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Chan C, Tan YC, Lim EW, Teo JY, Lin J, Tan WJ, Tay GCA, Tan EKW, Seow-En I. Evaluating the surgical trainee ergonomic experience during minimally invasive abdominal surgery (ESTEEMA study). Sci Rep 2024; 14:12502. [PMID: 38822017 PMCID: PMC11143188 DOI: 10.1038/s41598-024-63516-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
Minimally invasive abdominal surgery (MAS) can exert a physical cost. Surgical trainees spend years assisting minimally-invasive surgeries, increasing the risk of workplace injury. This prospective questionnaire-based cohort study was conducted amongst general surgery residents in Singapore. Residents assisting major MAS surgery were invited to complete anonymous online survey forms after surgery. The Phase 1 survey assessed physical discomfort scores and risk factors. Intraoperative measures to improve ergonomics were administered and evaluated in Phase 2. During Phase 1 (October 2021 to April 2022), physical discomfort was reported in at least one body part in 82.6% (n = 38) of respondents. Over a third of respondents reported severe discomfort in at least one body part (n = 17, 37.0%). Extremes of height, training seniority, longer surgical duration and operative complexity were significant risk factors for greater physical discomfort. In Phase 2 (October 2022 to February 2023), the overall rate of physical symptoms and severe discomfort improved to 81.3% (n = 52) and 34.4% (n = 22) respectively. The ergonomic measure most found useful was having separate television monitors for the primary surgeon and assistants, followed by intraoperative feedback on television monitor angle or position. Close to 20% of survey respondents felt that surgeon education was likely to improve physical discomfort.
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Affiliation(s)
- Cassandra Chan
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Ying Ching Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ee Wen Lim
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jinlin Lin
- Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Winson JianHong Tan
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Gerald Ci An Tay
- Department of Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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Bernhard JC, Robert G, Ricard S, Rogier J, Degryse C, Michiels C, Margue G, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Ferriere JM. Nurse-led coordinated surgical care pathways for cost optimization of robotic-assisted partial nephrectomy: medico-economic analysis of the UroCCR-25 AMBU-REIN study. World J Urol 2023; 41:325-333. [PMID: 35727334 DOI: 10.1007/s00345-022-04066-4] [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] [Received: 11/01/2021] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Robot-assisted partial nephrectomy (RAPN) reduces morbidity, enabling development of Enhanced Recovery After Surgery (ERAS) and day-case protocols. Additional financial costs limit its integration into clinical practice. We evaluated the medico-economic impact of RAPN using a nurse-led coordinated pathway of care (NLC-RAPN). METHODS All tumor RAPNs performed in 2017 were prospectively included in nurse-led protocols: NP-RAAC (ERAS) or Ambu-Rein (day case). Clinico-biological and pathological data were prospectively collected within the French Research Network for Kidney Cancer database (NCT03293563). Estimated costs were compared to "average" patients at the national level operated by open partial nephrectomy (OPN) or RAPN, using data from the 2017 French hospital discharge database and the national cost scale. RESULTS The NLC-RAPN cohort (n = 151) included 27 (18%) outpatients and the average hospital length of stay (LOS) was 2.4 days. In the national control cohorts for OPN (n = 2475) and RAPN (n = 3529), the average LOS were 8.0 and 5.2 days, respectively. The mean incomes per group were €7607 for NLC-RAPN, €9813 for OPN, and €8215 for RAPN. The mean daily cost of stay was €659 for NLC-RAPN, €838 for OPN, and €725 for RAPN. The overall cost for NLC-RAPN was €6594, €8733 for OPN, and €8763 for RAPN. The best operational margin was obtained for day-case NLC-RAPN (€1967). CONCLUSION Combining RAPN with nurse-led coordinated pathways of care led to a shorter hospital stay and reduced costs versus OPN. This may facilitate the economic sustainability of robotic assistance for hospitals where the extra cost is not covered by the healthcare system.
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Affiliation(s)
- Jean-Christophe Bernhard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France.
| | - Grégoire Robert
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Solène Ricard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France
| | - Julien Rogier
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Cécile Degryse
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Peggy Blanc
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marie Ferriere
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
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Mattogno PP, Marciano F, Catalino MP, Mattavelli D, Cocca P, Lopomo NF, Nicolai P, Laws ER, Witterick I, Raza SM, Devaiah AK, Lauretti L, Olivi A, Fontanella MM, Gentili F, Doglietto F. Ergonomics in Endoscopic Transsphenoidal Surgery: A Survey of the North American Skull Base Society. J Neurol Surg B Skull Base 2021; 83:e380-e385. [DOI: 10.1055/s-0041-1729906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objective Different surgical set-ups for endoscopic transsphenoidal surgery (ETS) have been described, but studies on their ergonomics are limited. The aim of this article is to describe present trends in the ergonomics of ETS.
Design and Participants A 33-question, web-based survey was sent to North American Skull Base Society members in 2018 and 116 responded to it (16% of all members). Most respondents were from North America (76%), in academic practice (87%), and neurosurgeons (65%); they had more than 5 years of experience in ETS (73%), had received specific training (66%), and performed at least 5 procedures/mo (55%).
Results Mean reported time for standard and complex procedures were 3.7 and 6.3 hours, respectively. The patient's body is usually positioned in a straight, supine position (84%); the head is in a neutral position (46%) or rotated to the side (38%). Most surgeons perform a binostril technique, work with a partner (95%), and operate standing (94%), holding suction (89%) and dissector (83%); sometimes the endoscope is held by the primary surgeon (22–24%). The second surgeon usually holds the endoscope (72%) and irrigation (42%). During tumor removal most surgeons stand on the same side (65–66%). Many respondents report strain at the dorsolumbar (50%) or cervical (26%) level. Almost one-third of surgeons incorporate a pause during surgery to stretch, and approximately half exercise to be fit for surgery; 16% had sought medical attention for ergonomic-related symptoms.
Conclusion Most respondents value ergonomics in ETS. The variability in surgical set-ups and the relatively high report of complaints underline the need for further studies to optimize ergonomics in ETS.
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Affiliation(s)
- Pier Paolo Mattogno
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Marciano
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Michael P. Catalino
- Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Davide Mattavelli
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Paola Cocca
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Department of Otolaryngology—Head and Neck Surgery, University of Padua, Padua, Italy
| | - Edward R. Laws
- Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ian Witterick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shaan M. Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Anand K. Devaiah
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Marco M. Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Fred Gentili
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Francesco Doglietto
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Sweeney K, Mackey M, Spurway J, Clarke J, Ginn K. The effectiveness of ergonomics interventions in reducing upper limb work-related musculoskeletal pain and dysfunction in sonographers, surgeons and dentists: a systematic review. ERGONOMICS 2021; 64:1-38. [PMID: 32866082 DOI: 10.1080/00140139.2020.1811401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
The aim of this systematic review was to summarise the effects of ergonomics interventions on work-related upper limb musculoskeletal pain and dysfunction, and on productivity in sonographers, surgeons and dentists. A total of 31 studies were included. All studies reported effects on upper limb pain. Nine studies reported effects on dysfunction and only two studies reported effects on productivity. Moderately strong evidence in reducing upper limb pain was found for instigation of microbreaks into long duration surgical procedures, and the use of wider, lighter handles in dental instruments. Moderate evidence was also found for use of prismatic glasses and favourable positioning in reducing upper limb pain. Weak, inconsistent or no evidence was found for all other ergonomics interventions in reducing upper limb pain and dysfunction and increasing productivity. The lack of high quality research, particularly in sonographers and in the outcome of productivity, should be addressed. Practitioner summary: This systematic review investigates the effectiveness of ergonomics interventions on upper limb pain, dysfunction and productivity in sonographers, dentists and surgeons. Instigation of microbreaks during long duration procedures and the use of wider, lighter instrument handles were most effective in reducing upper limb work-related pain. Abbreviations: ANOVA: analysis of variance; CLS: conventional laparoscopic surgery; DMAIC: define, measure, analyze, improve and control; GRADE: grading of recommendations, assessment, development and evaluations; HD: high definition; PRISMA: preferred reporting items for systematic reviews and meta-analyses; PROSPERO: The International Prospective Register of Systematic Reviews; RCT: randomised control trial; SILS: single incision laparoscopic surgery; VITOM: video telescopic operative microscope; WNSWLHD: Western New South Wales Local Health District; WMSD: work related musculoskeletal disorder.
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Affiliation(s)
- Kristie Sweeney
- School of Medical Sciences, University of Sydney, Camperdown, Australia
| | - Martin Mackey
- School of Medical Sciences, University of Sydney, Camperdown, Australia
| | | | - Jillian Clarke
- School of Medical Sciences, University of Sydney, Camperdown, Australia
| | - Karen Ginn
- School of Medical Sciences, University of Sydney, Camperdown, Australia
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Hislop J, Hensman C, Isaksson M, Tirosh O, McCormick J. Self-reported prevalence of injury and discomfort experienced by surgeons performing traditional and robot-assisted laparoscopic surgery: a meta-analysis demonstrating the value of RALS for surgeons. Surg Endosc 2020; 34:4741-4753. [DOI: 10.1007/s00464-020-07810-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022]
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Physical and Mental Impact of Laparoscopic Sleeve Gastrectomy on the Surgeon: French vs. American Positions. A Randomized and Controlled Study. Obes Surg 2018; 29:137-142. [PMID: 30187419 DOI: 10.1007/s11695-018-3496-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the physical and mental impact on the primary surgeon, by the patient's and surgical staff's dispositions at the operating table, during laparoscopic vertical sleeve gastrectomy. MATERIALS AND METHODS This is a randomized and controlled study that included 18 laparoscopic sleeve gastrectomy procedures performed by two surgeons in a private and academic hospital. The cases were randomized for the American or French position. After surgery, the National Aeronautics and Space Administration - Task Load Index (NASA-TLX) and the Body Part Discomfort (BPD) scales were applied to the primary surgeon. RESULTS An increased workload and more discomfort were reported when using the French position. The NASA-TLX was 28 ± 8 vs. 57 ± 18 (p = 0.001), and the BPD was 2 vs. 8 (p = 0.001). CONCLUSIONS The American position resulted in a lower physical and mental impact on the surgeon when performing a laparoscopic sleeve gastrectomy.
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