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Restaino S, D’Indinosante M, Perelli F, Arcieri M, Cherchi V, Petrillo M, Cavaliere AF, Cianci S, Pellecchia G, Meniconi RL, Coppola A, Chiantera V, Scambia G, Driul L, Vizzielli G. Ergonomics in the operating room and surgical training: a survey on the Italian scenario. Front Public Health 2024; 12:1417250. [PMID: 39171296 PMCID: PMC11337608 DOI: 10.3389/fpubh.2024.1417250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction Surgical-related injuries are frequent, in fact the reported percentage of musculoskeletal disorders in surgeons is between 47% and 87%. These conditions are caused by long periods of standing, incorrect postures, repeated movements, little rest between operations, the lack of integrated operator rooms, the correct number and arrangement of monitors and the use of non-ergonomic instruments. This survey aims to assess the Italian overview both highlighting how prevalent surgical-related injury is in our surgeons and whether there is an operating room ergonomics education program in Italian surgical specialty schools. Methods An anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of 3 different sections concerning the general characteristics of the participants, their surgical background and any training performed, and any injuries or ailments related to the surgical activity. The survey was carried out in the period 1th of December 2022 and the 6th of February 2023. Results At the close of our survey, 300 responses were collected. Among the participants, the two most represented specialties were Gynecology and Obstetrics (42.3%) and General Surgery (39.7%) and surgeons were mainly employed in the Northern regions of Italy (54.8%). Analyzing the participants' background, 61.7% of the respondents had laparoscopic training during their training and only 53.1% had a pelvic trainer during their residency. In accordance with 98.7% of the respondents, during surgery we have the feeling of being in an uncomfortable position that causes discomfort or muscle pain, and regarding the frequency of these discomforts, the majority of our study population experiences these problems monthly (46.2%), while in 29.6% it is experienced weekly, 12.1% annually and finally 12.1% daily. The surgical approach that is most correlated with these disorders is laparoscopy (62.7%) while the one that causes the least discomfort is robotic surgery (1.4%). These discomforts cause 43.9% of our population to take a break or do short exercises to reduce pain during surgery, and the body areas most affected are the back (61.6%), neck (40.6%) and shoulders (37.8%). Conclusion Despite this, our survey allows us to highlight some now-known gaps present in the surgical training program of our schools and the lack of protection toward our surgeons during their long career.
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Affiliation(s)
- Stefano Restaino
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Marco D’Indinosante
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Perelli
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Anna Franca Cavaliere
- Department of Gynecology and Obstetrics of "San Giovanni Calibita" Fatebenefratelli Hospital-Gemelli Hospital, Rome, Italy
| | - Stefano Cianci
- Dipartimento di Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | | | - Roberto Luca Meniconi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Vito Chiantera
- Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione "G. Pascale", Naples, Italy
| | - Giovanni Scambia
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
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Olig E, Ranieri G, Louie M. Ergonomic considerations for unique surgeon populations. Curr Opin Obstet Gynecol 2024; 36:260-265. [PMID: 38837696 DOI: 10.1097/gco.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Surgeons are rapidly diversifying as a population, introducing new ergonomic challenges. This review describes the challenges that are experienced by special populations of surgeons including small-handed surgeons, pregnant surgeons, and trainees, and evidence-based solutions to overcome them. RECENT FINDINGS Small-handed and female surgeons report more musculoskeletal complaints compared with their male counterparts. Pregnant surgeons frequently report development or worsening of musculoskeletal disorders such as carpal tunnel syndrome and low back pain. Trainees also report high rates of musculoskeletal complaints with minimal autonomy to alter their environment. Limited objective data exists regarding the ideal instruments currently available for special populations. Several small, randomized studies have proposed exercise regimens targeting the upper extremities and pregnancy-related pain syndromes with improvements in symptoms. Various methods of ergonomic education have been studied in trainees with improvements in operating room posture and performance. SUMMARY Limited objective data is available to recommend specific surgical instruments for high-risk surgeon populations. Beneficial exercise regimens have been described for musculoskeletal disorders commonly plaguing surgeons but have yet to be studied explicitly in small-handed or pregnant surgeons and trainees.
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Affiliation(s)
- Emily Olig
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona, USA
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Saikali S, Patel E, Mascarenhas A, Jaber A, Gamal A, Moschovas MC, Cui L, Li X, Patel V. Assessing Muscular Pain and Ergonomics Among Robotic Surgeons in China: A Validation. Surg Innov 2024; 31:435-442. [PMID: 38780068 DOI: 10.1177/15533506241255766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Robotic surgery has transformed minimally invasive procedures, offering precision and efficiency. However, the ergonomic aspects of robotic consoles and their impact on surgeon health remain understudied. This review investigates the burden of ergonomics and muscle fatigue among robotic surgeons in China, comparing the findings to a multinational study. METHODOLOGY A literature review identified themes related to physical discomfort in robotic surgery. A questionnaire was administered to Chinese robotic surgeons, yielding 40 responses. The study assessed demographic characteristics, surgeon experience, ergonomic practices, reported discomfort, and pain-relief mechanisms. RESULTS The study revealed that most surgeons experienced shoulder and neck pain, with mixed opinions on whether robotic surgery was the primary cause. Stretching exercises were commonly used for pain relief. Surgeons believed that case volume and surgery duration contributed to discomfort. Comparisons with a multinational study suggested potential demographic and experience-related differences. CONCLUSION While the study has limitations, including a small sample size and potential translation issues, it underscores the importance of addressing ergonomic concerns and providing proper training to robotic surgeons to ensure their well-being and longevity in the field. Further research with larger cohorts and platform-specific analyses is warranted.
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Affiliation(s)
- Shady Saikali
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Ela Patel
- Stanford University, Stanford, CA, USA
| | | | | | - Ahmad Gamal
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Marcio Covas Moschovas
- Advent Health Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Liang Cui
- Department of Urology, Peking University First Hospital. Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Vipul Patel
- Advent Health Global Robotics Institute, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
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Li L, Chen Z, Zaw THH, Luo B, Yang K, Wang X. Skill assessment based on clutch use in cross-platform robot-assisted surgery. Surg Endosc 2024:10.1007/s00464-024-10959-9. [PMID: 38874610 DOI: 10.1007/s00464-024-10959-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
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.
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Affiliation(s)
- Lu Li
- Department of Urology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, Wuhan, Hubei, China
| | - Ziyan Chen
- Department of Urology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, Wuhan, Hubei, China
| | - Thant Htet Htet Zaw
- Department of Pediatric Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Bin Luo
- The State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan, Hubei, China
| | - Kun Yang
- Department of Urology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, Wuhan, Hubei, China.
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, Wuhan, Hubei, China.
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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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Amirthanayagam A, O'Neill S, Goss C, Moss EL. Physical and psychological impact of surgery on the operating surgeon. Int J Gynecol Cancer 2024; 34:459-467. [PMID: 38438178 DOI: 10.1136/ijgc-2023-004594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
The impact of surgery on the surgeon's well-being encompasses both physical and psychological aspects. Physically, surgeons are at risk of work-related musculoskeletal symptoms due to the nature of their work, and this risk can be impacted by theater environment, equipment design, and workload. Many symptoms will be self-limiting, but work related musculoskeletal symptoms can lead to the development of an injury, which can have far reaching effects, including the need for medical or surgical treatment, time away from work, or a change in clinical duties. Additionally, surgery can place a significant cognitive workload on the lead operator and this can be exacerbated, or alleviated, by the surgical environment, experience of the assistance, surgical modality, and case complexity. Measuring and quantifying the impact of surgery on the surgeon is a challenging undertaking. Tools such as motion capture, physiological markers, including heart rate variability and salivary cortisol, and questionnaires can provide insights into understanding the overall impact of surgery on the surgeon. A holistic approach that incorporates injury prevention strategies, communication, and support, is vital in assessing and mitigating risk factors. Injury prevention assessment tools and interventions that can be used within the busy surgical environment are needed, alongside increased ergonomic awareness. Addressing the impact of surgery on the surgeon is a multifaceted challenge, and long term positive changes can only be sustained with the support of the whole surgical team and healthcare organizations by developing and maintaining a supportive working environment.
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Affiliation(s)
| | - Seth O'Neill
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Charles Goss
- Department of Occupational Health, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Esther L Moss
- College of Life Sciences, University of Leicester, Leicester, UK
- Department of Gynaecological Oncology, University of Leicester, Leicester, UK
- Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 PMCID: PMC11268371 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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Subba K, Lambert E, El-Ghobashy A. Tips and tricks in gynaecological robotic surgery. Best Pract Res Clin Obstet Gynaecol 2024; 93:102453. [PMID: 38219641 DOI: 10.1016/j.bpobgyn.2023.102453] [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: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
It was the dawn of a new era for robotic surgery when the Food and Drug Administration (FDA) approved da Vinci robotic surgical system for general laparoscopic procedures in 2000. The surgical practice saw a transformative breakthrough towards minimally invasive approach with the ever-increasing uptake of advanced robots proven to benefit patients and surgeons in various ways. However, these innovative machines only complement and enhance a surgeon's operating skills, and with such privilege come responsibilities and new challenges. Heavy reliance on such advanced devices while operating on humans necessitates thorough training and supervision to ensure safe and efficient applications. It is the surgeon's responsibility to direct the procedure constantly and lead other team members who assist during the surgery. In this chapter, we provide miscellaneous tips and tricks that can help beginners navigate through robotic surgery with more confidence and enthusiasm.
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Affiliation(s)
- Kamana Subba
- Obstetrics and Gynaecology, Gynaecological Oncology, UK.
| | | | - Alaa El-Ghobashy
- Department of Gynaecological Oncology, The Royal Wolverhampton NHS Trust, West Midlands, UK
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Wong SW, Lim R, Wong XJ, Crowe P. Ergonomic hand positioning overcomes visual perception mismatch in nonsimulated robotic colorectal surgery. J Surg Case Rep 2024; 2024:rjae143. [PMID: 38495050 PMCID: PMC10941812 DOI: 10.1093/jscr/rjae143] [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: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024] Open
Abstract
The aim of the study was to compare the internal instrument and external surgeon hand positions to determine whether visual perception mismatch (VPM) is a factor during robotic colorectal surgery. Continuous video footage of 24 consecutive robotic colorectal surgery cases were analysed concurrently with sagittal video recordings of surgeon hand positions. Separated sagittal hand positions would indicate nonergonomic positioning without clutching of the robotic controls, either matching the on-screen up/down instrument tip positions (no VPM) or in the opposite direction (true VPM). Variables (30-min surgery time blocks, anatomic target, and task performed), which resulted in hand separation or VPM, were analysed. Operating with the presence of VPM for more than one duration occurred 51 times and nonergonomic sagittal hand positioning occurred 22 times. For an experienced robotic surgeon, ergonomic positioning of the hands is favoured over adjustment for VPM despite the potential higher mental workload.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Ranah Lim
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Xiuling Jasmine Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, New South Wales, 2052, Australia
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Wong SW, Ang ZH, Lim R, Wong XJ, Crowe P. Factors affecting upper limb ergonomics in robotic colorectal surgery. J Surg Case Rep 2023; 2023:rjad632. [PMID: 38026740 PMCID: PMC10663069 DOI: 10.1093/jscr/rjad632] [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: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Zhen Hao Ang
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Ranah Lim
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Xiuling Jasmine Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, New South Wales, 2052, Australia
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Patel E, Saikali S, Mascarenhas A, Moschovas MC, Patel V. Muscle fatigue and physical discomfort reported by surgeons performing robotic-assisted surgery: a multinational survey. J Robot Surg 2023; 17:2009-2018. [PMID: 37115418 DOI: 10.1007/s11701-023-01608-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/23/2023] [Indexed: 04/29/2023]
Abstract
Robotic surgery has revolutionized surgical procedures and has provided many advantages over traditional laparoscopic and open surgeries. Despite the benefits, there are concerns about the physical discomfort and injuries that may be experienced by surgeons during robotic surgeries. This study aimed to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. A questionnaire was created and sent to 1000 robotic surgeons worldwide, with a response rate of 30.9%. The questionnaire consisted of thirty-seven multiple-choice questions, three short answer questions, and one multiple-option question pertaining to the surgeon's workload as well as their level of discomfort while and after performing surgery. The primary endpoint was to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. Secondary endpoints were to highlight any correlation between age group, BMI, hours of operation, workout regimen, and significant pain levels. The results showed that the most common muscle groups implicated in physical pain and discomfort were the neck, shoulders, and back, with many of the surgeons attributing their muscular fatigue and discomfort to the ergonomic design of the surgeon console. Despite the level of surgeon comfort the robotic console provides when compared to other conventional forms of surgery, the findings suggest the need for better ergonomic practices during robotic surgeries to minimize physical discomfort and injuries for surgeons.
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Affiliation(s)
- Ela Patel
- Global Robotics Institute, AdventHealth, Celebration, FL, USA
- Stanford University, Stanford, CA, 94305, USA
| | - Shady Saikali
- Global Robotics Institute, AdventHealth, Celebration, FL, USA.
| | | | - Marcio Covas Moschovas
- Global Robotics Institute, AdventHealth, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Vipul Patel
- Global Robotics Institute, AdventHealth, Celebration, FL, USA
- University of Central Florida (UCF), Orlando, FL, USA
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Lin E, Young R, Shields J, Smith K, Chao L. Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2023; 35:361-367. [PMID: 37144567 DOI: 10.1097/gco.0000000000000875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW To evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery. RECENT FINDINGS Factors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics. SUMMARY Considering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.
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Affiliation(s)
- Emily Lin
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Gorce P, Jacquier-Bret J. Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6419. [PMID: 37510651 PMCID: PMC10379148 DOI: 10.3390/ijerph20146419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I2 statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.
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Affiliation(s)
- Philippe Gorce
- International Institute of Biomechanics and Occupational Ergonomics, ErBio, Avenue du Dr Marcel Armanet, 83400 Hyères, France
- Université de Toulon, CS60584, CEDEX 9, 83041 Toulon, France
| | - Julien Jacquier-Bret
- International Institute of Biomechanics and Occupational Ergonomics, ErBio, Avenue du Dr Marcel Armanet, 83400 Hyères, France
- Université de Toulon, CS60584, CEDEX 9, 83041 Toulon, France
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14
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Barrios EL, Polcz VE, Hensley SE, Sarosi GA, Mohr AM, Loftus TJ, Upchurch GR, Sumfest JM, Efron PA, Dunleavy K, Bible L, Terracina KP, Al-Mansour MR, Gravina N. A narrative review of ergonomic problems, principles, and potential solutions in surgical operations. Surgery 2023:S0039-6060(23)00177-0. [PMID: 37202309 DOI: 10.1016/j.surg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/20/2023]
Abstract
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.
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Affiliation(s)
- Evan L Barrios
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Valerie E Polcz
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Sara E Hensley
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - George A Sarosi
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Tyler J Loftus
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Jill M Sumfest
- Gatorcare Health Management Corporation, University of Florida, Gainesville, FL
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Kim Dunleavy
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Letitia Bible
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Krista P Terracina
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Mazen R Al-Mansour
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, FL.
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15
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Raman AG, Parikh N, Gupta R, Lavadi RS, Gupta R, Heary RF, Kimmell K, Singer J, Agarwal N. Augmenting Career Longevity: An Analysis of Ergonomics Training Among 134 Neurological Surgeons. World Neurosurg 2023; 173:e11-e17. [PMID: 36646417 DOI: 10.1016/j.wneu.2023.01.036] [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: 09/27/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Work-related pain among neurosurgeons remains understudied, yet can have long-term consequences which affect operative efficiency and efficacy, career longevity, and life outside of work. OBJECTIVE This study provides insight into the extent of pain experienced by neurosurgeons and the effect of ergonomics training on pain. METHODS An online survey pertaining to ergonomics and pain was sent to all neurosurgeons on the Council of State Neurosurgical Societies (CSNS) email distribution list. Statistical comparisons of age groups against pain levels and ergonomics training against pain levels, as well as multivariate linear regression of demographics, training, and operating factors against pain levels were performed. RESULTS One hundred and thirty-four neurosurgeons responded to the survey. The mean average severity of pain across respondents was 3.3/10 and the mean peak severity of pain was 5.1/10. Among the reported peak pain severity scores, neurosurgeons with 21-30 years of operating experience had significantly higher pain scores than those with 11-20 years of experience (mean 6.2 vs. 4.2; P < 0.05), while neurosurgeons with more than 30 years of experience had significantly less pain than those with 21-30 years of experience (mean 4.4 vs. 6.2, P = 0.005). Training in ergonomics did not significantly improve respondents' reported peak or mean pain severities (17.9% reported having ergonomics training). CONCLUSIONS Ergonomics training did not appear to make a difference in neurosurgeons' pain severities. This may signify a need to optimize ergonomics pedagogy to achieve observable benefits.
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Affiliation(s)
- Alex G Raman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Neil Parikh
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Radhika Gupta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Raghav Gupta
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Robert F Heary
- Division of Neurosurgery, Mountainside Medical Center, Hackensack Meridian School of Medicine, Glen Ridge, New Jersey
| | | | - Justin Singer
- Department of Vascular Neurosurgery, Spectrum Health, Grand Rapids, Michigan
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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16
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Amirthanayagam A, Zecca M, Barber S, Singh B, Moss EL. Impact of minimally invasive surgery on surgeon health (ISSUE) study: protocol of a single-arm observational study conducted in the live surgery setting. BMJ Open 2023; 13:e066765. [PMID: 36882245 PMCID: PMC10008445 DOI: 10.1136/bmjopen-2022-066765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION The rapid evolution of minimally invasive surgery has had a positive impact on patient outcomes; however, it is reported to be associated with work-related musculoskeletal symptoms (WMS) in surgeons. Currently there is no objective measure to monitor the physical and psychological impact of performing a live surgical procedure on the surgeon. METHODS AND ANALYSIS A single-arm observational study with the aim of developing a validated assessment tool to quantify the impact of surgery (open/laparoscopic/robotic-assisted) on the surgeon. Development and validation cohorts of major surgical cases of varying levels of complexity performed by consultant gynaecological and colorectal surgeons will be recruited. Recruited surgeons wear three Xsens DOT monitors (muscle activity) and an Actiheart monitor (heart rate). Salivary cortisol levels will be taken and questionnaires (WMS and State-Trait Anxiety Inventory) completed by the participants preoperatively and postoperatively. All the measures will be incorporated to produce a single score that will be called the 'S-IMPACT' score. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the East Midlands Leicester Central Research Ethics Committee REC ref 21/EM/0174. Results will be disseminated to the academic community through conference presentations and peer-reviewed journal publications. The S-IMPACT score developed within this study will be taken forward for use in definitive multicentre prospective randomised control trials.
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Affiliation(s)
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, Leicestershire, UK
- NIHR Research Design Service East Midlands, Leicester, UK
| | - Baljit Singh
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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17
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Surgical Ergonomics and Preventing Work-Related Musculoskeletal Disorders. Obstet Gynecol 2023; 141:455-462. [PMID: 36735407 DOI: 10.1097/aog.0000000000005079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/03/2022] [Indexed: 02/04/2023]
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18
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Ryan MT, Montgomery EA, Fryer J, Yang AW, Mills C, Watson N, Noller M, Riley CA, Tolisano AM. Ergonomics in Otolaryngology: A Systematic Review and Meta-analysis. Laryngoscope 2023; 133:467-475. [PMID: 35575629 DOI: 10.1002/lary.30216] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To determine the proportion of otolaryngologists with work-related musculoskeletal discomfort (WRMD) and to review objective ergonomic data that contribute to WRMD. STUDY DESIGN Systematic review and meta-analysis. METHODS A comprehensive search of the literature identified 1121 articles for initial review of which 19 (3563 participants) met criteria for qualitative discussion and eight (2192 participants) met criteria for meta-analysis. Random effects meta-analyses were used to estimate the proportion of otolaryngologists reporting WRMD. RESULTS The overall proportion (95% confidence intervals [CI]) of general otolaryngologists reporting WRMD was 0.79 (0.66, 0.88) for any symptoms; 0.54 (0.40, 0.67) for neck symptoms; 0.33 (0.20, 0.49) for shoulder symptoms; and 0.49 (0.40, 0.59) for back symptoms. Surgeons performing primarily subspecialty cases had a lower estimated overall prevalence of WRMD versus those performing general ENT cases, however the odds ratio (OR) was not statistically significant (OR [95% confidence interval] 0.53 [0.22, 1.25]). 23%-84% of otolaryngologists underwent medical treatment for WRMD. 5%-23% took time off work and 1%-6% stopped operating completely as a result of WRMD. 23%-62.5% of otolaryngologists believed WRMD negatively impacted their quality of life. Objective measures of ergonomic posture indicate moderate to severe risk of injury during the routine clinic and surgical procedures with none found to be low risk. CONCLUSIONS Ergonomic stressors among otolaryngologists contribute to a high rate of WRMD across all subspecialties with notable impact on productivity, longevity, and quality of life. Laryngoscope, 133:467-475, 2023.
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Affiliation(s)
- Matthew T Ryan
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Emily A Montgomery
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Jacob Fryer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Alex W Yang
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Channah Mills
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Nora Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Michael Noller
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Charles A Riley
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Anthony M Tolisano
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
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19
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:916-923. [PMID: 36175710 DOI: 10.1245/s10434-022-12548-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard laparoscopy (SL) is responsible for musculoskeletal disorders in surgeons because of poor ergonomic positions, which could be reduced by robot-assisted laparoscopy (RAL) owing to the surgeons' seated position. One of the aims of the ROBOGYN-1004 study (NCT01247779) was to evaluate surgeons' workloads during real-time procedures of gynecological oncological surgery. METHODS Patients with gynecological cancer eligible for minimally invasive surgery were recruited from 13 French centers between December 2010 and December 2015. Physical workload was evaluated using the Borg scale every hour over the surgery duration and the perception of workload evaluated using NASA-TLX at the end of surgery. RESULTS A total of 369 patients were recruited, of whom 176 underwent RAL and 193 underwent SL (per-protocol analysis). Posture during SL was significantly more challenging for all body parts except the back. There was an increase in discomfort over time (up to 4 h) for the hands and arms, neck, and legs in SL compared with RAL. Perceived physical activity and abilities were rated higher in SL than in RAL (p < 0.01), whereas perceived personal performance was higher in SL (p < 0.01). Perceived physical effort during surgery was lower in RAL than in SL. CONCLUSIONS RAL improves the perception of physical workload. Compared with SL, the perceived effort is lower in RAL regardless of the complexity of the surgery.
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Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France
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20
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Cerier E, Hu A, Goldring A, Rho M, Kulkarni SA. Ergonomics Workshop Improves Musculoskeletal Symptoms in General Surgery Residents. J Surg Res 2022; 280:567-574. [PMID: 35787315 PMCID: PMC10084513 DOI: 10.1016/j.jss.2022.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Poor operative ergonomics can lead to muscle fatigue and injury. However, formal ergonomics education is uncommon in surgical residencies. Our study examines the prevalence of musculoskeletal (MSK) symptoms, baseline ergonomics knowledge, and the impact of an ergonomics workshop in general surgery residents. METHODS An anonymous voluntary presurvey and postsurvey was distributed to all general surgery residents at a single academic residency, assessing resident characteristics, MSK symptoms, and ergonomic knowledge before and after an ergonomics workshop. The workshop consisted of a lecture and a personalized posture coaching session with a physiatrist. RESULTS The presurvey received 33/35 (94%) responses. Of respondents, 100% reported some degree of MSK pain. Prevalence of muscle stiffness and fatigue decreased with increasing height. Females reported higher frequencies of MSK pain (P = 0.01) and more muscle fatigue than males (100% versus 73%, P = 0.03). All residents reported little to no ergonomics knowledge with 68% reporting that ergonomics was rarely discussed in the operating room. The postsurvey received 26/35 (74%) responses. Of respondents, 100% reported the workshop was an effective method of ergonomics education. MSK symptom severity improved in 82% of residents. Reports that ergonomics was rarely discussed in the operating room significantly decreased to 22.8% of residents (P < 0.01). CONCLUSIONS Surgical resident ergonomics knowledge is poor and MSK symptoms are common. Resident characteristics are associated with different MSK symptoms. Didactic teaching and personalized posture coaching improve ergonomics knowledge and reduce MSK symptom severity. Surgical residencies should consider implementing similar interventions to improve resident wellbeing.
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Affiliation(s)
- Emily Cerier
- Department of Surgery, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Andrew Hu
- Department of Surgery, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Annie Goldring
- Department of Physical Medicine and Rehabilitation, Section of Musculoskeletal Disease, Shirley Ryan Ability Lab, Chicago, Illinois
| | - Monica Rho
- Department of Physical Medicine and Rehabilitation, Section of Musculoskeletal Disease, Shirley Ryan Ability Lab, Chicago, Illinois
| | - Swati A Kulkarni
- Department of Surgery, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
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21
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Smith TG, Lowndes BR, Schmida E, Lund SB, Linden AR, Rivera M, Gas BL, Hallbeck MS. Course Design and Learning Outcomes of a Practical Online Ergonomics Course for Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:1489-1499. [PMID: 35907697 DOI: 10.1016/j.jsurg.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Course content was designed and the learning outcomes assessed for an online ergonomics course for surgical residents. This course could fulfill an optional Surgical Council on Resident Education (SCORE) curriculum on Surgical Ergonomics. DESIGN The online course included five 5-minute modules within the residents' learning system, each ending with an ungraded knowledge question, and a final 5-question multiple-choice retention quiz that allowed infinite attempts. The course was designed by ergonomists and surgeons at a quaternary academic hospital system. Participants were given two weeks to complete the modules. An electronic survey with questions assessing ergonomics knowledge and understanding on a 5-point Likert scale (strongly disagree - strongly agree) was distributed both before and after the course. The post-course survey included three additional questions to elicit feedback regarding learning experience and course design. Descriptive statistics and nonparametric paired comparisons were used to evaluate learning outcomes. SETTING General surgery residency program at an academic medical center in the U.S. PARTICIPANTS Twenty-two general surgery post graduate year 1 residents (PGY1s) were recruited to participate and completed the pre-course survey. Eight out of the 22 participants (36%) completed the online course and quiz; seven (32%) completed the course, quiz, and the post-course survey. RESULTS Participants had high pre-course awareness of the importance of surgical ergonomics, benefits of work-related musculoskeletal disorder (WMSD) prevention, as well as awkward intraoperative postures being an WMSD risk factor. Participants' confidence increased significantly from pre- to post-course in ability to assess risk (p = 0.021), but not in ability or willingness to mitigate risky surgical postures. Participants who completed the quiz answered a median of 4 (IQR: [4, 5]) questions correctly. All participants indicated that they would recommend this course to other residents. CONCLUSIONS These short practical ergonomics online learning modules increased surgical residents' confidence in assessing surgical WMSD risks.
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Affiliation(s)
- Tianqi G Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth Schmida
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Sarah B Lund
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anna R Linden
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mariela Rivera
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Becca L Gas
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota; Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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22
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Monfared S, Athanasiadis DI, Umana L, Hernandez E, Asadi H, Colgate CL, Yu D, Stefanidis D. A comparison of laparoscopic and robotic ergonomic risk. Surg Endosc 2022; 36:8397-8402. [PMID: 35182219 DOI: 10.1007/s00464-022-09105-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Work related injuries in minimally invasive surgery (MIS) are common because of the strains placed on the surgeon's or assistant's body. The objective of this study was to compare specific ergonomic risks among surgeons and surgical trainees performing robotic and laparoscopic procedures. MATERIALS AND METHODS Ergonomic data and discomfort questionnaires were recorded from surgeons and trainees (fellows/residents) for both robotic and laparoscopic procedures. Perceived discomfort questionnaires were recorded pre/postoperatively. Intraoperatively, biomechanical loads were captured using motion tracking sensors and electromyography (EMG) sensors. Perceived discomfort, body position and muscle activity were compared between robotic and laparoscopic procedures using a linear regression model. RESULTS Twenty surgeons and surgical trainees performed 29 robotic and 48 laparoscopic procedures. Postoperatively, increases in right finger numbness and right shoulder stiffness and surgeon irritability were noted after laparoscopy and increased back stiffness after robotic surgery. Further, the laparoscopic group saw increases in right hand/shoulder pain (OR 0.8; p = 0.032) and left hand/shoulder pain (0.22; p < 0.001) compared to robotic. Right deltoid and trapezius excessive muscle activity were significantly higher in laparoscopic operations compared to robotic. Demanding and static positioning was similar between the two groups except there was significantly more static neck position required for robotic operations. CONCLUSION Robotic assisted surgeries led to lower postoperative discomfort and muscle strain in both upper extremities, particularly dominant side of the surgeon, but increased static neck positioning with subjective back stiffness compared with laparoscopy. These recognized ergonomic differences between the two platforms can be used to raise surgeon awareness of their intraoperative posture and to develop targeted physical and occupational therapy interventions to decrease surgeon WMSDs and increase surgeon longevity.
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Affiliation(s)
- Sara Monfared
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios I Athanasiadis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Luke Umana
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Edward Hernandez
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Cameron L Colgate
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denny Yu
- Purdue University, West Lafayette, IN, USA
| | - Dimitrios Stefanidis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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23
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The Current State of Surgical Ergonomics. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:461-465. [PMID: 36256963 DOI: 10.1097/spv.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Work-related musculoskeletal disorders are widespread among surgeons, causing significant disability and career modification. Gender plays a role, as female surgeons have a two-fold greater risk for discomfort during certain operations due to generally smaller hand sizes and height as compared to male surgeons. There is a lack of appropriate surgical instrumentation geared toward smaller hand sizes. Maintaining a neutral position while operating, frequent changes in position, and increased awareness can contribute to decreasing the detrimental impact on surgeons' bodies from performing operations.
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Axt S, Dörflinger A, Johannink J, Kirschniak A, Rolinger J, Wilhelm P. Evaluation of different setting configurations with a new developed telemedical interface of a parallel kinematic robotic system – An experimental development study. Int J Med Robot 2022; 18:e2377. [DOI: 10.1002/rcs.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Steffen Axt
- Department of General Visceral and Transplant Surgery Tübingen University Hospital Tübingen Germany
| | - Andreas Dörflinger
- Department of General Visceral and Transplant Surgery Tübingen University Hospital Tübingen Germany
| | - Jonas Johannink
- Department of General Visceral and Transplant Surgery Tübingen University Hospital Tübingen Germany
| | - Andreas Kirschniak
- General and Visceral Surgery Maria Hilf Hospital Mönchengladbach Germany
| | - Jens Rolinger
- General and Visceral Surgery Maria Hilf Hospital Mönchengladbach Germany
| | - Peter Wilhelm
- General and Visceral Surgery Maria Hilf Hospital Mönchengladbach Germany
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Michael S, Mintz Y, Brodie R, Assalia A. Minimally invasive surgery and the risk of work-related musculoskeletal disorders: Results of a survey among Israeli surgeons and review of the literature. Work 2022; 71:779-785. [DOI: 10.3233/wor-205072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Samer Michael
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ahmad Assalia
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
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Dairywala MI, Gupta S, Salna M, Nguyen TC. Surgeon Strength: Ergonomics and Strength Training in Cardiothoracic Surgery. Semin Thorac Cardiovasc Surg 2021; 34:1220-1229. [PMID: 34597795 DOI: 10.1053/j.semtcvs.2021.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023]
Abstract
With the high prevalence of musculoskeletal pain in surgeons and interventionalists, it is critical to analyze the impact of ergonomics on cardiothoracic surgeon health. Here, we review the existing literature and propose recommendations to improve physical preparedness for surgery both in and outside the operating room. For decades, cardiothoracic surgeons have suffered from musculoskeletal pain, most commonly in the neck, and back due to a lack of proper ergonomics during surgery. A lack of dedicated ergonomics curriculum during training may leave surgeons at a high predisposition for work-related musculoskeletal disorders. We searched PubMed, Google Scholar, and other sources for studies relevant to surgical ergonomics and prevalence of musculoskeletal disease among surgeons and interventionalists. Whenever possible, data from quantitative studies, and meta-analyses are presented. We also contacted experts and propose an exercise routine to improve physical preparedness for demands of surgery. To date, many studies have reported astonishingly high rates of work-related pain in surgeons with rates as high as 87% in minimally-invasive surgeons. Several optimizations regarding correct table height, monitor positioning, and loupe angles have been discussed. Lastly, implementation of ergonomics training at some programs have been effective at reducing the rates of musculoskeletal pain among surgeons. Surgical work-related stress injuries are more common than we think. Many factors including smaller incisions and technological advancements have led to this plight. Ultimately, work-related injuries are underreported and understudied and the field of surgical ergonomics remains open for investigative study.
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Affiliation(s)
- Mohammed I Dairywala
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Salna
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, Department of Surgery, UCSF Health, San Francisco, California.
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Parks E, Balbinot J, Johnson PW, Cunha-Cruz J. EFFECT OF MUSCULOSKELETAL DISORDERS AND ORGANIZATIONAL CLIMATE ON WELL-BEING OF DENTAL HYGIENISTS. J Evid Based Dent Pract 2021; 21:101583. [PMID: 34479671 DOI: 10.1016/j.jebdp.2021.101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Erica Parks
- University of Washington, School of Dentistry and School of Public Health, Seattle, WA
| | - Juliana Balbinot
- University of Washington, School of Dentistry and School of Public Health, Seattle, WA
| | - Peter W Johnson
- University of Washington, School of Dentistry and School of Public Health, Seattle, WA
| | - Joana Cunha-Cruz
- University of Washington, School of Dentistry and School of Public Health, Seattle, WA.
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Arrighi-Allisan AE, Garvey KL, Wong A, Filip P, Shah J, Spock T, Del Signore A, Cosetti MK, Govindaraj S, Iloreta AM. Ergonomic Analysis of Functional Endoscopic Sinus Surgery Using Novel Inertial Sensors. Laryngoscope 2021; 132:1153-1159. [PMID: 34355793 DOI: 10.1002/lary.29796] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/07/2021] [Accepted: 07/17/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS Suboptimal ergonomics during endoscopic sinus surgery can lead to considerable physical discomfort and fatigue for the surgeon. The purpose of this pilot study is to objectively evaluate the ergonomic positions of trainee and attending surgeons while performing functional endoscopic sinus surgery (FESS). STUDY DESIGN Pilot prospective trial. METHODS Six surgeons (two attendings and four trainees) performed FESS while wearing 11 inertial measurement units (IMUs) affixed to either side of each major joint. Screen placement was standardized to be 1 m directly in front of the surgeon and on the patient's left, 0-15° declined from the surgeons' eyes. Bed height was standardized such that the workspace was 0 to 10 cm below the elbows. IMU data were analyzed to calculate joint angles. Ideal joint angles (i.e., <10° for neck and trunk) were determined by the validated Rapid Entire Body Assessment tool. Subjects subsequently completed a modified National Aeronautics and Space Administration Task Load Index to assess cognitive and physical burden and pain. Student's t-test was employed to detect differences between groups. RESULTS Trainees adopted positions involving significantly greater neck flexion (9.90° vs. -6.48°, P = .03) and reported significantly higher frustration levels (3.04 vs. 1.33, P = .02) while operating than attendings. For both cohorts, increased operative time was significantly correlated with greater back flexion (r = 0.90, P = .02; r = 0.55, P = .04, respectively). CONCLUSIONS Our data suggest that trainees operate with higher risk neck postures than do attendings. These data indicate high-risk operative postures may be borne of inexperience and present an opportunity for postural interventions at an early stage of training. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Annie E Arrighi-Allisan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Katherine L Garvey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Anni Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Peter Filip
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Janki Shah
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Todd Spock
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Anthony Del Signore
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Maura K Cosetti
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Alfred Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Jensen MJ, Liao J, Van Gorp B, Sugg SL, Shelton J, Corwin C, Lal G. Incorporating Surgical Ergonomics Education into Surgical Residency Curriculum. JOURNAL OF SURGICAL EDUCATION 2021; 78:1209-1215. [PMID: 33221251 DOI: 10.1016/j.jsurg.2020.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/04/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Education on surgical ergonomics during residency training is lacking. This study aimed to determine the feasibility and impact of incorporating surgical ergonomics lectures into residency curriculum. METHODS A survey was distributed to 42 residents with questions regarding demographics, surgical factors, prevalence of musculoskeletal (MSK) symptoms, and awareness of ergonomic recommendations. The residents then received 2 lectures on ergonomics in surgery. A follow up survey was distributed to evaluate the impact of the lectures. RESULTS Twenty-two residents completed the presession survey. Ninety-one percent reported MSK symptoms attributed to their training. Seventeen residents completed the follow up survey. All reported increased awareness of their own habits while operating and improved understanding of methods to prevent and/or treat work-related injuries. All residents recommended incorporating the lectures as an adjunct to their regular curriculum. CONCLUSIONS The rates of MSK symptoms and/or injury are high among surgeon trainees. Residency is an opportune time to educate on principles of ergonomics and may prevent future injuries.
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Affiliation(s)
- Megan J Jensen
- Departments of Otolaryngology - Head & Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Junlin Liao
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Barbara Van Gorp
- Departments of Physical therapy, University of Iowa, Iowa City, Iowa
| | - Sonia L Sugg
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Julia Shelton
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Claudia Corwin
- Departments of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Geeta Lal
- Departments of Surgery, University of Iowa, Iowa City, Iowa.
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Short C, Basuino M, Segalini N, Rialon KL, Brandt ML. Working Through the Pain: Surgical Culture and Musculoskeletal Injury. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ergonomics in Interventional Radiology: Awareness Is Mandatory. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050500. [PMID: 34069174 PMCID: PMC8157181 DOI: 10.3390/medicina57050500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.
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Bigham J, Chang E, Sorensen MD, Chansky H, Telfer S. Using Wearable Technology to Measure the Association Between Neck Posture and Neck Pain During Urologic Open and Robotic Surgery. J Endourol 2021; 35:1710-1715. [PMID: 33940950 DOI: 10.1089/end.2021.0260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Chronic neck pain is the most prevalent work-related musculoskeletal injury among surgeons. Urologists may be at higher risk of neck injury due to extended time spent operating in deep anatomical structures during open surgery. Our goal was to use wearable technology to quantify the relationship between neck posture and pain during open and robotic surgery. MATERIALS AND METHODS Urologic attendings and residents who spent at least 1 day per week performing surgery for over 6 hours took part in this study. Neck posture was measured in real time during surgery using inertial measurement devices attached at the occipital protuberance and 7th cervical vertebrae. Self-reported neck pain scores were obtained throughout their workday. RESULTS 30 participants and 202 hours of surgery were included in the study (21 attendings, 9 residents). There was a significant association between neck posture and pain (p = 0.04). Surgeons performing open procedures spent on average 147 minutes with their head in neck flexion postures of 30° or greater compared to 68 minutes for those performing robotic procedures (p =0.007). Surgeons performing open procedures reported a mean change in neck pain of 2.0 on the numeric analogue scale, compared to 1.3 for those performing robotic procedures (p = 0.04). CONCLUSIONS Real time measurements of neck flexion during urologic surgery shows that greater duration and higher degree of neck flexion were associated with increased neck pain. Raising awareness about ergonomics in the operating room during residency will enable future generations of surgeons to make conscious decisions regarding their neck posture in surgery.
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Affiliation(s)
- Joseph Bigham
- University of Washington, Orthopaedics and Sports Medicine, 1959 NE Pacific Street, Seattle, Washington, United States, 98195;
| | - Edward Chang
- University of Washington School of Medicine, 12353, Urology, Seattle, Washington, United States;
| | - Mathew D Sorensen
- University of Washington, Department of Urology, Seattle, Washington, United States.,VA Puget Sound Health Care System, Urology, Seattle, Washington, United States;
| | - Howard Chansky
- University of Washington School of Medicine, 12353, Orthopaedics and Sports Medicine, Seattle, Washington, United States;
| | - Scott Telfer
- University of Washington School of Medicine, 12353, Orthopaedics and Sports Medicine, Seattle, Washington, United States;
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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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Kanji F, Catchpole K, Choi E, Alfred M, Cohen K, Shouhed D, Anger J, Cohen T. Work-system interventions in robotic-assisted surgery: a systematic review exploring the gap between challenges and solutions. Surg Endosc 2021; 35:1976-1989. [PMID: 33398585 DOI: 10.1007/s00464-020-08231-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of a robot into the surgical suite changes the dynamics of the work-system, creating new opportunities for both success and failure. An extensive amount of research has identified a range of barriers to safety and efficiency in Robotic Assisted Surgery (RAS), such as communication breakdowns, coordination failures, equipment issues, and technological malfunctions. However, there exists very few solutions to these barriers. The purpose of this review was to identify the gap between identified RAS work-system barriers and interventions developed to address those barriers. METHODS A search from three databases (PubMed, Web of Science, and Ovid Medline) was conducted for literature discussing system-level interventions for RAS that were published between January 1, 1985 to March 17, 2020. Articles describing interventions for systems-level issues that did not involve technical skills in RAS were eligible for inclusion. RESULTS A total of 30 articles were included in the review. Only seven articles (23.33%) implemented and evaluated interventions, while the remaining 23 articles (76.67%) provided suggested interventions for issues in RAS. Major barriers identified included disruptions, ergonomic issues, safety and efficiency, communication, and non-technical skills. Common solutions involved team training, checklist development, and workspace redesign. CONCLUSION The review identified a significant gap between issues and solutions in RAS. While it is important to continue identifying how the complexities of RAS affect operating room (OR) and team dynamics, future work will need to address existing issues with interventions that have been tested and evaluated. In particular, improving RAS-associated non-technical skills, task management, and technology management may lead to improved OR dynamics associated with greater efficiency, reduced costs, and better systems-level outcomes.
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Affiliation(s)
- Falisha Kanji
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Ken Catchpole
- Medical University of South Carolina, Charleston, SC, USA
| | - Eunice Choi
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Myrtede Alfred
- Medical University of South Carolina, Charleston, SC, USA
| | - Kate Cohen
- Enterprise Information Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Jennifer Anger
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA.
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Knuttinen MG, Zurcher KS, Wallace A, Doe C, Naidu SG, Money SR, Rochon PJ. Ergonomics in IR. J Vasc Interv Radiol 2020; 32:235-241. [PMID: 33358387 DOI: 10.1016/j.jvir.2020.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022] Open
Abstract
Ergonomic research in the field of interventional radiology remains limited. Existing literature suggests that operators are at increased risk for work-related musculoskeletal disorders related to the use of lead garments and incomplete knowledge of ergonomic principles. Data from existing surgical literature suggest that musculoskeletal disorders may contribute to physician burnout and female operators are at a higher risk of developing musculoskeletal disorders. This review article aims to summarize the existing ergonomic challenges faced by interventional radiologists, reiterate existing solutions to these challenges, and highlight the need for further ergonomic research in multiple areas, including burnout and gender.
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Affiliation(s)
| | - Kenneth S Zurcher
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona.
| | - Alex Wallace
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona
| | - Christopher Doe
- Department of Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sailendra G Naidu
- Department of Interventional Radiology, Mayo Clinic, Phoenix, Arizona
| | - Samuel R Money
- Department of Surgery, Ochsner Clinic, New Orleans, Louisiana
| | - Paul J Rochon
- Department of Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
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Anne B, Ingo H, Rolf E, Fraeulin L, Fabian H, Mache S, Groneberg DA, Daniela O. A kinematic posture analysis of neurological assistants in their daily working practice-a pilot study. J Occup Med Toxicol 2020; 15:36. [PMID: 33298091 PMCID: PMC7724787 DOI: 10.1186/s12995-020-00286-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Background The aim of this pilot study was to analyze postures during the work of neurologists with respect to their occupational activities. Methods A total data material of 64.8 h (3885.74 min) of nine (three m/six f) neurologists (assistant physicians) was collected. Kinematic data were collected using the CUELA system (electro-goniometry). In addition, the occupational tasks performed on-site were subject to a detailed objective activity analysis. All activities were assigned to the categories “Office activities” (I), “Measures on patients” (II) and “Other activities” (III). The angle values of each body region (evaluation parameters) were evaluated according to ergonomic ISO standards. Results Only 3.4% of the working hours were spent with (II), while 50.8% of time was spent with (I) and 45.8% with (III). All tasks of category (II) revealed an increased ergonomic risk to the head, neck, trunk and back areas. During category (I) especially neck and back movements in the sagittal plane showed higher ergonomic risk levels. Conclusion Despite frequently performed awkward body positions in (II), the ergonomic risk is considered as rather low, since the percentage time share totaled only 3.4%. As a result, “Office activities” have been detected as high predictor to cause stress load on the musculoskeletal system in the daily work of neurologists.
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Affiliation(s)
- Bijanzadeh Anne
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt am Main, Germany
| | - Hermanns Ingo
- Institute for Occupational Health and Safety (IFA) of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany
| | - Ellegast Rolf
- Institute for Occupational Health and Safety (IFA) of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany
| | - Laura Fraeulin
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt am Main, Germany
| | - Holzgreve Fabian
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt am Main, Germany.
| | - Stefanie Mache
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt am Main, Germany.,Institute for Occupational Medicine and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, House 1, 20459, Hamburg, Germany
| | - David A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt am Main, Germany
| | - Ohlendorf Daniela
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt am Main, Germany
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An analysis of the ergonomic risk of surgical trainees and experienced surgeons during laparoscopic procedures. Surgery 2020; 169:496-501. [PMID: 33246648 DOI: 10.1016/j.surg.2020.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Work-related musculoskeletal injuries have been increasingly recognized to affect surgeons. It is unknown whether such injuries also affect surgical trainees. The purpose of this study was to assess the ergonomic risk of surgical trainees as compared with that of experienced surgeons. METHODS Ergonomic data were recorded from 9 surgeons and 11 trainees. Biomechanical loads during surgery were assessed using motion tracking sensors and electromyography sensors. Demanding and static positions of the trunk, neck, right/left shoulder, as well as activity from the deltoid and trapezius muscles bilaterally were recorded. In addition, participants reported their perceived discomfort on validated questionnaires. RESULTS A total of 87 laparoscopic general surgery cases (48 attendings and 39 trainees) were observed. Both trainees and attendings spent a similarly high percentage of each case in static (>60%) and demanding positions (>5%). Even though residents reported overall more discomfort, all participants shared similar ergonomic risk with the exception of trainees' trunk being more static (odds ratio: -11.42, P = .006). CONCLUSION Surgeons are prone to ergonomic risk. Trainees are exposed to similar postural ergonomic risk as surgeons but report more discomfort and, given that musculoskeletal injuries are cumulative over time, the focus should be on interventions to reduce ergonomic risk in the operating room.
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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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Wee IJY, Kuo LJ, Ngu JCY. A systematic review of the true benefit of robotic surgery: Ergonomics. Int J Med Robot 2020; 16:e2113. [PMID: 32304167 DOI: 10.1002/rcs.2113] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ergonomics, as defined by the optimization of one's physical environment to enhance work performance, is an important consideration in surgery. While there have been reviews on the ergonomics of laparoscopy, this has not been the case for robotic surgery despite the rising number of publications. METHODS This study was performed in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search was performed on main databases to identify relevant articles. RESULTS Twenty-nine articles were included, comprising 3074 participants. Studies employing objective measurement tools showed that robotics conferred superior ergonomic benefits and reduced work load compared to laparoscopy, for both surgeons and trainees. Survey studies also demonstrated that self-reported discomfort was lower in robotic procedures compared to laparoscopy and open surgery. Compared to other subspecialities, gynecological procedures seem to be associated with greater surgeon-reported strain. CONCLUSION Robotic surgery is ergonomically superior to open and laparoscopic surgery. However, rates of physical strain remain significant and should be addressed by formal ergonomic training and adequate console familiarization.
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Affiliation(s)
- Ian Jun Yan Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li-Jen Kuo
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
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Hislop J, Tirosh O, McCormick J, Nagarajah R, Hensman C, Isaksson M. Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis. Surg Endosc 2019; 34:31-38. [PMID: 31583468 DOI: 10.1007/s00464-019-07161-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The repetitive and forceful motions used by operating surgeons increase the risk of developing musculoskeletal disorders. Most ergonomists consider the surgical environment to be incredibly harsh for its workers. Traditional Laparoscopic Surgery (TLS) in particular has a number of physical and mental challenges associated with it, and while Robotic-Assisted Laparoscopic Surgery (RALS) provides several features that improve upon TLS, some surgeons have still reported musculoskeletal symptoms they attribute to RALS. In this paper, we endeavored to systematically review muscle activation for both TLS and RALS, to compare the modalities and present the results as a meta-analysis. METHODS A literature search was conducted using Pubmed, Embase, and Cochrane databases in November 2018 with the following inclusion criteria: full text was available in English, the paper contained original data, EMG was one of the primary measurement techniques, and the paper included EMG data for both TLS and RALS. Results from studies were compared using standardized mean difference analysis. RESULTS A total of 379 papers were found, and through screening ten were selected for inclusion. Sample populations ranged from 1 to 31 surgeons, and a variety of study designs and metrics were used between studies. The biceps were the only muscle group that consistently and significantly demonstrated lower muscle activation for RALS for all included studies. CONCLUSIONS The results may support the belief that RALS is ergonomically superior to TLS, shown through generally lower muscle activation scores. However, these results must be interpreted with caution due to the heterogeneity between the studies and multiple potential sources for bias within studies. This analysis would be strengthened with a higher number of homogenous, high-quality studies examining larger sample sizes.
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Affiliation(s)
- Jaime Hislop
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia.
| | - Oren Tirosh
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - John McCormick
- Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, Australia
| | - Romesh Nagarajah
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Chris Hensman
- FRACS, CLAM Conjoint Senior lecturer Monash University Department of Surgery and University of Adelaide, University of Adelaide, LapSurgery Australia, Melbourne, Australia
| | - Mats Isaksson
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia
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Mishima T, Yoshida K, Takayasu K, Watanabe M, Kinoshita H, Matsuda T. Analysis of Gripping Force on a Master Controller During Simulated Robotic Surgery. J Endourol 2019; 33:802-808. [DOI: 10.1089/end.2019.0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takao Mishima
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Kenji Yoshida
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Kenta Takayasu
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Masato Watanabe
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Marçon B, Ngueyon Sime W, Guillemin F, Hubert N, Lagrange F, Huselstein C, Hubert J. An Ergonomic Assessment Of Four Different Donor Nephrectomy Approaches For The Surgeons And Their Assistants. Res Rep Urol 2019; 11:261-268. [PMID: 31579673 PMCID: PMC6773969 DOI: 10.2147/rru.s220219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Open surgery is increasingly being replaced by laparoscopic approaches that are more demanding for the surgical team. The physical and mental workload of these approaches have not been quantified. Materials and methods A multicenter prospective study was performed evaluating the physical and mental stresses of 4 surgical approaches (open surgery [OS], standard laparoscopy [SL], hand-assisted laparoscopy [HAL], and robot-assisted laparoscopy [RAL]) for donor nephrectomy for the surgeon and their assistant. The Borg Scale was used to evaluate exertion in different body parts every 30 mins during surgery and the NASA-TLX score was used to evaluate overall workload. Results 264 nephrectomies were performed over a 33-month period and 258 questionnaires evaluating these surgeries were obtained. Surgeons experienced less left shoulder and arm exertion and left forearm and hand exertion, but greater lower back exertion, as measured by the Borg scale, with RAL. Leg exertion was significantly greater with OS. Assistant surgeons experienced increased exertion in the back, right shoulder and arm, and right forearm and hand with RAL. NASA Task load index (TLX) surgeon scores showed mental demand was similar for all 4 surgical approaches. Physical demand was lower and overall performance was higher with RAL. Discussion Four different nephrectomy surgical approaches were evaluated in a multicenter setting. Surgeon and assistant scores of physical exertions were generally in the "easy" range but confirmed that robotic surgery is an ergonomic progress compared to other techniques, except for the axial skeleton. Further, it degrades the working conditions for the assistant.
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Affiliation(s)
- Baptiste Marçon
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, France
| | - Willy Ngueyon Sime
- Clinical Epidemiology Center Inserm CIC-EC 1433, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54505, France
| | - Francis Guillemin
- Clinical Epidemiology Center Inserm CIC-EC 1433, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54505, France
| | - Nicolas Hubert
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, France
| | - François Lagrange
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, France
| | - Céline Huselstein
- Department of Health Sciences and Engineering, Faculty of Medicine, Lorraine University, Nancy, France
| | - Jacques Hubert
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, France.,IADI-UL-INSERM (U1254), University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy 54511, France
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Abstract
Surgeons face hazardous working conditions due to ergonomic deficiencies found throughout the operating room. More than 80% of surgeons have succumbed to a work-related injury or illness as a consequence of sustaining awkward or static positions throughout lengthy operations over a career. While the focus of the procedure is directed to the patient, there is little concurrent regard for proper posture or spinal stability. Even when symptoms of discomfort are experienced, they are often ignored. This results in decreased production and may ultimately threaten surgical careers. Surgeons are often unaware of recommendations or guidelines designed to improve their comfort while operating. Furthermore, there is a significant lack of any formal ergonomic education, especially for minimally invasive procedures. Several modifiable risk factors can be adjusted in the operating room to provide a safer working environment. In addition, strengthening, stability, and exercise programs directed by a trained therapist may be employed to improve the surgeon's musculoskeletal health.
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Affiliation(s)
| | - Justin A Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
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Abstract
PURPOSE OF REVIEW Work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons and result in significant disability. We aimed to review the English-language literature regarding ergonomic risk, prevalence of WMSDs, and unique ergonomic considerations of gynecologic surgery. RECENT FINDINGS Surgeon WMSDs are prevalent, with rates ranging from 66 to 94% for open surgery, 73-100% for conventional laparoscopy, 54-87% for vaginal surgery, and 23-80% for robotic-assisted surgery. Risk factors for injury in open surgery include use of loupes, headlamps, and microscopes. Unique risks in laparoscopic surgery include table and monitor position, long-shafted instruments, and poor instrument handle design. In vaginal surgery, improper table height and twisted trunk position create injury risk. Although robotic surgery offers some advantages in neck and shoulder strain, it remains associated with trunk, wrist, and finger strain. SUMMARY WMSDs are prevalent among surgeons but have received little attention because of under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed and implemented in order to protect surgeons from preventable, potentially career-altering injuries.
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Dalager T, Jensen PT, Winther TS, Savarimuthu TR, Markauskas A, Mogensen O, Søgaard K. Surgeons' muscle load during robotic-assisted laparoscopy performed with a regular office chair and the preferred of two ergonomic chairs: A pilot study. APPLIED ERGONOMICS 2019; 78:286-292. [PMID: 29650223 DOI: 10.1016/j.apergo.2018.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 03/17/2018] [Accepted: 03/26/2018] [Indexed: 05/14/2023]
Abstract
Surgeons work in awkward work postures and have high precision demands - well-known risk factors for musculoskeletal pain. Robotic-assisted laparoscopy is expected to be less demanding compared to conventional laparoscopy; however, studies indicate that robotic-assisted laparoscopy is also associated with poor ergonomics and musculoskeletal pain. The ergonomic condition in the robotic console is partially dependent upon the chair provided, which often is a regular office chair. Our study quantified and compared the muscular load during robotic-assisted laparoscopy using one of two custom built ergonomic chairs and a regular office chair. The results demonstrated no differences that could be considered clinically relevant. Overall, the study showed high levels of static and mean muscular activity, increased perceived physical exertion from pre-to-post surgery, and moderate to high risk for musculoskeletal injuries measured by the Rapid Upper Limb Assessment worksheet. Authors advocate for further investigation in surgeons' ergonomics and physical work demands in robotic surgery.
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Affiliation(s)
- T Dalager
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 101, 3rd Floor, 5000 Odense C, Denmark.
| | - P T Jensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Division of Obstetrics and Gynecology, Karolinska University Hospital, Kvinnokliniken, 17176 Stockholm, Sweden
| | - T S Winther
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - T R Savarimuthu
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - A Markauskas
- Department of Gynaecology and Obstetrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - O Mogensen
- Division of Obstetrics and Gynecology, Karolinska University Hospital, Kvinnokliniken, 17176 Stockholm, Sweden; Clinical Institute, University of Southern Denmark, Winsløwparken 19, 3rd Floor, 5000 Odense C, Denmark
| | - K Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
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Gürkan MA, Gürkan FT. Measurement of Pain in Multiple Sclerosis. ACTA ACUST UNITED AC 2019; 55:S58-S62. [PMID: 30692858 DOI: 10.29399/npa.23336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
life is pain. It is important to determine the features and the measurement of pain. Common types of pain are described in multiple sclerosis. One-dimensional and multi-dimensional pain scales, which are also used in different painful diseases, are used in the measurement of these pain. Scoring and recording in one-dimensional pain scales are easy and a better measurement is achieved in acute pain. However, the disadvantage of these scales is that they do not give detailed information about the nature of the pain. Multidimensional pain scales are used in chronic and complex pain. Multidimensional scales have some disadvantage about application by patients because of complexity. The development of specific scales for the better measurement of pain in multiple sclerosis is important for the effective treatment of pain in patients.
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Affiliation(s)
| | - Fulya Tuzcu Gürkan
- Ege University Faculty of Medicine, Department of Physiology, Bornova, İzmir, Turkey
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Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg 2018; 153:e174947. [PMID: 29282463 DOI: 10.1001/jamasurg.2017.4947] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (MSDs). This has been called "an impending epidemic" in the context of the looming workforce shortage; however, prevalence estimates vary by study. Objectives To estimate the prevalence of work-related MSDs among at-risk physicians and to evaluate the scope of preventive efforts. Data Sources and Study Selection Systematic search in MEDLINE (Ovid), Embase (Elsevier), Web of Science, PubMed (National Center for Biotechnology Information), and 2 clinical trial registries, without language restriction, for studies reporting on the prevalence and prevention of work-related MSDs among at-risk physicians published until December 2016. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for meta-analyses and systematic reviews of observational studies were used. At-risk physicians were defined as surgeons and medical interventionalists. Studies reporting on specific disorders or pain assessed with validated instruments were included. Data Extraction and Synthesis Study characteristics; disease prevalence for the neck, shoulder, back, and upper extremity; and measures of resulting disability were recorded. Study estimates were pooled using random-effects meta-analytic models. Main Outcomes and Measures Career prevalence of injuries and 12-month prevalence of pain. Results Among 21 articles (5828 physicians [mean age, 46.0 years; 78.5% male; 12.8 years in practice; 14.4 hours performing procedures per week]) included in this systematic review and meta-analysis, pooled crude prevalence estimates of the most common work-related MSDs were degenerative cervical spine disease in 17% (457 of 2406 physicians) (95% CI, 12%-25%), rotator cuff pathology in 18% (300 of 1513 physicians) (95% CI, 13%-25%), degenerative lumbar spine disease in 19% (544 of 2449 physicians) (95% CI, 5%-16%), and carpal tunnel syndrome in 9% (256 of 2449 physicians) (95% CI, 5%-16%). From 1997 to 2015, the prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Pooled prevalence estimates for pain ranged from 35% to 60% and differed by assessment instrument. Of those with a work-related MSD, 12% (277 of 2319 physicians) (95% CI, 7%-18%) required a leave of absence, practice restriction or modification, or early retirement. Heterogeneity was considerable for all crude analyses (mean I2 = 93.5%) but was lower for sensitivity analyses (mean I2 = 72.3%). Interventions focused on products and behaviors. Twelve at-risk specialties described a gross lack of awareness and an unmet need for ergonomics education. Conclusions and Relevance Prevalence estimates of work-related MSDs among at-risk physicians appear to be high. Further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders in this population.
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Affiliation(s)
- Sherise Epstein
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emily H Sparer
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bao N Tran
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Qing Z Ruan
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jack T Dennerlein
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Dhruv Singhal
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Sánchez A, Rodríguez O, Jara G, Sánchez R, Vegas L, Rosciano J, Estrada L. Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model. J Robot Surg 2018; 12:523-527. [DOI: 10.1007/s11701-017-0777-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/23/2017] [Indexed: 12/14/2022]
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Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery. Ann Surg 2017; 266:905-920. [DOI: 10.1097/sla.0000000000002223] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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