Surgery without Ergonomics is a Pain | Andreea Newtson, MD
A confession: I failed my physical fitness test in college. I went to the University of Chicago—which is not known for its students’ athleticism—so it was cruel that we were forced to take a physical fitness test in the first place. I was therefore a bit surprised when I became interested in surgery, a very athletic specialty.
Surgery is physical. In training, we focus on how to operate to achieve the desired outcome, even if it means contorting your body into uncomfortable positions for extended periods of time. But this is not sustainable. The data on work-related musculoskeletal disorders (WRMD) among surgeons is alarming—rates range from 66-94% for open surgery, 73-100% for conventional laparoscopy, and 23-80% for robotics.1 An SGO survey revealed that 88% of gynecologic oncologists report physical strain.2 WRMD affect productivity and forces surgeons into early retirement.3 Risk factors include shorter stature, smaller glove sizes, and female gender—all bad news for the changing demographics of our field. Only 16% of respondents in that survey received formal ergonomics training.4
Improving surgeons’ ergonomics when operating is a key component in preserving our workforce—at least, until surgeon exoskeletons are ready for prime time. Our workforce is valuable, so it seems short sighted to fail to protect a workforce that took so many resources to develop.
Here are some tips to try and reduce strain:
- Table height
- Open: 5cm below the tallest surgeon’s elbow with the other surgeons on stools to compensate5
- Laparoscopic: Lower, with elbows flexed at 90-120o 6
- Lower arms parallel to the ground, bent around 90o
- Distribute weight equally among feet
- Neck flexion 20o
- Shoulder abduction 30o
- Microbreaks: 20 second breaks every 20 minutes decrease fatigue and increase accuracy without affecting operating time9
Additionally, click here for a helpful video demonstration.
Andreea Newtson, MD, is a Gynecologic Oncologist at the University of Nebraska Medical Center in Omaha, NE.
1. Catanzarite et al. Ergonomics in Surgery: A review. Female Pelvic Medicine and Reconstructive Surgery. Volume 24, No 1, January/February 2018
2. Franasiak et al. Physical strain and urgent need for ergonomic training among gynecologiconcologists who perform minimally invasive surgery. Gynecologic Oncology. 126 (2012) 437–442
3. Catanzarite et al. Ergonomics in Surgery: A review. Female Pelvic Medicine and Reconstructive Surgery. Volume 24, No 1, January/February 2018
4. Franasiak et al. Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery. Gynecologic Oncology. 126 (2012) 437–442
5. Ayoub MM. Work place design and posture. Hum Factors 1973; 15: 265.
6. Matern U, Waller P, Giebmeyer C, et al. Ergonomics: requirements for adjusting the height of laparoscopic operating tables. JSLS 2001; 5: 7.
7. Cardenas-Trowers et al. Ergonomics: making the OR a comfortable place. International urogynecology journal (2018) 29:1065-1066
8. Catanzarite et al. Ergonomics in Surgery: A review. Female Pelvic Medicine and Reconstructive Surgery. Volume 24, No 1, January/February 2018
9. Dorion et al. Do Micropauses Prevent Surgeon’s Fatigue and Loss of Accuracy Associated With Prolonged Surgery? An Experimental Prospective Study. Annals of Surgery. Volume 257(2), February 2013, p 256-259