Rates of musculoskeletal problems amongst surgeons are high, especially amongst those performing laparoscopic surgery. In the context of open surgery, the use of loupes, headlamps, and microscopes is associated with greater risk. Laparoscopic surgery presents its own specific challenges relating to table and monitor position, instrument handle design and requisite long-shafted instruments. Even robotic surgery has proved problematic, with wrist and finger strain often reported.
These injuries tend to be under-reported and have historically garnered little attention. However, their impact can be significant – sometimes even career shortening – and so it makes good sense to be mindful of ergonomics from the outset.
The same holds true for simulated surgery. Unlike several box trainers, the eoSim was designed with ergonomics in mind, accurately reflecting the good operating angles that can be achieved in theatre by lowering the operating table and tilting it towards the surgeon. Useful ergonomic principles during laparoscopic surgery and simulation are:
Head: look straight forwards without rotation or extension of the neck. Ideally no more than 20-30 degrees of neck flexion.
Shoulders: relaxed and neutral position.
Arms: alongside the body.
Elbows: bent to 90-120 degrees.
The Human Factors Engineering Lab at the Mayo Clinic has been exploring the usefulness of intra-operative microbreaks as a way to mitigate for work-related musculoskeletal pain and injury. They have developed a range surgeon-specific stretching exercises, called OR-stretch, in an effort to enhance performance, reduce pain, and optimise mental focus. They found that those who integrated the program into their list reported a reduction in shoulder pain with minimal impact on operative time / patient flow.
Regarding human factors in surgery, eoSurgical will soon be releasing beta versions of new modules which superimpose non-technical challenges into our already-validated laparoscopic curriculum. These are inspired by the Non-Technical Skills for Surgeons (NOTSS) designed by the Royal College of Surgeons of Edinburgh. Watch this space!
Consultant neurosurgeon and honorary senior lecturer, Edinburgh