Ergonomics and Musculoskeletal Health of the Surgeon

Efficacy of pelvic floor muscle training with physical therapy for low back pain: A systematic review and meta-analysis

OBJECTIVE

To assess the efficacy of pelvic floor muscle training and physical therapy interventions in patients with low back pain.

DATA SOURCES

The Ovid-Medline, Ovid-Embase, Cochrane Library, CINAHL, Web of Science, and PEDro databases were searched for randomised, controlled trials published in English or Korean between database inception and September 2024.

REVIEW METHODS

Studies providing pelvic floor muscle training in individuals with low back pain were included. The risk of bias using the Cochrane Risk of Bias 2 tool and the grading of recommendation, assessment, development, and evaluation (GRADE) system was used to evaluate the quality of evidence. The meta-analysis was performed using Review Manager software 5.4.

RESULTS

Nineteen studies were included in this review. Pelvic floor muscle training showed low certainty evidence for improving pain (standardised mean difference = -0.73, 95% CI [-1.10, -0.36]) and reflected a clinically meaningful reduction in pain. The evidence for disability improvement had a low certainty (mean difference = -5.21, 95% CI [-7.15, -3.26]) due to high heterogeneity. Substantial improvements in pain and disability were observed when pelvic floor muscle training was added to standard physical therapy, with low certainty of evidence supporting these findings. Whereas pelvic floor muscle training substantially improved pain compared to other interventions, there was no marked improvement in disability.

CONCLUSION

Pelvic floor muscle training is potentially beneficial in addition to physical therapy for reducing low back pain, particularly in pregnancy-related cases. However, the evidence should be interpreted considering the quality and risk of bias.

Comparison of neck angle and musculoskeletal discomfort of surgeon in cataract surgery between three-dimensional heads-up display system and conventional microscope

The three-dimensional heads-up display system (3D HUDS) is increasingly utilized by ophthalmologists and suggested to offer ergonomic benefits compared to conventional operating microscopes. We aimed to quantitatively assess the surgeon's neck angle and musculoskeletal discomfort during cataract surgery using commercially available 3D HUDS and conventional microscope. In this single-center comparative observational study, the surgeon conducted routine phacoemulsification surgeries using Artevo® 800 and Opmi Lumera® 700 (both from Carl Zeiss Meditec, Jena, Germany). The surgeon's intraoperative neck angle was measured using the Cervical Range of Motion device. Postoperative musculoskeletal discomfort was assessed using the Visual Analog Scale (VAS) score after each surgery. A total of 80 cataract surgeries were analyzed, with 40 using Artevo® 800 and 40 using Opmi Lumera® 700. The neck angle was extended when using Artevo® 800 and flexed when using Opmi Lumera® 700 during continuous curvilinear capsulorhexis (CCC), phacoemulsification, and intraocular lens (IOL) placement (- 8.18 ± 2.85° vs. 8.27 ± 2.93° in CCC, - 7.83 ± 3.30° vs. 8.87 ± 2.83° in phacoemulsification, - 7.43 ± 3.80° vs. 7.67 ± 3.73° in IOL placement, respectively; all p < 0.001). The VAS score was significantly lower in surgeries performed with Artevo® 800 (1.27 ± 0.55 vs. 1.73 ± 0.64, p < 0.001). The findings suggest that 3D HUDS help reduce neck flexion and lower work-related musculoskeletal discomfort through ergonomic improvements.

Gender differences in ergonomics during simulated ureteroscopy

BACKGROUND

Female urologists report higher rates of work-related physical discomfort compared to male urologists. We compared ergonomics during simulated ureteroscopy, the most common surgery for kidney stones, between male and female urologists.

METHODS

Surface electromyography was used to measure muscle activation during common ureteroscopic tasks in urology trainees and staff with different surgeon positions and ureteroscopes. Subjective workload was assessed using the NASA Task Load Index (NASA-TLX). Paired t-tests, Wilcoxon rank-sum tests, and multivariate regressions were used to compare muscle activation by gender for each trial condition.

RESULTS

There was no difference in age or distribution of training level between genders, though men had larger glove sizes. Across all conditions, women required greater muscle activation in multiple muscle groups and had greater NASA-TLX scores compared to men.

CONCLUSIONS

There may be gender differences in ergonomics during ureteroscopy based on muscle activation and subjective workload, suggesting potential for personalizing surgical ecosystems.

Trends and outcomes in colorectal cancer surgery: a multicenter cross-sectional study of minimally invasive versus open techniques in Germany

BACKGROUND

The objective of this study was to assess the trend from open to modern minimally invasive (laparoscopic and robot-assisted) surgical techniques for colorectal cancer (CRC) in Germany, with a particular focus on hospital mortality, postoperative complications, and length of hospital stay.

METHODS

A multicenter cross-sectional study was conducted using data from 36 German hospitals, encompassing 1,250,029 cases from January 2019 to December 2023. The study included all hospitalized patients aged ≥ 18 with CRC who underwent surgery. Surgical cases were categorized as open or minimally invasive. Outcomes assessed included in-hospital mortality, morbidity, and hospital length of stay. Statistical analyses involved multivariable logistic and linear regression models adjusted for main diagnosis, metastasis presence, age, sex, and comorbidities.

RESULTS

The study included 4525 CRC cases: 2767 underwent open surgery and 1758 underwent minimally invasive surgery (173 robotic). In-hospital mortality was significantly higher in open surgery (6.1% vs. 1.7%). Open surgery was also significantly associated with higher rates of acute post-hemorrhagic anemia (OR: 2.38; 95% CI: 1.87-3.02), respiratory failure (OR: 1.71; 95% CI: 1.34-2.18), and intraoperative and postprocedural complications (OR: 3.64; 95% CI: 2.83-4.70). Average hospital stay was longer for open surgery (19.5 days vs. 11.0 days).

CONCLUSION

Despite the advantages of minimally invasive surgery, including reduced mortality, morbidity, and shorter hospital stays, open surgery remains the predominant approach for CRC in Germany. These findings underscore the need for increased adoption of minimally invasive techniques and highlight the potential benefits of shifting toward minimally invasive methods to enhance the overall quality of CRC care.

Ergonomics in facial plastic and reconstructive surgery

PURPOSE OF REVIEW

Understanding effective ergonomic interventions is crucial for enhancing occupational health and career longevity. There is a paucity of clear ergonomics guidelines in facial plastic and reconstructive surgery (FPRS), placing practitioners at high risk of work-related musculoskeletal disorders (WMSDs) and their consequences.

RECENT FINDINGS

There is mounting evidence that FPRS specialists are at increased risk of WMSDs as compared with the public and other surgical specialties. Numerous studies have demonstrated that implementation of ergonomics principles in surgery decreases WMSDs. Furthermore, WMSDs are reported as early as the first year of surgical residency, marking the importance of early intervention.

SUMMARY

Fatigue and physical injuries among surgeons occur more often than expected, particularly during complex, extended procedures that necessitate maintaining a constant posture. FPRS procedure often place surgeons into procrustean positions. Thus, integrating ergonomic practices into the practice of FPRS is essential for reducing WMSDs.

Using wearable technology for Posture Regulation to Improve Surgical Ergonomics in the paediatric operating room: the UPRISE trial: a pilot study

BACKGROUND

The rising prevalence of work-related musculoskeletal disorders has numerous physical, financial, and mental repercussions for surgeons. This study aims to establish whether the use of a wearable posture device can improve the operating time spent in suboptimal, high-risk postures.

METHODS

Surgeons were recruited in Phase 1 of this prospective randomised study and baseline postural data was obtained. In Phase 2, participants were randomised to receive either a traditional educational workshop or intraoperative vibrations from the device to correct postural lapses. During minor elective day cases, intraoperative postural data was collected and stratified by forward flexion angle, into five risk categories (negligible to very high). Participants' experience with the sensor was also assessed.

RESULTS

A total of 100 surgical procedures (Phase 1: n = 50; Phase 2: n = 50) were performed by eight surgeons of varying seniority. Exposure to the educational intervention increased time spent in suboptimal posture (Phase 1 vs. Phase 2); 47.5% vs. 67.8%, p = 0.05. However, the vibrational intervention significantly reduced this time; 50.0% vs. 20.7%, p = 0.005. Procedure type didn't influence posture although, laparoscopic interventions spent most time in negligible-risk postures; 47.7% vs. 49.3%, compared to open procedures. Surgical consultants spent less time in suboptimal posture compared to fellow/registrars; 30.3% vs. 72.6% (Phase 1) and 33.8% vs. 65.3% (Phase 2).

CONCLUSION

Vibrational intervention from the device significantly decreased the time spent in suboptimal, high-risk postures. As procedure type wasn't correlated with postural changes, surgeon-specific factors in regulating posture are paramount. Finally, surgeon experience was positively correlated with improved surgical ergonomics.

Safety and Optimizing Ergonomics for Cardiothoracic Surgeons

Cardiothoracic surgery, demanding in nature, often results in surgeons suffering from musculoskeletal injuries, causing chronic pain and leading to premature retirement. A significant majority report experiencing pain, exacerbated by minimally invasive techniques such as video-assisted thoracoscopic surgery. Despite this, many surgeons delay seeking medical assistance. To mitigate these risks, preventative strategies such as strength exercises, stretching during operations, and taking brief breaks are crucial. However, the surgical community faces a shortage of institutional support and comprehensive ergonomic education. Advancements in technology, including artificial intelligence and virtual reality, could offer future solutions.

Worker and work-related factors influence on musculoskeletal symptoms among veterinary surgeons

Worker and work-related musculoskeletal symptoms are prevalent among surgeons operating on human patients. Despite incidence rates for accidents among veterinarians and their staff being 2.9 times higher than that of general practitioners of human medicine, little is known about musculoskeletal symptoms among veterinary surgeons. In this study, 212 board-certified members of the American College of Veterinary Surgeons responded to a survey regarding various work-related activities and their experience with musculoskeletal symptoms in 10 different body regions. Across all body regions, reported pain increased from before to after a typical day of surgery (p <.01). Gender, weight, age, and years performing surgery were worker factors that were related to pain (p <.05), while number of procedures, practice focus, and proportion of minimally invasive surgery were work factors related to pain (p <.05). Our findings suggest that musculoskeletal symptoms are prevalent among veterinary surgeons and may help provide evidence for guidelines for minimising musculoskeletal injuries in veterinary surgery.Practitioner summary: Little is known about the risk factors for musculoskeletal symptoms (MSS) among veterinary surgeons. This cross-sectional survey of veterinary surgeons investigates worker and work factors related to MSS. We show that MSS are prevalent and identify key factors providing evidence that MSS are a concern in veterinary surgery.

Reducing Surgeon Fatigue Through Ergonomics: Importance and Benefits in Laparoscopic Surgeries

Laparoscopy, despite enhancing surgical outcomes, presents ergonomic challenges, such as visual-motor axis dissociation and increased cognitive load, leading to inefficiency and fatigue. Ergonomics, optimizing tasks and environments to fit human capabilities, can address these issues by designing user-friendly instruments, improving surgeon positioning, and enhancing operating room setups. These interventions reduce suturing time, alleviate discomfort, and decrease musculoskeletal disorders among surgeons. Ergonomic training for surgical teams further minimizes risk factors and promotes better body mechanics. Prioritizing ergonomics in surgical environments may lead to improved patient outcomes, greater surgeon well-being, and increased job satisfaction, highlighting its critical importance in modern surgery.

Skill assessment based on clutch use in cross-platform robot-assisted surgery

BACKGROUND

Many studies have investigated the transfer of skills between laparoscopic and robot-assisted surgery (RAS). These studies have considered time, error, and clinical outcomes in the assessment of skill transfer. However, little is known about the specific operations of the surgeon. Clutch control use is an important skill in RAS. Therefore, the present study aimed to propose a novel objective algorithm based on computer vision that can automatically evaluate a surgeon's clutch use. Additionally, the study aimed to evaluate the correlation between clutch metrics and surgical skill on different surgical robot platforms.

METHODS

The robotic surgery training center of Wuhan University trained 30 laparoscopic surgeons as the study group between 2023 and 2024. Laparoscopic surgeons were trained by combining robotic simulator exercises and RAS animal experiments. During the training, video and hand movement data were collected. Hand movements identified by a skin-color model were combined with labeling information to classify clutch use. The metrics were validated on different robotic platforms (dv-Trainer, EDGE MP1000, Toumai™ MT1000, and DaVinci Xi system) and among surgeons with different surgical skill levels.

RESULTS

On the robotic simulator, clutch accuracy in the expert group was significantly higher than in the study group for all tasks. No significant differences were observed in the number of clutches between the expert and study groups. In the RAS experiment, the number of clutches decreased significantly for both study and expert groups. The accuracy was maintained at a high level in the expert group but decreased rapidly in the study group.

CONCLUSIONS

We proposed a new objective assessment of surgical skills, clutch use metrics, in cross-platform RAS. Additionally, we verified that the metrics significantly correlated with the surgical skill levels of the surgeons.

General surgeons' occupational musculoskeletal injuries: A systematic review

INTRODUCTION

Surgeons are expected to work long hours in operating theatres. A high prevalence of work-related musculoskeletal (WRMSK) injuries and pain in healthcare professions exists. We aimed to study WRMSK pain and injuries in general surgeons and study their risk in different surgical techniques comprising open, laparoscopic and robotic-assisted surgery.

METHODS

A systematic search was performed in compliance with The PRISMA checklist. Search was performed in PubMed and Cochrane library databases for 6 years to 2024. The search terms used were "disability and surgeon", "occupational injuries and surgeon", and "musculoskeletal pain and surgeons", in addition to MESH terms in PubMed database. Risk of bias was calculated among studies.

RESULTS

The search revealed 3648 citations from which a final list of 24 citations were included after application of inclusion and exclusion criteria. The citations comprised over 1900 surgeons including consultants and surgical trainees from different subspecialities. Incorporated citations consisted of 21 cross-sectional 3 observational studies. Most common pain sites, risks and preventative measure for MSK injuries were revealed.

CONCLUSION

There is high prevalence of WRMSK pain among general surgeons. Surgeons were primarily affected at physical body parts ranging from the neck, shoulders, upper back and lower back to upper extremity. Robotic-assisted surgery led to lower post-operative discomfort and decreased demanding muscle activity in upper extremities but enhanced static neck position resulting in subjective back stiffness compared with laparoscopic surgery.

Hand Surgeon Posture: An Evaluation and Factors That Affect It

Objective

Approximately 68% of orthopaedic surgeons report occupational related musculoskeletal pain, with back pain being the most common. Poor posture while operating has been proven to contribute to these high rates of musculoskeletal pain. There is little research regarding intraoperative surgeon posture within the field of hand and upper extremity surgery. This prospective study aims to investigate and analyze hand surgeon posture in the operating room.

Methods

Posture of three hand surgeons was recorded using the UPRIGHT GO posture tracking device while performing a prospective series of 223 hand and upper extremity surgeries. This device reports posture in terms of overall percentage of time spent slouched versus upright. For this cohort of 223 cases, data were collected including surgical procedure, whether the surgery was performed in a seated or standing position, whether or not loupes were worn during the procedure, and if the surgeon was the primary or assistant surgeon. These data were then analyzed to look for any contributing factors to poor posture.

Results

The three hand surgeons in this study spent an average of 40.3% of their time slouched while operating. The average percentage of time slouched was significantly greater with the use of loupes versus no loupes. Additionally, mean time slouching was slightly increased when the surgeon was seated and also when the surgeon was acting as the assistant surgeon.

Conclusion

The three orthopaedic hand surgeons in our study spent a significant portion of their operative time slouched. The main variable associated with a significant risk of poor surgical posture was wearing loupes. Slight increases in slouching were seen with operating while seated and as the assistant surgeon. Surgeon awareness of these variables, as well as techniques to improve surgeon posture, should be developed in order to help contribute to better surgeon posture within the field of hand surgery.

Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review

There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.

Effect of laparoscopic handle size on surgical performance: A randomized crossover trial

Laparoscopic instrument handles design and dimensions are crucial to determine the configuration of surgeons' hand grip and, therefore, can have a deleterious effect on overall surgical efficiency and surgeons' comfort. The aim of this study is to investigate the impact of laparoscopic handle size and hand surface area on surgical task performance. A single-blind, randomized crossover trial was carried out with 29 novice medical students. Participants performed three simulated tasks in "black box" simulators using two scissor-type handles of different sizes. Surgical performance was assessed by the number of errors and time required to complete each task. Hand anthropometric data were measured using a 3D scanner. Execution time was significantly higher when cutting and suturing tasks were performed with the smaller handle. In addition, hand surface area was positively correlated with peg transfer task time when performed with the standard handle and was correlated with cutting task time in small and standard handle groups. We also found positive correlations between execution time and the number of errors executed by larger-handed participants. Our findings indicate that laparoscopic handle size and hand area influence surgical performance, highlighting the importance of considering hand anthropometry variances in surgical instrument design.

A Tubular-Mounted Digital Camera Versus Optical Surgical Microscope for Minimally Invasive Lumbar Decompression Surgery: The Impact on Operative Times, Ergonomics, and Workflow

OBJECTIVE

Understanding ergonomic impact is foundational to critically evaluating value and safety of enabling technologies in minimally invasive spine surgeries. This study assessed the impact of a tubular-mounted digital camera (TMDC) versus an optical surgical microscope (OSM) in single-level minimally invasive spine surgeries on operative times, durotomy rate, surgeon ergonomics, safety, and operating room workflow.

METHODS

This retrospective study compared consecutive single-level minimally invasive lumbar decompression surgeries in a TMDC cohort (September 2021-June 2022) with an historical OSM cohort (January 2020-July 2021). Data included patient demographics, operative times, durotomy incidence, surgeon ergonomics (Rapid Entire Body Assessment scores), and equipment impact via staff surveys. Operative times were assessed by t test, while Pearson χ2 test compared sex. Age, body mass index, and Charlson Comorbidity Index comparisons were made by Wilcoxon rank sum tests, and survey results were analyzed with Wilcoxon signed rank tests.

RESULTS

TMDC and OSM groups included 74 and 82 patients, respectively. Age, sex, and Charlson Comorbidity Index did not significantly differ between groups. The TMDC group had a higher body mass index (29.6 ± 5.1) than the OSM group (29.0 ± 7.5) (P = 0.04). The TMDC group had significantly shorter operative times (57.3 ± 16.6 minutes) than the OSM group) (66.7 ± 22.5 minutes) (P = 0.004), with no difference in durotomy rates (P = 0.42). TMDC use yielded lower Rapid Entire Body Assessment scores compared with OSM (4.1 ± 0.77) (P < 0.001). Surveys indicated improved safety, setup time, and workflow with TMDC (P < 0.001).

CONCLUSIONS

TMDC in single-level minimally invasive lumbar decompression surgery improved surgeon ergonomics, reduced operative times, and maintained durotomy rates, enhancing operating room efficiency. Evaluating ergonomic impact of technology is vital for safety and value assessment.

Prevalence of disability secondary to work-related musculoskeletal injuries among orthopaedic surgeons

Background

Orthopaedic surgeons encounter many work-place hazards that can lead to musculoskeletal injuries (MSI) and their clinical sequelae. This study aims to evaluate musculoskeletal injuries among orthopaedic surgeons and compare their rates of disability claims and time off work. Additionally, this study provides a perspective on the financial impact of work-related injuries among orthopaedic surgeons.

Methods

An electronic survey was developed to assess work-place hazards among orthopaedic surgeons. The survey included questions on demographics, musculoskeletal injuries, and disabilities. Electronic surveys were emailed to all current members of the American Academy of Orthopaedic Surgeons (AAOS) between March and April 2021 in the United States. Descriptive statistics were run for all variables and chi-squared and t-tests when applicable.

Results

1645 members of the AAOS completed the survey (7.03 % response rate), and 243 (14.9 %) reported a work-related injury to their place of employment at some point during their career. Of the respondents, 1129 (76.4 %) reported having active disability insurance, and 61 (3.7 %) orthopaedic surgeons filed a disability claim secondary to a work-related injury at some point during their career. Of the surgeons that claimed disability, 39 (66.1 %) returned to work, and 20 (33.9 %) had an early retirement. Foot/ankle injuries led to the highest rates of early retirement overall (62.5 %).

Conclusion

This study captures the prevalence of disability claims made by orthopaedic surgeons due to work-place hazards. To our knowledge, this is the first study to broadly compare disability claims amongst orthopaedic surgeons. This data should be used to implement changes in the orthopaedic community to decrease injuries and disability claims.

The rise of robotic colorectal surgery: better for patients and better for surgeons

Robotic colorectal surgery represents a major technological advancement in the treatment of patients with colorectal disease. Several recent randomized controlled trials comparing robotic colorectal surgery with laparoscopic surgery have demonstrated improved short-term patient outcomes in the robotic group. Whilst the primary focus of research in robotic surgery has been on patient outcomes, the robotic platform also provides unparalleled benefits for the surgeon, including improved ergonomics and surgeon comfort, with the potential to reduce occupational injuries and prolong career longevity. It is becoming clear that robotic surgical systems improve patient outcomes and may provide significant benefits to the surgical workforce.

Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery

OBJECTIVE

The main objective of this study was to develop and evaluate the feasibility and effectiveness of a novel exoskeleton system designed to provide ergonomic assistance to surgeons while preserving or improving the quality of endoscopic sinus and skull base surgical procedures.

METHODS

To evaluate the functionality and ergonomic characteristics of the device, five experiments were conducted in different and increasingly realistic scenarios: silicone model of the nasal cavity, freshly frozen cadavers and finally in a real surgery. Each volunteer's task was recorded and timed. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) rating scale was used to estimate the surgeons' workload while performing the tasks.

RESULTS

Twenty-five volunteers took part in the experiments. Volunteers perceived more comfort and less fatigue and pain when using the armrest than when not using the device (3.3, SD 1.75 vs. 5.9 SD 1.49; p = 0.02). Participants found the device intuitive, comfortable, and improving accuracy and stability with endoscope use.

CONCLUSION

A new system that provides ergonomic assistance to surgeons was tested in simulation surgery with acceptable usability. Initial results in terms of pain and fatigue reduction and efficiency were excellent, justifying further research into this technology.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:79-86, 2024.

Ergonomic risk assessment of surgeon's position during radical prostatectomy: Laparoscopic versus robotic approach

BACKGROUND AND OBJECTIVES

Radical prostatectomy (RP) is a definitive surgical therapy for localized prostate cancer. Evidence suggests that the poor ergonomics of surgeons during RP may lead to work-related musculoskeletal disorders and loss of productivity. Since each surgery modality has its physical demands, we compared the ergonomic risk between laparoscopic (LRP) and robotic-assisted (RARP) radical prostatectomy.

METHODS

The study assessed the posture of 10 urological surgeons during LRP and RARP surgeries with the Rapid Entire Body Assessment (REBA) scale.

RESULTS

We found that the RARP approach resulted in lower REBA scores over the LRP procedure.

CONCLUSIONS

Robotic surgery improves body posture for the urological surgeon like in other medical specialties. However, the surgeons display harmful postures in both surgeries.

Evaluating the Efficacy of a Novel Side-Support Surgical Tray Stand for Endoscopic Transnasal Skull Base Surgery: A Prospective Study

Objective Endoscopic transnasal skull base surgery is a valuable technique used in the surgical treatment of various skull base pathologies. In such surgeries, the reconstruction of the skull base is crucial for surgical success and minimizing complications. This study presents a new side-support surgical tray designed to improve the exposure of the lateral femoral surgical area during surgery, enhancing surgical efficiency and reducing the risk of surgical complications. The study compared this innovative tray stand with the conventional double-sided support tray stand to evaluate its impact on surgical procedures and complications. Materials and methods The study prospectively analyzed 248 endoscopic transnasal skull base surgeries requiring lateral femoral autologous tissue harvesting. One hundred fifty-eight cases were performed using the side-support surgical tray stand (experimental group), while 90 cases used the conventional double-sided support tray stand (control group). Various parameters were evaluated, including satisfaction scores of surgeons, circulating nurses, instrument nurses, and anesthetists, as well as objective outcomes such as surgical duration and the incidence of complications. Results Surgeons in the experimental group expressed higher satisfaction with the surgical field exposure and the portability of the surgical tray stand compared to the control group. Likewise, circulating nurses in the experimental group reported greater satisfaction with the installation and portability, surpassing that of the control group (p< 0.01). Although the stability of instrument nurses in the experimental group was slightly less than that of the control group, it had no discernible impact on surgical cooperation. Anaesthesiologists in the experimental group exhibited higher satisfaction regarding the convenience of intraoperative monitoring and management than their counterparts in the control group. The average duration required for intraoperative autologous tissue harvesting in the experimental group was significantly shorter than in the control group (p < 0.01). Furthermore, the incidence of postoperative wound infections and intracranial infections in the experimental group was notably lower than in the control group (would infections, p = 0.046; intracranial infection, p = 0.025). Conclusion The novel side-support surgical tray stand effectively improves surgical exposure, convenience, and safety while reducing the risk of surgical site and intracranial infections. It also shortens surgical duration and lowers complication rates, making it a suitable choice for clinical application.

Surgical fatigue syndrome and EDiS3 intervention, should every surgeon need to know how to mitigate muscle skeletal discomfort?

Background

Surgical fatigue syndrome (SFS) is a frequent, but underestimated, entity that occurs during laparoscopic surgeries. It could impair surgical outcomes, patient safety, and surgeon health. Furthermore, current surgical education lacks effective interventions to avoid it. Discomfort represents the most common manifestation and includes musculoskeletal fatigue, numbness, or frank pain. The most common affected sites are the back neck, dominant hand shoulder, and high or low back. We propose an integral intervention (surgeon posture, instruments/devices design & use and discomfort improvement) that prevents or mitigates SFS.

Methods

An experimental study was conducted on 57 general surgery residents and general surgeons. Participants in the experimental and control group executed standardized laparoscopic knots in a simulator and knowledge, body discomfort, and posture/ergonomic risk was evaluated before and after intervention application.

Results

A statistically significant decrease in discomfort intensity was found in the experimental group. Also, discomfort presentation by the anatomic site diminishes and surgical performance improves.

Conclusions

Intervention prevents or mitigates discomfort associated with muscle-skeletal component of SFS.

ACGME competency

Practice Based-Learning and Improvement.

Factors affecting upper limb ergonomics in robotic colorectal surgery

The aim of the study was to examine the factors which may influence suboptimal ergonomic surgeon hand positioning during robotic colorectal surgery (RCS). An observational study of 11 consecutive RCS cases from June 2022 to August 2022 was performed. Continuous video footage of RCS cases was analysed concurrently with video recordings of surgeon's hand positions at the console. The outcome studied was the frequency with which either hand remained in a suboptimal ergonomic position outside the predetermined double box outlines, as marked on the surgeon's video, for >1 min. Situations which resulted in poor upper limb ergonomics were dissection in the peripheral operating field location, left-hand use, use of the stapler, dissection of the main mesenteric blood vessels, and multi-quadrant surgery. Being aware of situations when suboptimal ergonomic positions occur can allow surgeons to consciously compensate by using the clutch or pausing to take a rest break.

What does this paper add to the literature?

The study is important because it is the first to look at factors which may influence poor upper limb ergonomics during non-simulated RCS. By recognizing these factors and compensating for them, it may improve surgeon ergonomics with resultant better performance.

Evolution of operating microscopes and development of 3D visualization systems for intraocular surgery

The recent development of high-resolution, heads-up, 3D visualization microscopy systems has provided new technical and visualization options for ophthalmic surgeons. In this review, we explore the evolution of microscope technologies, the science behind modern 3D visualization microscopy systems, and the practical benefits (as well as disadvantages) that these systems provide over conventional microscopes for intraocular surgical practice. Overall, modern 3D visualization systems reduce the requirements for artificial illumination and provide enhanced visualization and resolution of ocular structures, improving ergonomics, and facilitating a superior educational experience. Even when considering their disadvantages, such as those related to technical feasibility, 3D visualization systems have an overall positive benefit/risk ratio. It is hoped these systems will be adopted into routine clinical practice, pending further clinical evidence on the benefits they may provide on clinical outcomes.

Can a Wireless Full-HD Head Mounted Display System Improve Knee Arthroscopy Performance? - A Randomized Study Using a Knee Simulator

INTRODUCTION

Our prototype wireless full-HD Augmented Reality Head-Mounted Display (AR-HMD) aims to eliminate surgeon head turning and reduce theater clutter. Learning and performance versus TV Monitors (TVM) is evaluated in simulated knee arthroscopy.

METHODS

19 surgeons and 19 novices were randomized into either the control group (A) or intervention group (B) and tasked to perform 5 simulated loose-body retrieval procedures on a bench-top knee arthroscopy simulator. A cross-over study design was adopted whereby subjects alternated between devices during trials 1-3, deemed the "Unfamiliar" phase, and then used the same device consecutively in trials 4-5, to assess performance in a more "Familiarized" state. Measured outcomes were time-to-completion and incidence of bead drops.

RESULTS

In the unfamiliar phase, HMD had 67% longer mean time-to-completion than TVM (194.7 ± 152.6s vs 116.7 ± 78.7s, P < .001). Once familiarized, HMD remained inferior to TVM, with 48% longer completion times (133.8 ± 123.3s vs 90.6 ± 55s, P = .052). Cox regression revealed device type (OR = 0.526, CI 0.391-0.709, P < .001) and number of procedure repetitions (OR = 1.186, CI 1.072-1.311, P = .001) are significantly and independently related to faster time-to-completion. However, experience is not a significant factor (OR = 1.301, CI 0.971-1.741, P = .078). Bead drops were similar between the groups in both unfamiliar (HMD: 27 vs TVM: 22, P = .65) and familiarized phases (HMD: 11 vs TVM: 17, P = .97).

CONCLUSION

Arthroscopic procedures continue to be better performed under conventional TVM. However, similar quality levels can be reached by HMD when given more time. Given the theoretical advantages, further research into improving HMD designs is advocated.

Digital Survey Assessment of Individual and Occupational Factors Associated with Musculoskeletal Disorders among Indian Ophthalmologists

Purpose

To study the prevalence of musculoskeletal disorder (MSD) and the associated occupational risk factors among Indian ophthalmologists, including residents and fellows.

Methods

A cross-sectional survey was conducted among ophthalmologists in India using a semi-structured questionnaire in a web-based survey. The questionnaire was prepared in English after extensive literature research and consulting with subject experts. It was pretested on ten ophthalmologists and after confirming that there were no ambiguities, the questionnaire was circulated. After providing informed consent online and ensuring the confidentiality of information, respondents could fill out the questionnaire containing questions to assess demographic details, risk factors, and musculoskeletal symptoms.

Results

We received 551 valid responses, out of which 74.77% reported musculoskeletal symptoms since starting practice in ophthalmology. We found a statistically significant association of work-related MSD with greater hours of practice, a higher number of hours of surgery, and a larger patient load. The self-reported symptoms were maximum in lower back (56.55%), followed by neck (49.03%), upper back (38.59%), and shoulder (23.79%). As a remedial measure, 58.98% resorted to rest while only 8.98% consulted orthopedist. Only 46% were aware of good ergonomic practices. Surgery (74.5%), indirect ophthalmoscopy (51.69%), and slit-lamp examination (50.73%) were reported as the major culprits. Respondents declared an interference with personal life (39.56%), with work (33.74%) as well as having caused psychological stress (43.2%) due to work-related MSD.

Conclusion

A vast majority of our respondents reported work-related MSD. Major risk factors were hours of practice, hours of surgery, higher body mass index, sedentary lifestyle, and higher patient load. The awareness of ergonomic practices was low.

Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope

OBJECTIVE

The comparative postural health of surgeons performing endoscopic and microscopic otologic surgeries has been a topic of active debate, with many nascent or anecdotal reports suggesting the latter encourages suboptimal ergonomics. Using inertial body sensors to measure joint angles, this study sought to objectively evaluate and compare the ergonomics of surgeons during endoscopic and microscopic otologic surgeries.

STUDY DESIGN

Prospective pilot trial.

SETTING

Large, multicenter, academic hospital system. Performed 21 otologic operations (10 endoscopic and 11 microscopic) in November 2020 and January 2021. All attendings were fellowship trained in otology/neurotology.

SUBJECTS

Eight otolaryngologists (four attendings and four residents) performing 21 otologic surgeries (11 microscopic and 10 endoscopic).

INTERVENTION

Approach to otologic surgery: endoscope or microscope.

MAIN OUTCOME MEASURES

Surgeons' neck and back angles while wearing ergonomic sensors affixed to either side of each major joint, mental and physical burdens and pain after each surgery (via modified NASA Task Load Index).

RESULTS

Residents' necks (9.54° microscopic vs. -4.79° endoscopic, p = 0.04) and backs (16.48° microscopic vs. 3.66° endoscopic, p = 0.01) were significantly more flexed when performing microscopic surgery than when performing endoscopic surgery, although attending neck and back flexion were comparable during microscopic and endoscopic surgeries. Attendings reported significantly higher pain levels after operating microscopically than after operating endoscopically (0.13 vs. 2.76, p = 0.01).

CONCLUSIONS

Residents were found to operate with significantly higher risk back and neck postures (as defined by the validated ergonomic tool, Rapid Entire Body Assessment) when operating microscopically. Attendings reported significantly higher levels of pain after operating microscopically versus endoscopically, suggesting that the suboptimal microscopic postures adopted earlier in training may pose an indelible risk later in a surgeon's career.

De Quervain Tenosynovitis as a Risk Factor of New-Onset Adhesive Capsulitis: A Nationwide Cohort Study

This study investigated the association of de Quervain tenosynovitis (DQT) with subsequent adhesive capsulitis (AC) development. Patients with DQT between 2001 and 2017 from the Taiwan National Health Insurance Research Database were the DQT cohort. The 1:1 propensity score matching method was applied for creating control cohort. The primary outcome was defined as new-onset of AC at least 1 year after the date of confirmed diagnosis of DQT. In total, 32,048 patients with mean age 45.3 years were included. DQT was significantly positively associated with risk of new-onset AC after adjustment for baseline characteristics. Furthermore, severe DQT requiring rehabilitation was positively associated with risk of new-onset AC. In addition, male gender and age under 40 may be additional risk factors for new-onset AC, compared to female gender and age over 40. Cumulative incidence of AC after 17 years was 24.1% among patients with severe DQT requiring rehabilitation and was 20.8% among patients with DQT without rehabilitation. This is the first population-based study to demonstrate an association between DQT and new-onset AC. The findings recommend that preventive occupational therapy, including active modification for the shoulder joint and adjustments to daily activities, may be necessary for patients with DQT to reduce their risk of developing AC.

Factors Associated With Musculoskeletal Pain Among Hair Transplant Surgeons: Analyses of Survey Data and Review of the Literature

BACKGROUND

The prevalence of work-related musculoskeletal disorders (WRMD) is increasing among all surgical specialties.

OBJECTIVE

Results of a cross-sectional survey of hair transplant surgeons were analyzed, with the aims to (1) determine the prevalence of WRMD, (2) assess risk factors associated with musculoskeletal (MSK) symptoms, and (3) identify mitigation measures.

MATERIALS AND METHODS

A survey pertaining to demographics, MSK-related symptoms and its impacts, and pain mitigation measures taken, if any, were distributed to 834 hair transplant surgeons. Risk factors associated with pain severity were assessed using linear regression.

RESULTS

Overall, 78.5% (73 of 93) respondents had experienced pain when performing surgery. Musculoskeletal symptoms were most severe in the neck, followed by upper/lower back, and extremities. Number of grafts performed per session of follicular unit extraction positively correlated with pain severity; female surgeons and surgeons aged >71 years were at higher risk. A majority expressed concern that WRMD may limit their career and agreed to a need for improved workplace education. Strength training and ergonomic improvements of surgical procedure were not commonly adopted.

CONCLUSION

In sum, WRMD can be debilitating in health care professionals. Workplace ergonomic adjustments and physical exercise programs may be warranted to better mitigate MSK symptoms.

A narrative review of ergonomic problems, principles, and potential solutions in surgical operations

BACKGROUND

Ergonomic development and awareness are critical to the long-term health and well-being of surgeons. Work-related musculoskeletal disorders affect an overwhelming majority of surgeons, and various operative modalities (open, laparoscopic, and robotic surgery) differentially affect the musculoskeletal system. Previous reviews have addressed various aspects of surgical ergonomic history or methods of ergonomic assessment, but the purpose of this study is to synthesize ergonomic analysis by surgical modality while discussing future directions of the field based on current perioperative interventions.

METHODS

pubmed was queried for "ergonomics," "work-related musculoskeletal disorders," and "surgery," which returned 124 results. From the 122 English-language papers, a further search was conducted via the articles' sources for relevant literature.

RESULTS

Ninety-nine sources were ultimately included. Work-related musculoskeletal disorders culminate in detrimental effects ranging from chronic pain and paresthesias to reduced operative time and consideration for early retirement. Underreporting symptoms and a lack of awareness of proper ergonomic principles substantially hinder the widespread utilization of ergonomic techniques in the operating room, reducing the quality of life and career longevity. Therapeutic interventions exist at some institutions but require further research and development for necessary widespread implementation.

CONCLUSION

Awareness of proper ergonomic principles and the detrimental effects of musculoskeletal disorders is the first step in protecting against this universal problem. Implementing ergonomic practices in the operating room is at a crossroads, and incorporating these principles into everyday life must be a priority for all surgeons.

Psychological Stress and Hand Eczema in Physicians and Dentists: A Comparison Based on Surgical Work

BACKGROUND

This research looks at the connection between psychological stress and the prevalence of hand eczema (HE) among physicians and dentists (surgeons, non-surgeons).

METHODS

This cross-sectional field study involved 185 participants: physicians (surgeons, non-surgeons), dentists (surgeons, non-surgeons) and controls. Hand lesions were examined using the Osnabrueck Hand Eczema Severity Index (OHSI), and participants answered the Nordic Occupational Skin Questionnaire (NOSQ) and Perceived Stress Scale (PSS). Patch tests were performed using commercial contact allergens.

RESULTS

The estimated prevalence of HE (self-reported) was 43.9% (physicians 44.6%; dentists 43.2%). HE was significantly more reported by surgeons than controls (p < 0.004; V = 0.288). Degrees of perceived stress (PSS) did not differ significantly between the groups, though physicians non-surgeons most exhibited high stress (50%), and physicians surgeons most exhibited low stress (22.5%). High stress was associated with 2.5 higher odds for self-reported HE (p = 0.008). Low stress was greater among physicians/dentists who did not report eczema (41.0% vs. 24.6%); moderate stress was more common among those who reported eczema (72.3% vs. 51.8%; p = 0.038; V = 0.210).

CONCLUSIONS

Since high stress levels may negatively influence physicians'/dentists' work and quality of life, measures to decrease stress could be introduced into the treatment of healthcare workers who are prone to it.

A Change Management Approach to Promoting and Endorsing Ergonomics within a Dental Setting

Musculoskeletal pain and disorders (MSDs) constitute a well-recognised occupational hazard to the dental community. Fortunately, they are preventable. Dental office ergonomics plays a key role in addressing these musculoskeletal challenges. An ergonomic improvement project based on Kotter's eight-step change model management theory was implemented within a dental practice. The project provided valuable evidence-based ergonomic interventions to prevent or reduce MSDs. The task force motivated staff to engage in strategies and interventions to enact an ergonomic vision. This case study represents an action plan to guide this ergonomic change. The key results of this project were an evidence-based ergonomics health promotional brochure, reduced sick leave attributable to MSDs, and workplace ergonomic checkpoints. The ergonomic change model represents an ongoing process where innovative trends and evaluative methods can be supported. Research limitations and practical implications were acknowledged.

Knowledge, Attitudes, and Practices Regarding Ergonomic Hazards Among Healthcare Workers in a Saudi Government Hospital

Background

Musculoskeletal disorders (MSDs) affecting healthcare workers (HCWs) must be considered and addressed as a serious issue. Thus, it is important to incorporate ergonomics into clinical practice to prevent MSDs. The objectives of this study were to investigate HCWs’ knowledge, attitudes, and practices regarding ergonomics in a large governmental healthcare facility.

Methods

A cross-sectional study was conducted in which the participants were interviewed to complete a validated four-section questionnaire (demographic data, knowledge, attitudes, and practice information related to ergonomics). The questionnaire was newly self-developed based on a literature review and was pilot tested after development.

Results

This study included 273 HCWs. Their average knowledge score regarding ergonomics was 2.6, or “fair to good.” Overall, the participants reported good attitude scores, with a total average score of 1 and 2, or “agree to strongly agree.” The findings also indicated that appropriate ergonomics practices were often not implemented, as the average practice score was 1 to 2, or “always to sometimes engaging in bad practice.” The risk factors of being Saudi, being a woman, and having low academic achievement were associated with poor knowledge, attitudes, and practices related to ergonomics among HCWs.

Conclusion

This study showed that the majority of the participants had fair knowledge and good attitudes toward ergonomics at work while practicing. However, the practice of ergonomics at work was not implemented. It is important to apply ergonomics at work to prevent MSDs; therefore, ergonomic principles should be included in the undergraduate health curriculum for all HCWs, with emphasis on practicing ergonomics in their routine clinical work.

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Prevalence Of Neck and Back Pain Among Gynecologists and Obstetrics in Tertiary Care Hospital of Lahore

Neck pain is identified as the ache, irritation and discomfort in the area below your head up to third Thoracic vertebrae. It can radiate to shoulders, arms and fingers also. The presenting complaints of cervical patients include headache, stiff neck, stress, muscle pain, fever, and tenderness, radiating pain, weakness in the arm and difficulty in lifting or gripping activities. Patients may also present with numbness, tingling and weakness of the arm. Objective: To determine the prevalence of neck and back pain among gynecologists and obstetrics in different tertiary care hospitals of Lahore. Methods: The cross-sectional study included 310 gynecologist and obstetrics that were recruited using non-probability convenience sampling. The cases of the neck pain were recruited from the obstetrics and gynecology department of different hospitals including: Fatima Memorial Hospital, Shalimar Hospital, Services Hospital, Mayo Hospital and Sir Ganga Ram Hospital, Lahore. Research was completed within six months from 23 October 2021 to 30th April 2022. Results: Among 310 participants, 196 (63.2%) reported neck pain among which; 153 (44.4%) gynecologists reported pain two times per week. Out of total, 306 (98.7%) reported fatigue especially on long days. Results regarding pain area showed that 196 (63.2%) had neck pain, 64 (24.6%) had back pain and 50 (16.1%) had shoulder pain. Results regarding frequency of pain showed that out of 310 (100%), 153 (49.4%) had pain 2 times per week and 105 (33.9%) had pain 0-2 times per month. Conclusions: Prevalence of low back pain was 20.65% whereas prevalence of neck pain in gynecologists was 63.23%. The study suggests that neck pain and fatigue were common in gynecologists and obstetrics. They lack of postural awareness and don’t follow ergonomics principles during surgical procedures. 

Presentation of Preclinical Gastrointestinal Anatomy via Laparoscopic Simulation

In this report, the authors examine the integration of teaching anatomical science with clinical implications in minimally invasive surgery. The authors hypothesized that implementation of integrated laparoscopic simulation during undergraduate medical education would improve student learning of anatomical structures from in situ, laparoscopic orientations; and subsequently improve student preparation for clinical rotations and clerkships. During the fall of 2020 and 2021, 260 (130 students/year) second year medical students at the University of Nebraska Medical Center participated in a six‐week gastrointestinal curriculum. Following a traditional anatomy dissection experience, students completed a laparoscopic event consisting of narrated laparoscopic videos and hands‐on laparoscopic simulation. To examine the integrated curricular event, outcome measures focused on technical performance using grasping forceps, anatomical knowledge, and perception of the educational innovation. Outcomes were analyzed via timed performance and a pre and post assessment that was designed to assess student anatomical knowledge and perception. Completion of the technical performance assessment ranged from 1 min, 17 s to 6 min. Student knowledge of anatomical structures from in situ, laparoscopic orientations following the laparoscopic simulation sessions was significantly improved (53.3% pre vs 81.0% post), and almost all students (98.9%) agreed that the simulation sessions improved their understanding of laparoscopic anatomy and procedures. This report demonstrates the implementation of a multidisciplinary, integrated simulation that satisfied basic science anatomy teaching objectives, while enhancing student enthusiasm for the content. Future studies will examine the subsequent impact of the innovation on student preparedness for clinical rotations and clerkships.

Minimally invasive surgery and the risk of work-related musculoskeletal disorders: Results of a survey among Israeli surgeons and review of the literature

BACKGROUND: Minimally invasive surgery (MIS) has many advantages for patients, however, it places surgeons at risk for Work-related musculoskeletal disorders (WMSD). Recently, the importance of prevention of such injuries and improvement of the ergonomics of the operating room is increasing. OBJECTIVES: To assess the prevalence of WMSD among minimally invasive surgeons in Israel, discuss the contributing factors and the overall awareness for ergonomic training. In addition, a review of the literature on the topic was conducted. METHODS: An online questionnaire was sent to the members of the Israeli Society of Endoscopic Surgery. The results were analyzed and summarized. For literature review, PubMed was used to search for English-language publications related to the issue. RESULTS: Of 83 respondents, the majority (77%) have considerable experience in MIS (more than 10 years). The prevalence of WMSD was 12% before beginning the practice of laparoscopy compared to 78% after 15–20 years of practice. Injury sites included back pain, neck and upper extremity (shoulder pain, tennis elbow and carpal tunnel syndrome) in 41%, 25% and 34% respectively. More than two thirds of responders unaware of possible ergonomic solutions and didn’t consider adopting any appropriate preventive measures. CONCLUSIONS: The incidence of WMSD among MIS surgeons is high and underestimated. There is a desperate need to prevent such morbidity among surgeons by increasing awareness and providing the means to improve their work environment. Surgeons should adhere to ergonomic recommendations for positioning of monitors, table height, posture, foot pedal placement and laparoscopic devices use.

Operation-related Musculoskeletal Injuries among United States Surgeons: A Gender-stratified National Survey

Operation-related musculoskeletal injury (ORMI) among surgeons is a well-described phenomenon. Our study aimed to determine the prevalence of self-reported ORMI among surgeons of various subspecialties and preliminarily investigate the role of gender.

METHODS

An anonymous survey, querying information pertinent to ORMIs, was distributed online through the American College of Surgeons community membership forum. Nonparametric univariate analysis and a multivariate regression model were conducted. A P value of 0.05 determined significance.

RESULTS

A total of 624 male and female surgeons responded to the survey, with 50.8% reporting having an injury related to operating. Among the entire cohort, the prevalence of ORMI was significantly higher among female surgeons than male surgeons (P = 0.01), although there was no significant difference among the genders in ORMI prevalence when stratifying by age group (all P > 0.05).

CONCLUSION

Female surgeons are more likely to report an ORMI, although the impact of confounding variables such as age, operative case volume, and surgical subspecialty remain to be fully elucidated.

Chairless Chairs for Orthopedic Surgery Purpose – A Literature Review

Musculoskeletal disorders are often found in various types of work, including surgeons. Standing working position is immobile and rigid when performing surgical operations. The equipment used is less ergonomic which is the main parameter. The surgeon profession belongs to the category of the high-risk profession and has the potential to experience musculoskeletal disorders. Surgeons who suffer musculoskeletal disorders sense disease start from mild-to-severe due to the muscles receiving static loads frequently in the long-term. The emergence of musculoskeletal disorders can be caused by working environment conditions and standing position while working, causing injury to joints, vertebral discs, nerves, cartilage, tendons, and muscles. This paper describes in extensive the potential for reducing musculoskeletal problems with the use of a chairless chair for surgeons in carrying out operations. Musculoskeletal problems in surgery and the use of chairless chairs have been further explored to close the existing research gap.

Human factors in pelvic surgery

In the pelvis, anatomic complexity and difficulty in visualization and access make surgery a formidable task. Surgeons are prone to work-related musculoskeletal injuries from the frequently poor design and flow of their work environment. This is exacerbated by the strain of surgery in the pelvis. These injuries can result in alterations to a surgeons practice, inadvertent patient injury, and even early retirement. Human factors examines the relationships between the surgeon, their instruments and their environment. By bridging physiology, psychology, and ergonomics, human factors allows a better understanding of some of the challenges posed by pelvic surgery. The operative approach involved (open, laparoscopic, robotic, or perineal) plays an important role in the relevant human factors. Improved understanding of ergonomics can mitigate these risks to surgeons. Other human factors approaches such as standardization, use of checklists, and employing resiliency efforts can all improve patient safety in the operating theatre.

The relationship between low back pain and the basic lumbar posture at work: a retrospective cross-sectional study

PURPOSE

This study aimed to analyze the relationship between work-related lumbar posture (sitting, standing, walking, alternating posture) and LBP in workers.

METHODS

This is a retrospective study comprising 529 records of adult workers from a database of a private company. Predominant work-related lumbar posture was classified based on time spent in each posture. A total of 22 personal, occupational, clinical, and psychosocial covariates were evaluated. LBP symptoms in the last 12 months and during the last 7 days were the outcomes of the study. The multivariate analysis model evaluated the independent relationship between the work-related lumbar posture classification and other potential exposure factors with LBP.

RESULTS

The adjusted logistic regression model indicated that predominant walking reduced the likelihood to report LBP during the last 12 months when compared to standing (OR = 0.54; 95% CI 0.30, 0.99; p = 0.048), but there is no association between work-related postures and recent LBP. The adjusted analyses also revealed an association between LBP during the last 12 months and female sex, blue-collar task, frequently feeling tiredness, pain at any other body region previous 12 months, previous LBP, and monotonous work. Recent LBP was associated with female sex, pain at any other body region last 7 days, and previous LBP.

CONCLUSIONS

Standing posture increases the likelihood to report LBP during the last 12 months when compared to walking. LBP over previous year and during the previous 7 days was associated with personal and clinical factors.

Robotic Surgery: Rediscovering Human Anatomy

Since its advent, robotic surgery has redefined the operating room experience. It directly addressed and resolved many of the shortcomings of laparoscopic methods while maintaining a minimally invasive approach that brought benefits in cosmesis and healing for patients but also benefits in ergonomics and precision for surgeons. This new platform has brought with it changes in surgical training and education, principally through the utilization of virtual reality. Accurate depictions of human anatomy seen through augmented reality allow the surgeon-in-training to learn, practice and perfect their skills before they operate on their first patient. However, the anatomical knowledge required for minimally invasive surgery (MIS) is distinct from current methods of dissection and prosection that inherently cater towards open surgery with large cuts and unobstructed field. It is integral that robotic surgeons are also equipped with accurate anatomical information, heralding a new era in which anatomists can work alongside those developing virtual reality technology to create anatomical training curricula for MIS. As the field of surgery and medicine in general moves to include more and more technology, it is only fitting that the building blocks of medical education follow suit and rediscover human anatomy in a modern context.

'Ergopaedics': the future of ergonomics in orthopaedics

Ergonomics is the scientific study of people and their working conditions, aiming to improve effectiveness. Improved ergonomics of orthopaedic theatres and equipment would reduce the risk of occupational injury and help to encourage more women into an underrepresented specialty.

Ergonomic Analysis of Functional Endoscopic Sinus Surgery Using Novel Inertial Sensors

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.

Improving the Breast Surgeon's Ergonomic Workload for Nipple-Sparing Mastectomies Using Exercise and Operating Room Positioning Protocol

BACKGROUND

The objective of this study was to examine whether an exercise program and standardized operating room positioning protocol (EOPP) would improve surgeon muscle workload and/or surgeon perception of mental/physical workload for nipple-sparing mastectomy (NSM).

METHODS

This prospective study analyzed muscle workload by EMG of four surgeons performing NSM before and after an EOPP. Surveys were administered assessing surgeon perception of mental/physical workload. EMG data were analyzed using repeated-measures ANOVA, controlling for surgeon, first assistant, duration and difficulty of procedure, left or right side, and sequence of the procedure.

RESULTS

A total of 56 NSM cases performed by 3 surgeons were analyzed. One surgeon was excluded because of muscle injury and undergoing active physical therapy during the study period. After implementation of the EOPP, the left (P = 0.005) and right (P = 0.020) upper trapezii muscles had a significant decrease in overall ergonomic workload but there was no significant change in overall ergonomic workload for the bilateral cervical erector spinae, anterior deltoid, and lumbar erector spinae muscle groups. When analyzing muscle group exertion by surgeon, there was significant variability in all muscles except the left cervical erector spinae. Following the EOPP, surgeons reported that the procedures were more physically (P = 0.01) and mentally (P = 0.002) demanding and visualization (P = 0.04) was worse. The breast laterality and sequence did not affect muscle exertion.

CONCLUSIONS

An EOPP decreased the overall ergonomic workload of one muscle group for surgeons performing NSM but did not impact surgeon perception of mental/physical workload. Further investigation is needed to improve surgeon ergonomics.

Lithotomy versus Prone Position for Perianal Surgery: A Randomized Controlled Trial

Purpose

Studies objectively comparing lithotomy and prone positions regarding surgeon comfort, ergonomics, patient comfort, and position related complications are scarce.

Methods

The patients posted for surgery of either fistula in ano, hemorrhoids, or were included in this study. Subjective Mental Effort Questionnaire (SMEQ) and Local Experienced Discomfort (LED) scale were used to score the level of mental and physical stress among the operating surgeon, assistants, and the scrub nurse. Other parameters studied were the exposure of the operative site, patient comfort level, and position-related complications.

Results

Thirty patients were operated in each position. Mean ± standard deviation of jackknife prone vs. lithotomy surgeon SMEQ score (15.6 ± 10.4 vs. 107.0 ± 11.5, P < 0.05) and LED score (1.8 ± 1.5 vs. 6.7 ± 0.5, P < 0.05) were found to be statistically significant. Prone vs. lithotomy assistant SMEQ score (29.1 ± 13.1 vs. 100.6 ± 8.7, P < 0.05) and LED score (4.6 ± 1.1 vs. 7.4 ± 0.8, P < 0.05) were also found to be statistically significant. SMEQ (10.0 ± 0.0 vs. 20.6 ± 2.5, P < 0.05) and LED scores (1.1 ± 0.3 vs. 3.3 ± 0.5, P < 0.05) of scrub nurses and LED scores (2.5 ± 0.5 vs. 6.3 ± 0.7, P < 0.05) of patients were also statistically significant. Exposure of the operative site was significantly better in the prone position (5.0 vs. 2.1, P < 0.05).

Conclusion

Significantly better SMEQ, LED, and exposure score suggests the superiority of jackknife prone position over the lithotomy in terms of significantly less mental and physical stress to the operating surgeon, assistant, and scrub nurse; better ergonomics, and excellent exposure.

Assessing Risks Awareness in Operating Rooms among Post-Graduate Students: A Pilot Study

Background: In this study, we promote a global approach to occupational risk perception in order to improve occupational health and safety training programs. The study investigates the occupational risk perception of operating room healthcare workers using an Analytic Hierarchy Process approach. Methods: A pilot study was carried out through a cross-sectional survey in a university hospital in Southern Italy. An ad hoc questionnaire was administered to enrolled medical post-graduate students working in the operating room. Results: Fifty medical specialists from seven fields (anaesthetists, digestive system surgeons, general surgeons, maxillofacial surgeons, thoracic surgeons, urologists, and gynaecologists) were questioned about perceived occupational risk by themselves. Biological, ionizing radiation, and chemical risks were the most commonly perceived in order of priority (w = 0.300, 0.219, 0.210). Concerning the biological risk, gynaecologists unexpected perceived this risk as less critical (w = 0.2820) than anaesthesiologists (w = 0.3354), which have the lowest perception of the risk of ionizing radiation (w = 0.1657). Conclusions: Prioritization methods could improve risk perception in healthcare settings and help detect training needs and perform sustainable training programs.