Around 80% of surgeons experience strain or pain as a result of performing open and laparoscopic operations [1]. This discomfort is largely attributed to the postures required of surgeons during procedures [1]. To eliminate this occupation hazard, many researchers have pointed to the value of ergonomic techniques. Ergonomics describes the process of “designing the working environment to fit the worker, instead of forcing the worker to fit the working environment” [2]. Although this process tends to be overlooked by surgeons and medical administrators, thinking about ergonomics in the operating room (OR) could be essential to surgeons’ longevity, productivity, and success.
As part of improving ergonomics in the OR, it is crucial to identify the sources of pain and strain that surgeons commonly report. Open surgical procedures require a surgeon’s head and back to be bent [3]. Similarly, minimally invasive procedures are characterized by restricted freedom of movement, an uncomfortable positioning of one’s shoulders and arms, and static neck and back posture [3]. Other sources of discomfort include wearing hefty lead aprons, standing for long periods, and performing repetitive movements [1]. It is no wonder, then, that a survey of 127 surgeons reported that 39.5% of respondents complained of neck issues, 34.9% of erector spinae muscle issues, and 18.6% of right deltoid muscle issues [3].
As benign as these body positions may seem, when held for a long time, they can result in persistent medical problems. 41.8% of the respondents of the aforementioned study said that their complaints persist while they perform surgery [3]. As a result, they may suffer from decreased speed and stamina, impeded concentration, and fatigue while operating [2]. The negative effects of uncomfortable posture can spill over into surgeons’ personal lives. Many professionals report experiencing disturbed sleep and relationships and, in severe cases, decreased quality of life [2]. To manage their conditions, surgeons may need to take muscle relaxants or non-steroid anti-inflammatory drugs, participate in therapy, request work leave, or even retire early [1, 3].
Although surgeons across medical specialties reportedly experience this form of injury, some may be more prone to injury than others [2]. For one, female surgeons are especially at risk, given how many surgical tools were not designed with them in mind [4]. Consider, for instance, how tables may not drop low enough to accommodate women, who tend to be shorter in size than men [4]. These design flaws add to the already-significant strain that surgical practitioners already face. Trainees are another population at risk of exacerbated injury [5]. They may lack knowledge of and/or ignore proper techniques in their haste to jump into surgery, thereby exposing them to a risk of injury early in their careers [5].
To avoid chronic pain and bodily deterioration, surgeons can adopt various ergonomics-friendly practices in the OR. For one, surgeons should optimize the table height for their bodies, avoid positions that cause significant strain (perhaps by turning to robotic platforms), and maintain even weight distribution during surgery [1]. Investing in technology such as comfortable, lightweight headgear; three-dimensional video displaces; or even just athletic footwear can also make a big difference in the OR [6]. Where possible, women surgeons should opt for instruments designed with the female body in mind to eliminate unnecessary resistance and discomfort [6]. Lastly, maintaining a healthy life outside of the OR, with regular exercise and an emphasis on core strength, back strength, and flexibility, can help surgeons avoid debilitating sources of pain [1].
References
[1] P. Hemmati et al., “Ergonomics for Surgeons by Surgeons—Posture, Loupes, and Exercise,” JAMA Surgery, vol. 157, no. 9, p. 751-752, June 2022. [Online]. Available: https://doi.org/10.1001/jamasurg.2022.0676.
[2] K. A. Aaron et al., “The risk of ergonomic injury across surgical specialties,” PLoS One, vol. 16, no. 2, p. 1-13, February 2021. [Online]. Available: https://doi.org/10.1371/journal.pone.0244868.
[3] S. Janki et al., “Ergonomics in the operating room,” Surgical Endoscopy, vol. 31, no. 6, p. 2457-2466, October 2016. [Online]. Available: https://doi.org/https://doi.org/10.1007%2Fs00464-016-5247-5.
[4] M. Fox, “Surgeons Face Unique Ergonomic Challenges,” American College of Surgeons, Updated September 1, 2022. [Online]. Available: https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/september-2022-volume-107-issue-9/surgeons-face-unique-ergonomic-challenges/.
[5] D. Betsch et al., “Ergonomics in the operating room: it doesn’t hurt to think about it, but it may hurt not to!,” Canadian Journal of Ophthalmology, vol. 55, no. 3, supp. 1, p. 17-21, June 2020. [Online]. Available: https://doi.org/10.1016/j.jcjo.2020.04.004.
[6] D. Cook, “Ergonomics in the OR: Protecting Your Surgeons,” Outpatient Surgery, Updated September 11, 2019. [Online]. Available: https://www.aorn.org/outpatient-surgery/article/2019-September-ergonomics-in-the-or-protecting-your-surgeons.