract
Background Work-related musculoskeletal disorder (WRMD) is a rising concern for surgeons, particularly those involved in minimally invasive surgery (MIS). Severe WRMD can adversely affect surgeon’s health and foreshorten their careers if not appropriately managed. Aims The aim of this study was to assess the prevalence of WRMD among Irish otolaryngologists and determine their knowledge of the best ergonomic principles. Methods A national survey was distributed electronically to all otolaryngology consultants and non-consultant hospital doctors (NCHDs) in Ireland. The survey assessed respondents’ age, grade, history of WRMD, and treatments sought for WRMD and knowledge of best ergonomic practice. Results Forty-nine of one hundred and two respondents completed the survey. The lifetime prevalence of WRMD among this cohort was 75.5%. Pain was the most commonly experienced symptom at 71.4%. The neck was the most frequently affected location (59.2%). Treatment for WRMD was sought by 36.7% of participants. The majority of respondents (73.5%) were unaware of recommendations made in the field of surgical ergonomics, while 85.7% were interested in learning ergonomic principles. Conclusion This study demonstrates a high prevalence of WRMD amongst otolaryngologists working in Ireland and demonstrates a need for ergonomic training for surgeons.
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Affiliation(s)
- Seamus Boyle
- St. James and Tallaght University Hospitals, Dublin, Ireland.
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Kapoor S, Mahomed K, Kapoor V. Work-related musculoskeletal injuries among obstetricians and gynaecologists: A cross-sectional survey of Fellows of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Aust N Z J Obstet Gynaecol 2021; 61:785-792. [PMID: 33763876 DOI: 10.1111/ajo.13339] [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: 09/24/2020] [Accepted: 02/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Obstetricians and gynaecologists (O&Gs) are at a risk of work-related musculoskeletal injuries (WRMI) on a daily basis. AIMS To describe the prevalence of WRMI among O&Gs in Australia and New Zealand, explore risk factors for such injuries, and evaluate their impact. METHODS An online survey of Fellows of Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted in July 2016. It comprised questions on personal attributes, type of work, site and cause of WRMI, if any and treatment required. RESULTS We received responses from 765 O&Gs giving a response rate of 38.3% (765/1997). Four hundred and ten specialists (53.6%) reported suffering a WRMI at some point, including 252 (32.9%) who reported multiple injuries. In multivariable analysis, females had increased risk of WRMI (odds ratio (OR): 2.12; 95% CI: 1.54-2.91) and among generalists and subspecialists, gynaecological oncologists had highest risk for WRMI (OR: 3.13; 95% CI: 1.21-8.14). Commonest sites of injury were back (218/633, 34.4%) and shoulder (131/633, 20.7%). Laparoscopic surgery (117/633, 18.5%) was the commonest cause of injury. Treatment was required for 88.6% of injuries (561/633) including 8.4% (53/633) of cases which required surgery. Ongoing symptoms post-injury were reported for 52.1% of injuries (330/633) and in 25.8% (163/633) of instances the practitioner needed to modify their scope of work. CONCLUSION This survey among a large cohort of O&Gs shows a high prevalence of WRMI with a profound negative impact on the practitioner and profession. There is a pressing need to advocate for improved ergonomics in their workplaces.
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Affiliation(s)
- Shveta Kapoor
- Obstetrics and Gynaecology, Ipswich Hospital, Ipswich, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Kassam Mahomed
- Obstetrics and Gynaecology, Ipswich Hospital, Ipswich, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Vishal Kapoor
- University of Queensland, Brisbane, Queensland, Australia.,Queensland Children's Hospital, Brisbane, Queensland, Australia
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Stretching and Strength Training to Improve Postural Ergonomics and Endurance in the Operating Room. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2810. [PMID: 33133890 PMCID: PMC7572150 DOI: 10.1097/gox.0000000000002810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
Plastic surgeons report the highest prevalence of chronic musculoskeletal pain and fatigue among surgical subspecialties. Musculoskeletal pain impacts daily life, career longevity, and economic burden secondary to occupational injury. Poor postural awareness and ergonomic set up in the operating room represent the most common etiology. Methods A literature review was performed to highlight the ergonomic set-up, postural pitfalls, occupational injuries, and musculoskeletal pain in the operating room. An institutional survey was administered among resident and attending surgeons regarding musculoskeletal pain, posture, ergonomic education, and future improvements. Literature results, survey data, and intraoperative photographs were analyzed in collaboration with physical therapists and personal trainers. Results Survey results demonstrated that 97% of resident and attending respondents experienced musculoskeletal pain and 83% reported a lack of education in posture and ergonomics. The main postural pitfalls included head forward and flexed positioning, abduction and internal arm rotation, and kyphosis of the thoracic spine. The collaborators developed instructional videos to assess posture and biomechanics and demonstrate targeted stretching and strength exercises to address specific neck, back, and shoulder pain. Conclusions Poor posture is unavoidable in the operating room at times. These educational videos should be utilized for self-motivated and prophylactic conditioning outside of the operating room to maintain physical well-being throughout a career in plastic surgery. Future focus should be aimed at implementing dedicated ergonomic education and physical wellness programs early in surgical resident training.
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Kim JS, Chen W, Grunwaldt L, Losee JE, Bise C, Schuster L. Musculoskeletal Pain Survey Outcomes in Cleft Surgeons and Orthodontists. Cleft Palate Craniofac J 2020; 58:222-229. [PMID: 32757766 DOI: 10.1177/1055665620946184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Determine prevalence and characteristics of musculoskeletal pain and pathology in cleft providers. DESIGN An IRB-exempt survey based on previously validated surveys was administered. Data collected included demographics, practice description, musculoskeletal pain history, formal diagnoses, and interventions. SETTING Survey was sent to all cleft centers approved by the American Cleft Palate-Craniofacial Association worldwide. PATIENTS, PARTICIPANTS All cleft surgeons and orthodontists at these centers met entry criteria. Eighty-three providers responded. Cleft center coordinators were unable to confirm the number of survey recipients. MAIN OUTCOME MEASURES The hypothesis formulated prior to data collection was that prevalence would be comparable to general plastic surgeons and other at-risk health care providers. RESULTS Average age of respondents was 49.8 ± 11.3 years; 33.9% of respondents were female. Average body mass index was 24.8 ± 3.5 kg/m2. Headaches were observed in 62.7% of surveyed respondents while musculoskeletal symptoms were reported in 89.8%. Of the 12 body parts addressed, most commonly affected were the neck (71.2%), shoulders (52.5%), and lower back (67.8%). Pain interfered with hobbies and home life in the majority of respondents (62.7%). Those who reported a formal diagnosis were more likely to undergo treatment including surgery (P < .01), medication (P = .03), and physical therapies (P < .01). CONCLUSIONS Cleft surgeons and orthodontists experience a higher frequency of headaches compared to the general population, and musculoskeletal disorders are more prevalent than reported by general plastic surgeons. Pain interferes with hobbies and home life. Formal diagnosis leads to treatment. Preventative exercises and interventions are presented.
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Affiliation(s)
- Justine S Kim
- 6595University of Pittsburgh Medical Center, PA, USA
| | - Wendy Chen
- 6595University of Pittsburgh Medical Center, PA, USA
| | | | - Joseph E Losee
- Surgery and Pediatrics, 6614University of Pittsburgh School of Medicine, PA, USA
| | - Christopher Bise
- University of Pittsburgh School of Health and Rehabilitation Sciences, PA, USA
| | - Lindsay Schuster
- 72058University of Pittsburgh Medical Center Children's Hospital, PA, USA
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Dahmash AB, Alkholaiwi F, Alahmari A, Shadid AM, Alharbi AM, Al Hussain O. Work-Related Musculoskeletal Symptoms in Otorhinolaryngology-Head and Neck Surgery Residents. Sultan Qaboos Univ Med J 2020; 20:e202-e208. [PMID: 32655913 PMCID: PMC7328838 DOI: 10.18295/squmj.2020.20.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives Work-related musculoskeletal disorders in Saudi Arabia are not often reported in the literature. This study aimed to identify musculoskeletal symptoms among otorhinolaryngology residents in Saudi Arabia. Methods This cross-sectional survey-based study was conducted in May 2018 and included residents registered in the Saudi Otorhinolaryngology-Head and Neck Surgery Board Training programme, Riyadh, Saudi Arabia. The Nordic Musculoskeletal Questionnaire was used to assess musculoskeletal symptoms in addition to demographic and occupational factors, including operating position and the average number of operating hours. Results A total of 45 residents (response rate: 68.2%) completed the survey, including 33 males (73.3%) and 12 females (26.7%). Most residents (91.1%) reported at least one musculoskeletal symptom. The most commonly reported musculoskeletal over the previous 12 months were shoulder complaints (64.4%) followed by neck complaints (60%). In the short term (i.e. within seven days preceding the survey), neck complaints were more common than shoulder complaints (28.9% versus 20%). Lower back complaints were the most common cause of activity limitation (24.4%) followed by shoulder complaints (13.3%), while those with neck complaints reported it as a cause for visiting a physician (8.9%). Hip and thigh complaints were significantly more frequent among residents with operation times of eight hours or more compared to those who operating for less than eight hours (42.9% versus 5.9%; P = 0.021). Conclusion A high incidence of shoulder, neck and lower back complaints was found in this study. Residency is an ideal time in an otorhinolaryngologist’s career to implement programmes in ergonomic best practices before bad habits are developed.
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Affiliation(s)
| | - Feras Alkholaiwi
- Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdussalam Alahmari
- Department of ENT, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Asem M Shadid
- College of Medicine, Imam Mohammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdulrahman M Alharbi
- College of Medicine, Imam Mohammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Omair Al Hussain
- Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad ibn Saud Islamic University, Riyadh, Saudi Arabia
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Rodman C, Kelly N, Niermeyer W, Banks L, Onwuka A, Mason E, Chiang T. Quantitative Assessment of Surgical Ergonomics in Otolaryngology. Otolaryngol Head Neck Surg 2020; 163:1186-1193. [DOI: 10.1177/0194599820932851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives Objective evaluation of the ergonomic risk of common otolaryngology procedures and assessment of work-related musculoskeletal pain and injury. Study Design Cross-sectional intraoperative assessment and survey. Setting Department of Otolaryngology at a tertiary children’s hospital. Subjects and Methods Sixteen otolaryngology attendings, fellows, and residents participated in a blinded study. Intraoperative ergonomics was assessed for tonsillectomies, adenoidectomies, and tympanostomy tube insertions using the Rapid Upper Limb Assessment (RULA). Follow-up surveys were sent to all participating surgeons to determine the prevalence of musculoskeletal pain and formal ergonomic training. Results Zero percent (N = 0/275) of intraoperative observations were found to have a negligible level of ergonomic risk, with 47% low risk, 37% high risk, and 16% very high risk. Tympanostomy tube insertions conferred less risk than tonsillectomy and adenoidectomy, while the use of headlamp or loupes conferred increased risk. Eighty percent of respondents reported having musculoskeletal pain and 40% reported experiencing pain while operating within the past year. The most common area of pain was the cervical spine. No surgeons reported formal ergonomic training. Conclusions Our study demonstrates an unacceptable level of ergonomic risk for common procedures in otolaryngology. Furthermore, most participants reported experiencing musculoskeletal pain despite the duration of examined procedures being relatively short. The high prevalence of work-related musculoskeletal pain and the lack of ergonomic training in our cohort highlight the need for increased awareness of ergonomics as well as the development of formal ergonomic curricula.
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Affiliation(s)
- Cole Rodman
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Natalie Kelly
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Weston Niermeyer
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Laura Banks
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Eric Mason
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tendy Chiang
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Dale L, Fiedler J. Risk factors for musculoskeletal disorders in an obstetrician-gynecologist and orthopedic surgeon. Work 2020; 65:749-761. [PMID: 32310206 DOI: 10.3233/wor-203128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Orthopedic and obstetrician-gynecologist (OB/GYN) surgeons have risks for musculoskeletal disorders (MSD) during work in the operating room (OR). Risks for MSD have not been identified as a result of work outside the OR or during non-work tasks. OBJECTIVE The purpose of the study was to determine risk factors for MSD in an orthopedic and OB/GYN surgeon. METHODS A case study format and mixed method design were used to gather data by using the Rapid Upper Limb Assessment (RULA) to measure MSD risks in the OR; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) to measure surgeons' upper extremity disability; observation of surgeon office hours; and semi-structured interviews to gather qualitative data. RESULTS Both surgeons had risks for MSD during occupational performance outside of work, with some risks similar to those experienced at work. Both surgeons had MSD risks during work inside and outside the OR. Both surgeons experienced MSD symptoms exacerbated by work and non-work tasks. CONCLUSIONS Identifying and reducing MSD risk should include a comprehensive analysis of occupational performance for orthopedic and OB/GYN surgeons.
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Affiliation(s)
- Lucinda Dale
- School of Occupational Therapy, University of Indianapolis Indianapolis, IN, USA
| | - Jordan Fiedler
- School of Occupational Therapy, University of Indianapolis Indianapolis, IN, USA
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Anderson M, Goldman RH. Occupational Reproductive Hazards for Female Surgeons in the Operating Room. JAMA Surg 2020; 155:243-249. [DOI: 10.1001/jamasurg.2019.5420] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matilda Anderson
- Western Health Surgical Department, Victoria, Australia
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rose H. Goldman
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cambridge Health Alliance, Department of Medicine, Cambridge, Massachusetts
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Vijendren A, Devereux G, Tietjen A, Duffield K, Van Rompaey V, Van de Heyning P, Yung M. The Ipswich Microbreak Technique to alleviate neck and shoulder discomfort during microscopic procedures. APPLIED ERGONOMICS 2020; 83:102679. [PMID: 29735161 DOI: 10.1016/j.apergo.2018.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 03/19/2018] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
Neck and shoulder disorders are a considerable health problem amongst frequent microscope users. We aimed to investigate the neck and shoulder discomfort experienced during prolonged microscopic activity and to assess the benefits of minibreaks. A prospective crossover study was performed on 17 healthy volunteers sitting still while looking down a bench with and without the Ipswich Microbreak Technique (IMT). We used a subjective measure of time to fatigue and pain in the neck and shoulder regions as well as objective readings from a surface electromyogram (sEMG). The IMT delayed the sensation of pain in the neck and shoulder region while reducing the overall sEMG muscle activation. In conclusion, IMT is a useful strategy in reducing and delaying the pain in neck and shoulder from prolonged working under the microscope. This technique can be incorporated in other activities that involve a sustained stationary position.
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Affiliation(s)
| | - Gavin Devereux
- Department of Science and Technology, University of Suffolk, IP4 1QJ, UK
| | - Aaron Tietjen
- Department of Science and Technology, University of Suffolk, IP4 1QJ, UK
| | | | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium
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Alnefaie MN, Alamri AA, Hariri AF, Alsaad MS, Alsulami AM, Abbas AM, Alfozan AA, Aljiffry MM, Al-Abbadi H. Musculoskeletal Symptoms Among Surgeons at a Tertiary Care Center: a Survey Based Study. Med Arch 2019; 73:49-54. [PMID: 31097861 PMCID: PMC6445622 DOI: 10.5455/medarh.2019.73.49-54] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: Musculoskeletal (MSK) manifestations represent a common work-related physical complication that affect surgeons and impacts their life and the healthcare service negatively. Aim: The aim of this study was to determine the prevalence of work related MSK manifestations among surgeons in a tertiary care hospital and to identify the possible associated risk factors. Methods: A Web-based self-administered cross-sectional survey was conducted. This study targeted all surgeons regardless of their nationalities, ages, genders, and marital statuses. The questionnaire assessed the participants’ demographic data as well as musculoskeletal manifestations. Results: Most respondents (80%) suffered from MSK manifestations that were related to performing surgeries. Back and neck areas represented the most affected body parts (71.1% and 59.8%, respectively). A significantly higher percentage of those with musculoskeletal manifestations practiced for 5-10 years (28.9%) (p = 0.006). Conclusion: MSK pain is common among Saudi surgeons in different specialties. More attention should be directed to improving the physical environments in which the surgeons are operating. Moreover, surgeons should be educated about the recommended ergonomic positions that can prevent or decrease their work related MSK manifestations.
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Affiliation(s)
- Majed N Alnefaie
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah A Alamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Mohammed S Alsaad
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Anas Mn Abbas
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel A Alfozan
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Murad M Aljiffry
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatim Al-Abbadi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Work-Related Musculoskeletal Discomfort and Injury in Craniofacial and Maxillofacial Surgeons. J Craniofac Surg 2019; 30:1982-1985. [PMID: 31369503 DOI: 10.1097/scs.0000000000005631] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Long, complex surgical procedures with non-ergonomic postures, headlights, loupe magnification, and microscope use may put craniofacial and maxillofacial surgeons at an increased risk of work-related musculoskeletal discomfort (WRMD). Identifying the prevalence and impact of WRMD may guide preventive strategies to prolong well-being, job satisfaction, and career duration. METHODS A 31-question survey was designed to evaluate WRMD. The survey was sent to American Society of Craniofacial Surgeons and American Society of Maxillofacial Surgeons members. The survey was created and distributed electronically through a private survey research center (Qualtrics Survey Software). RESULTS There were 95 respondents (23.75% response rate): 75% male, 56% aged 31 to 50 years old, and 73% in academic practice. On a scale of 0 to 10 (0 no pain, 10 worst pain), WRMD for surgery without loupes/microscope had a median of 3, with loupes 4, and with microscope 5. Pain was most common in the neck. Pain within 4 hours of surgery was present in 55% and 38% feared pain would influence future surgical performance. Surgeon discomfort affects posture (72%), stamina (32%), sleep (28%), surgical speed (24%), relationships (18%), and concentration (17%). Medical treatment for discomfort was sought by 22%. Time off work for treatment occurred in 9%. CONCLUSION The WRMD can affect many aspects of a craniofacial or maxillofacial surgeon's life and has the potential to shorten or end a career. Occupational health and surgical ergonomics should be emphasized during surgical training and in surgical practice.
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Dalager T, Søgaard K, Boyle E, Jensen PT, Mogensen O. Surgery Is Physically Demanding and Associated With Multisite Musculoskeletal Pain: A Cross-Sectional Study. J Surg Res 2019; 240:30-39. [DOI: 10.1016/j.jss.2019.02.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/22/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
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Work-related musculoskeletal symptoms in otorhinolaryngology and their relationship with physical activity. A nationwide survey. The Journal of Laryngology & Otology 2019; 133:713-718. [PMID: 31317837 DOI: 10.1017/s0022215119001452] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The main objective of this study was to determine the prevalence of work-related musculoskeletal symptoms in otolaryngology and head and neck surgery specialists and trainees in Spain, and to measure the effect that physical exercise could have on muscular discomfort. METHOD A cross-sectional survey was administered between September and December 2017 to practising otolaryngologists. RESULTS Four hundred and three ENT surgeons responded, with a median age of 44.9 years, and 89.8 per cent reported discomfort or physical symptoms that they attributed to surgical practice. More female surgeons reported musculoskeletal symptoms (92.8 per cent vs 87.1 per cent; p = 0.04). When the level of physical activity was compared with the frequency of physical discomfort, no significant difference was found. CONCLUSION This study has shown a high prevalence of musculoskeletal disorders among ENT surgeons in Spain but has failed to demonstrate an important role of physical exercise in the prevention of musculoskeletal disorders.
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Abstract
PURPOSE OF REVIEW Awareness of ergonomics is growing into surgical specialties including otolaryngology. Most otolaryngologists experience occupational physical discomfort, and daily incorporation of standard ergonomic principles may alleviate some of this pain. RECENT FINDINGS Further demonstration of surgery-related physical discomfort has been documented based on surveys of general otolaryngologists and subspecialty rhinologists. One study utilized surface electromyography to document physical findings directly associated with the endoscopic sinus surgery procedure. However, relatively little work has been published on interventions to relieve task-related pain and body discomfort in rhinology. SUMMARY Surgeon fatigue and bodily injury is a surprisingly frequent occurrence and is more likely to occur in procedures that are mentally challenging, prolonged, and require the surgeon to operate in a fixed position. Endoscopic sinus and skull base surgeons appear particularly susceptible to task-related physical discomfort, and incorporation of ergonomic principles should be a priority.
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Dalager T, Højmark A, Jensen PT, Søgaard K, Andersen LN. Using an intervention mapping approach to develop prevention and rehabilitation strategies for musculoskeletal pain among surgeons. BMC Public Health 2019; 19:320. [PMID: 30885182 PMCID: PMC6423851 DOI: 10.1186/s12889-019-6625-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to describe the development of strategies to prevent and rehabilitate musculoskeletal pain among surgeons. Musculoskeletal pain affects surgeons' life, and evidence on interventions for effective prevention and rehabilitation is lacking for this occupational group. METHODS An Intervention Mapping approach was used to develop intervention strategies specifically tailored to surgeons. This approach entailed conducting a systematic scoping literature search and semi-structured interviews with six surgeons. RESULTS The first step was to develop a logic model of the problem of musculoskeletal pain among surgeons. Step two was to formulate health-enhancing outcomes and performance objectives for the intervention, while in step three theory-based methods and practical strategies for the intervention were identified. CONCLUSION The present Intervention Mapping study demonstrated that musculoskeletal pain among surgeons is a complex area that needs attention. Our findings highlight a need for individual behavioural changes as well as organisational, attitudinal, and management changes.
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Affiliation(s)
- Tina Dalager
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anne Højmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Pernille Tine Jensen
- Clinical Institute, University of Southern Denmark and Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Clinical Institute, University of Southern Denmark and Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Lotte Nygaard Andersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Vaisbuch Y, Aaron KA, Moore JM, Vaughan J, Ma Y, Gupta R, Jackler RK. Ergonomic hazards in otolaryngology. Laryngoscope 2018; 129:370-376. [DOI: 10.1002/lary.27496] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Yona Vaisbuch
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Ksenia A. Aaron
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Justin M. Moore
- Department of Neurosurgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - John Vaughan
- Environmental Health and Safety Department; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Raghav Gupta
- Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Robert K. Jackler
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
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Dianat I, Bazazan A, Souraki Azad MA, Salimi SS. Work-related physical, psychosocial and individual factors associated with musculoskeletal symptoms among surgeons: Implications for ergonomic interventions. APPLIED ERGONOMICS 2018; 67:115-124. [PMID: 29122182 DOI: 10.1016/j.apergo.2017.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
This study evaluated the effect of physical, psychosocial and individual factors on the presence of musculoskeletal symptoms (MSS) among surgeons (n = 312) in Iran. Data were collected using questionnaires and analysed by multivariate logistic regression. The prevalence of MSS, particularly in the knees (48.7%), neck (45.8%), low back (42.3%) and shoulders (40.1%) was relatively high. Work-related factors including time spent on surgeries each week (>25 h/week), number of hours working in standing position per day (>4 h/day), moderate to high levels of work-family conflict, duration of each surgery (>3 h), number of years worked as a surgeon (>10 years) and surgical specialty (particularly cardiothoracic and obstetric/gynecologic surgeries) were independently associated with the presence of MSS in different body regions. Individual factors including gender (being female) and little or no involvement in sport and physical activity were also independently associated with the occurrence of complaints. Implications of the findings for further research and development work for improving the working conditions and consequently reducing MSS among this working group are discussed.
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Affiliation(s)
- Iman Dianat
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ahmad Bazazan
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
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Bolduc-Bégin J, Prince F, Christopoulos A, Ayad T. Work-related musculoskeletal symptoms amongst Otolaryngologists and Head and Neck surgeons in Canada. Eur Arch Otorhinolaryngol 2017; 275:261-267. [PMID: 29075981 DOI: 10.1007/s00405-017-4787-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/20/2017] [Indexed: 11/28/2022]
Abstract
The first objective of this study was to identify work-related musculoskeletal symptoms and determine their prevalence in the practice of Otolaryngology and Head and Neck surgery in Canada. The second objective was to establish potential associations between those musculoskeletal symptoms and variables related to demographic status of the surgeons, their workload and work ergonomics. This study was designed as a Canadian census on work-related musculoskeletal symptoms amongst Otolaryngologist and Head and Neck surgeons. The census was a self-administered electronic survey. It was distributed to all Otolaryngologists and Head and Neck surgeons members of either the Canadian Society of Otolaryngology-Head and Neck Surgery or the Association of Oto-rhinolaryngology-Head and Neck Surgery of Quebec. The questionnaire contained three sections: demographic and workload-related data, identification of work-related musculoskeletal symptoms and evaluation of working ergonomics. The response rate was 23%. Ninety seven percent (97%) of respondents experienced some physical symptom in one or many regions of their body. Seventy-four percents (74%) of respondents noted an exacerbation of their musculoskeletal symptoms by work. Musculoskeletal symptoms limited the daily activities of 45% of respondents while 23% think that their occupational longevity will be diminished by these limitations. The prevalence of work-related musculoskeletal disorders is high among otolaryngologists and its impact on the surgeon's personal and professional life is high. There is a need to improve ergonomics in the clinical and operative room settings and to educate surgeons on ergonomic principles.
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Affiliation(s)
- Josiane Bolduc-Bégin
- Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier de Trois-Rivières, Trois Rivières, QC, Canada
| | - François Prince
- Departments of Kinesiology and Surgery, University of Montreal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology, Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, 1560, rue Sherbrooke Est, Montreal, QC, H2L 4M1, Canada
| | - Tareck Ayad
- Division of Otolaryngology, Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, 1560, rue Sherbrooke Est, Montreal, QC, H2L 4M1, Canada.
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Glue ear in adults, paediatric sleep apnoea and the nose in exercise. The Journal of Laryngology & Otology 2016; 130:417. [PMID: 27095549 DOI: 10.1017/s0022215116001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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