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Wong SW, Parkes A, Crowe P. Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review. J Robot Surg 2024; 18:224. [PMID: 38801617 PMCID: PMC11130008 DOI: 10.1007/s11701-024-01992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.
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Affiliation(s)
- Shing Wai Wong
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Allan Parkes
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Philip Crowe
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
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2
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Bessone V, Roppenecker DB, Adamsen S. Work-Related Musculoskeletal Injury Rates, Risk Factors, and Ergonomics in Different Endoscopic Specialties: A Review. Healthcare (Basel) 2024; 12:885. [PMID: 38727442 PMCID: PMC11083686 DOI: 10.3390/healthcare12090885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Endoscopy-related musculoskeletal injuries (ERIs) are frequent among gastrointestinal, pulmonary, nasal, and urologic endoscopists, impacting the healthcare system. The present review aims to compare the ERI rates, risk factors, and ergonomic recommendations in the different endoscopic fields. A review was conducted using PubMed and Cochrane Library for articles based on surveys and published until 10 January 2024. Demographic, work, and ERI data from 46 publications were included, covering 10,539 responders. The ERI incidence ranged between 14% and 97%, highlighting the need of intervention independent of the specialties. The neck, back, and shoulder were the most frequent ERI locations, while gender, age, years of experience, and procedure volume the most common risk factors. Ergonomic recommendations suggest concentrating on endoscope design changes, especially in gastrointestinal endoscopy, to increase the comfort, adaptability of the equipment in the operating room, and workflow/institutional policy changes. The inclusion of an ergonomic timeout guarantees the correct equipment positioning, the neutralisation of the endoscopist's posture, and an indirect break between procedures. Ergonomic training to increase awareness and best practice should be promoted, also using new technologies. Future research should concentrate on intervention and comparative studies to evaluate to which extent prevention measures and newly designed equipment could reduce ERI incidence.
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Affiliation(s)
- Veronica Bessone
- Ambu Innovation GmbH, Karl-Drais-Strasse 4B, DE-86159 Augsburg, Germany
| | | | - Sven Adamsen
- Ambu A/S, Baltorpbakken 13, DK-2750 Ballerup, Denmark
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
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3
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Kaldany A, Patel HV, Shaw NM, Jones CP, Breyer BN. Ergonomics in Urology: Current Landscape and Future Directions. Urology 2024; 184:235-243. [PMID: 38160765 DOI: 10.1016/j.urology.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Optimal ergonomics are essential to improving clinical performance and longevity among urologists, as poor ergonomics can contribute to work-related injury and physician burnout. While a majority of urologists experience muscular injury throughout their career, women and trainees are disproportionately affected. These disparities are exacerbated by the lack of formal ergonomics education within urologic training programs. This review provides an overview of practical approaches to optimize ergonomics across working environments for urologists and trainees. We highlight intraoperative techniques and novel devices which have been shown to reduce work-related injury, and we identify knowledge gaps to guide future areas of ergonomic research.
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Affiliation(s)
- Alain Kaldany
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Hiren V Patel
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Nathan M Shaw
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Charles P Jones
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA
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4
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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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Hayashi MC, Sarri AJ, Pereira PASV, Rocha MM, Zequi SDC, Machado MT, de Souza AH, Magno LAV, Faria EF. Ergonomic risk assessment of surgeon's position during radical prostatectomy: Laparoscopic versus robotic approach. J Surg Oncol 2023; 128:1453-1458. [PMID: 37602508 DOI: 10.1002/jso.27419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
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.
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Affiliation(s)
- Marcel Calegari Hayashi
- Programa de Pós-Graduação em Oncologia (PPGO), Fundação Pio XII, Hospital de Câncer de Barretos, Barretos, Brazil
| | - Almir J Sarri
- Programa de Pós-Graduação em Oncologia (PPGO), Fundação Pio XII, Hospital de Câncer de Barretos, Barretos, Brazil
| | | | | | | | | | | | - Luiz Alexandre Viana Magno
- INCT em Neurotecnologia Responsável (INCT-NeurotecR), Belo Horizonte, Brazil
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, Brazil
| | - Eliney Ferreira Faria
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, Brazil
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6
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Gabrielson AT, Tetteh E, Shao J. Lessons from the first meeting of the society of surgical ergonomics: If you build it, they will come. Am J Surg 2023; 226:732-734. [PMID: 37607854 DOI: 10.1016/j.amjsurg.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Andrew T Gabrielson
- James Buchanan Brady Urological Institute at Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emmanuel Tetteh
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jenny Shao
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan Medicine, Ann Arbor, MI, USA.
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7
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Hislop J, Orth D, Tirosh O, Isaksson M, Hensman C, McCormick J. Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis. Surg Endosc 2023; 37:6640-6659. [PMID: 37433911 PMCID: PMC10462557 DOI: 10.1007/s00464-023-10228-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/17/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry. METHODS PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses. RESULTS A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools. CONCLUSIONS The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.
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Affiliation(s)
- Jaime Hislop
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Dominic Orth
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Oren Tirosh
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
- Institute for Health and Sport, Victoria University, Footscray, VIC, Australia.
| | - Mats Isaksson
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Chris Hensman
- Department of Surgery, Monash University,, Melbourne, VIC, Australia
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- LapSurgery Australia, Melbourne, VIC, Australia
| | - John McCormick
- Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, VIC, Australia
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8
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Razavi S, De EJB. Ergonomics in Urology: Silent Contributor to Burnout Among Women in Urology? Urology 2023; 173:222-225. [PMID: 36566785 DOI: 10.1016/j.urology.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Sarah Razavi
- The Arthur Smith Institute for Urology, New York, NY.
| | - Elise J B De
- Department of Urology, Albany Medical college, Albany, NY
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9
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Gillespie AM, Wang C, Movassaghi M. Ergonomic Considerations in Urologic Surgery. Curr Urol Rep 2023; 24:143-155. [PMID: 36580226 DOI: 10.1007/s11934-022-01142-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW This paper aims to discuss the various work-related musculoskeletal disorders (WRMDs) among urologists and provide an overview of the latest recommendations to improve awareness of ergonomic principles that can be applied in the operating room, with special consideration of challenges faced during pregnancy. RECENT FINDINGS Urologists suffer from a large burden of WRMDs. The main drivers of pain associated with the various surgical approaches include repetitive movements, static and awkward body positions, and the use of burdensome equipment. Pregnant surgeons are at an even greater risk of WRMDs and face high rates of pregnancy complications. Laparoscopy, endoscopy, robot-assisted surgeries, and open surgeries present unique ergonomic challenges for the practicing urologist. Proper posture and equipment use, optimal operating room setup, intraoperative stretching breaks, and an emphasis on teaching ergonomic principles can reduce the risk of WRMDs. Surgeons are also at increased risk of WRMDs during pregnancy but may continue to operate while taking measures to limit physical exertion and fatigue. Improving awareness of and incorporating ergonomic principles early in a urologist's career may reduce the risk of injury and improve operative performance and longevity.
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Affiliation(s)
- Anton M Gillespie
- Columbia University Vagelos College of Physicians & Surgeons, 630 W 168th St, New York, NY, 10032, USA
| | - Connie Wang
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Miyad Movassaghi
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA.
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10
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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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11
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Gabrielson AT, Tanidir Y, Castellani D, Ragoori DR, Lim EJ, Corrales M, Winoker JS, Schwen ZR, Matlaga B, Seitz C, Skolarikos A, Gözen AS, Monga M, Chew BH, Teoh JYC, Traxer O, Somani BK, Gauhar V. A Global Survey of Ergonomics Practice Patterns and Rates of Musculoskeletal Pain Among Urologists Performing Retrograde Intrarenal Surgery. J Endourol 2022; 36:1168-1176. [PMID: 35521646 DOI: 10.1089/end.2022.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Retrograde intrarenal surgery (RIRS) requires awkward body posture for long durations. Few urologists receive ergonomics training despite the availability of ergonomics best practices utilized by other surgical specialties. We characterize ergonomics practice patterns and rates of musculoskeletal (MSK) pain among urologists performing RIRS. METHODS A web-based survey was distributed via the Endourological Society, the EAU, and social media. Surgeon anthropometrics and ergonomic factors were compared to ergonomics best practices. Pain was assessed with the Nordic Musculoskeletal Questionnaire (NMQ). RESULTS Overall, 519 of 526 participants completed the survey (99% completion rate). Ninety-three percent of urologists consider ergonomic factors when performing RIRS to reduce fatigue (68%), increase performance (64%), improve efficiency (59%), and reduce pain (49%). Only 16% received ergonomics training. Residents/fellows had significantly lower confidence in ergonomic technique compared to attending surgeons of any career length. Adherence to proper ergonomic positioning for modifiable factors were highly variable. On NMQ, 12-month rates of RIRS-associated pain in ≥1 body part, pain limiting activities of daily living, and pain requiring medical evaluation were 81%, 51%, and 29%, respectively. Annual case volume >150 cases (OR 0.55 [0.35-0.87]) and higher adherence to proper ergonomic techniques (OR 0.67 [0.46-0.97]) were independently associated with lower odds of pain. Limitations include a predominantly male cohort which hindered the ability to assess gender disparities in pain and ergonomic preferences. CONCLUSION Adherence to ergonomics best practices during RIRS is variable and may explain high rates of MSK pain among urologists. These results underscore the importance of utilizing proper ergonomic techniques and may serve as a framework for establishing ergonomics guidelines for RIRS.
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Affiliation(s)
- Andrew T Gabrielson
- Johns Hopkins University James Buchanan Brady Urological Institute, 117539, 600 N. Wolfe Street, Baltimore, Baltimore, Maryland, United States, 21287-0010;
| | - Yiloren Tanidir
- Marmara University School of Medicine, Urology, Marmara Universitesi Pendik EAH, Fevzi Cakmak Mah. Mimar Sinan Cad., No:41 Uroloji AD. Kat:4, Ust kaynarca / Pendik, Istanbul, Turkey, 34899;
| | - Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | - Deepak Reddy Ragoori
- Asian Institute of Nephrology and Urology, 519389, Urology, 6-3-562/A, behind MORE megamart, Errum Manzil, Hyderabad, Telangana, India, 500082;
| | - Ee Jean Lim
- Singapore General Hospital, Department of Urology, Academia Level 5, 20 College Rd, Singapore 169856, Singapore, Singapore, 169856;
| | - Mariela Corrales
- Hospital Tenon, 55705, Urology, 4 Rue de la Chine, Paris, Île-de-France, France, 75020;
| | - Jared S Winoker
- The Smith Institute for Urology, 536758, Urology, 130 E 77th St - 5th Floor, Baltimore, MD, New York, New York, United States, 10075;
| | - Zeyad R Schwen
- University of Pittsburgh, Graduate School of Medicine, Pittsburgh, Pennsylvania, United States;
| | - Brian Matlaga
- Johns Hopkins University, Brady Urological Institute, Baltimore, Maryland, United States;
| | | | - Andreas Skolarikos
- University of Athens, 2nd Department of Urology, 6 LASKAREOS ST, NEA ZOI PERISTERI, Athens, Greece, 12137;
| | - Ali Serdar Gözen
- SLK Kliniken, Urology, am gesundbrunnen 25, Heilbronn, Germany, 74078.,Germany;
| | - Manoj Monga
- University of California San Diego School of Medicine, 12220, Urology, La Jolla, California, United States;
| | - Ben H Chew
- University of British Columbia, Urologic Sciences, Level 6, 2775 Laurel st., Level 6 - 2775 Laurel St, Vancouver, British Columbia, Canada, V5Z 1M9.,University of British Columbia, 8166, Urologic Sciences, 2775 Laurel St, Level 6, Vancouver, British Columbia, Canada, V5Z 1M9;
| | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | - Olivier Traxer
- Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France;
| | - Bhaskar K Somani
- University Hospitals Southampton NHS Trust, Urology, Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland, SO16 6YD.,United Kingdom of Great Britain and Northern Ireland;
| | - Vineet Gauhar
- Ng Teng Fong General Hospital, 242949, Urology, Singapore, Singapore;
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12
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Miller DT, Semins MJ. Safety During Ureteroscopy: Radiation, Eyes, and Ergonomics. Front Surg 2021; 8:737337. [PMID: 34778359 PMCID: PMC8580849 DOI: 10.3389/fsurg.2021.737337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
It is known that urologic surgeons are at risk of work-place injury due to the physical requirements of operating and exposure to hazards. These hazards include radiation, exposure to body fluids, use of laser energy, and orthopedic injury due to the physical nature of operating. The risks that these hazards present can be mitigated by implementing several evidence-based safety measures. The methods to protect against radiation exposure include keeping radiation usage in the operating room as low as reasonably achievable, donning lead aprons, and wearing protective glasses. Additionally, protective glasses decrease the risk of eye injury from laser injury and exposure to body fluids. Finally, practicing sound surgical ergonomics is essential to minimize the risk of orthopedic injury and promote career longevity. The interventions discussed herein are simple and easy to implement in one's daily practice of urology.
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Affiliation(s)
- David T Miller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michelle J Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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13
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Gabrielson AT, Clifton MM, Pavlovich CP, Biles MJ, Huang M, Agnew J, Pierorazio PM, Matlaga BR, Bajic P, Schwen ZR. Surgical ergonomics for urologists: a practical guide. Nat Rev Urol 2021; 18:160-169. [PMID: 33432182 DOI: 10.1038/s41585-020-00414-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
Poor ergonomics in the operating room can have detrimental effects on a surgeon's physical, psychological and economic well-being. This problem is of particular importance to urologists who are trained in nearly all operative approaches (open, laparoscopic, robotic-assisted, microscopic and endoscopic surgery), each with their own ergonomic considerations. The vast majority of urologists have experienced work-related musculoskeletal pain or injury at some point in their career, which can result in leaves of absence, medical and/or surgical treatment, burnout, changes of specialty and even early retirement. Surgical ergonomics in urology has been understudied and underemphasized. In this Review, we characterize the burden of musculoskeletal injury in urologists and focus on various ergonomic considerations relevant to the urology surgeon. Although the strength of evidence remains limited in this space, we highlight several practical recommendations stratified by operative approach that can be incorporated into practice without interrupting workflow whilst minimizing injury to the surgeon. These recommendations might also serve as the foundation for ergonomics training curricula in residency and continuing medical education programmes. With improved awareness of ergonomic principles and the sequelae of injury related to urological surgery, urologists can be more mindful of their operating room environment and identify ways of reducing their own symptoms and risk of injury.
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Affiliation(s)
- Andrew T Gabrielson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Marisa M Clifton
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mitchell Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacqueline Agnew
- Department of Environmental Health and Engineering, Johns Hopkins Education and Research Center for Occupational Safety and Health, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian R Matlaga
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad R Schwen
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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14
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Gender equity in ergonomics: does muscle effort in laparoscopic surgery differ between men and women? Surg Endosc 2021; 36:396-401. [PMID: 33492502 DOI: 10.1007/s00464-021-08295-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women surgeons may experience more ergonomic challenges while performing surgery. We aimed to assess ergonomics between men and women surgeons. METHODS Laparoscopic surgeons from a single institution were enrolled. Demographics and intraoperative data were collected. Muscle groups were evaluated objectively using surface electromyography (EMG; TrignoTM, Delsys, Inc., Natick, MA), and comprised upper trapezius (UT), anterior deltoid, flexor carpi radialis (FCR), and extensor digitorum (ED). Comparisons were made between women (W) and men (M) for each muscle group, assessing maximal voluntary contraction (MVC) and median frequency (MDF). The Piper Fatigue Scale-12 (PFS-12) was used to assess self-perceived fatigue. Statistical analyses were performed using SPSS v26.0, α = 0.05. RESULTS 18 surgeries were recorded (W:8, M:10). Women had higher activation of UT (32% vs 23%, p < 0.001), FCR (33% vs 16%, p < 0.001), and ED (13% vs 10%, p < 0.001), and increased effort of ED (90.4 ± 18.13 Hz vs 99.1 ± 17.82 Hz). Comparisons were made between W and M for each muscle group, assessing MVC and MDF. CONCLUSIONS After controlling for surgeon's height and duration of surgery, an increase in muscle activation was seen for women laparoscopic surgeons. Since poor ergonomics could be a major cause of work-related injuries, we must understand differences in ergonomics between men and women and evaluate which factors impact these variations.
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15
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Teplitsky SL, Leong JY, Calio B, Hubosky SG, Bagley D. Ergonomics in Endourology: Measurement of Force for Deflection in Contemporary Ureteroscopes. J Endourol 2021; 35:215-220. [PMID: 32993396 DOI: 10.1089/end.2020.0369] [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] [Indexed: 11/12/2022] Open
Abstract
Introduction: Few studies have examined the ergonomic hazards to endourologists during endoscopic procedures. We have evaluated the forces required to deflect different flexible ureteroscopes across a range of measurements with several different standard instruments within the working channel. Methods: Five ureteroscopes were studied: the Uscope, Neoflex, LithoVue™, URF-P6, and the Flex-X2™. A pull-force meter (Nextech DFS 500) was attached to the thumb lever to deflect the tip from 30° to 210° at 30° intervals. Measurements were made with upward and downward deflection separately. The forces were reported in Newtons (N) to the nearest 10th, as positive values regardless of the direction of the force. Measurements were made with the channel empty or containing an instrument: a 365 μm laser fiber, a 2.4F Nitinol basket, 3F biopsy forceps, or a 0.038" guidewire using the flexible or the stiff tip. Results: The maximum downward deflection force, measured at 210° of deflection, with an empty channel range from a minimum of 5.7 N in one scope to a maximum of 33.4 N in another. The force necessary for deflection ranges from 2.0 to 7.0 N (0.45-1.57 foot-pounds) at 30° to 8.5 to 25.3 N (1.8-5.69) at 180°. Maximum upward deflection shows similar results with a minimum of 7.9 N in one scope and a maximum of 43.1 N of force in another. Working instruments in the channel increased the force needed for deflection. Conclusions: Forces required for steep deflection of the tip of a flexible ureteroscope reach extremely high levels or limit the deflection capability of the scope. The force is higher with increased deflection and with instruments within the channel.
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Affiliation(s)
- Seth L Teplitsky
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian Calio
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott G Hubosky
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Demetrius Bagley
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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16
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Golan R, Shah O. Performance Optimization Strategies for Complex Endourologic Procedures. Urology 2020; 139:44-49. [PMID: 32045590 DOI: 10.1016/j.urology.2020.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To identify and address factors that may impact a surgeon's performance during endourologic procedures. METHODS A literature review was performed for articles focusing on surgical ergonomics, education, sports and performance psychology. RESULTS As urologists and trainees have become more comfortable approaching complex pathology endoscopically, there remains an opportunity to refine surgeon-related factors and optimize extrinsic factors to maximize efficiency and provide patients with the highest quality outcomes and safety. CONCLUSION Medical centers and training programs should strive to include formal lessons on stress-coping mechanisms, communication, and dedicated ergonomic training, as these all play a role in physician well-being and may lead to improved clinical outcomes.
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Affiliation(s)
- Ron Golan
- Department of Urology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY.
| | - Ojas Shah
- Department of Urology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY.
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17
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Gómez-Núñez JG. Editorial Comment on: Is Your Career Hurting You? The Ergonomic Consequences of Surgery in 701 Urologists Worldwide by Lloyd et al. (From: Lloyd GL, Chung ASJ, Steinberg S, et al. J Endourol 2019;33:1037-1042; DOI: 10.1089/end.2019.0150). J Endourol 2019; 33:1043-1044. [PMID: 31565965 DOI: 10.1089/end.2019.0672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Joel Gustavo Gómez-Núñez
- Departamento de Clínicas Quirúrgicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara Jal, México.,Urólogo/Endourólogo, Hospital General Regional (HGR) 180, Instituto Mexicano del Seguro Social (IMSS) Delegación Jalisco, Tlajomulco de Zúñiga Jal, México.,Departamento de Urología, Urólogo/Endourólogo, Instituto Jalisciense de Cancerología, Secretaria de Salud, Guadalajara Jal, México
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