Top

Surgical Endoscopy

Published in:

Open Access 01-06-2017

Ergonomics in the operating room

Authors: Shiromani Janki, Evalyn E. A. P. Mulder, Jan N. M. IJzermans, T. C. Khe Tran

Published in: Surgical Endoscopy | Issue 6/2017

Abstract

Background

Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to investigate the current frequency and effects of occupational musculoskeletal injuries on work absence.

Methods

An online questionnaire was conducted among all surgeons affiliated to the Dutch Society for Endoscopic Surgery, Gastrointestinal Surgery, and Surgical Oncology. In addition, this survey was conducted among surgeons, gynaecologists, and urologists of one cluster of training hospitals in the Netherlands.

Results

There were 127 respondents. Fifty-six surgeons currently suffer from musculoskeletal complaints, and 30 have previously suffered from musculoskeletal complaints with no current complaints. Frequently reported localizations were the neck (39.5 %), the erector spinae muscle (34.9 %), and the right deltoid muscle (18.6 %). Most of the musculoskeletal complaints were present while operating (41.8 %). Currently, 37.5 % uses medication and/or therapy to reduce complaints. Of surgeons with past complaints, 26.7 % required work leave and 40.0 % made intraoperative adjustments. More surgeons with a medical history of musculoskeletal complaints have current complaints (OR 6.1, 95 % CI 1.9–19.6). There were no significant differences between surgeons of different operating techniques in localizations and frequency of complaints, or work leave.

Conclusions

Despite previous various ergonomic recommendations in the operating room, the current study demonstrated that musculoskeletal complaints and subsequent work absence are still present among surgeons, especially among surgeons with a positive medical history for musculoskeletal complaints. Even sick leave was necessary to fully recover. There were no significant differences in reported complaints between surgeons of different operating techniques. Almost half of the respondents with complaints made intraoperative ergonomic adjustments to prevent future complaints. The latter would be interesting for future research.

Santos-Carreras L, Hagen M, Gassert R, Bleuler H (2012) Survey on surgical instrument handle design: ergonomics and acceptance. Surg Innov 19:50–59CrossRefPubMed

Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D (2010) Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg 210:306–313CrossRefPubMed

Vecchio R, MacFayden BV, Palazzo F (2000) History of laparoscopic surgery. Panminerva Med 42:87–90PubMed

Spaner SJ, Warnock GL (1997) A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J Laparoendosc Adv Surg Tech A 7:369–373CrossRefPubMed

Berguer R, Chen J, Smith WD (2003) A comparison of the physical effort required for laparoscopic and open surgical techniques. Arch Surg 138:967–970CrossRefPubMed

Berguer R (1999) Surgery and ergonomics. Arch Surg 134:1011–1016CrossRefPubMed

Berguer R, Forkey DL, Smith WD (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13:466–468CrossRefPubMed

Van Veelen MA, Nederlof EAL, Goossens RHM, Schot CJ, Jakimowicz JJ (2003) Ergonomic problems encountered by the medical team related to products used for minimally invasive surgery. Surg Endosc 17:1077–1081CrossRefPubMed

Bureau of Labor Statistics (2012) Occupational safety and health definitions. http://www.bls.gov/iif/oshdef.htm. Accessed 10 Mar 2016

10.

Albayrak A, Van Veelen MA, Prins JF, Snijders CJ, De Ridder H, Kazemier G (2007) A newly designed ergonomic body support for surgeons. Surg Endosc 21:1835–1840CrossRefPubMed

11.

Szeto GPY, Cheng SWK, Poon JTC, Ting ACW, Tsang RCC, Ho P (2012) Surgeons’ static posture and movement repetitions in open and laparoscopic surgery. J Surg Res 172:19–31CrossRef

12.

Esposito C, Najmaldin A, Schier F, Yamataka A, Ferro M, Riccipetitoni G, Czauderna P, Ponsky T, Till H, Escolino M, Iaquinto M, Marte A, Saxena A, Settimi A, Rothenberg S (2014) Work-related upper limb musculoskeletal disorders in pediatric minimally invasive surgery: a multicentric survey comparing laparoscopic and sils ergonomy. Pediatr Surg Int 30:395–399CrossRefPubMed

13.

Hemal AK, Srinivas M, Charles AR (2001) Ergonomic problems associated with laparoscopy. J Endourol 15:499–503CrossRefPubMed

14.

Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J (1997) A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc 11:139–142CrossRefPubMed

15.

Esposito C, El Ghoneimi A, Yamataka A, Rothenberg S, Bailez M, Ferro M, Gamba P, Castagnetti M, Mattioli G, Delagausie P, Antoniou D, Montupet P, Marte A, Saxena A, Bertozzi M, Philippe P, Varlet F, Lardy H, Caldamone A, Settimi A, Pelizzo G, Becmeur F, Escolino M, De Pascale T, Najmaldin A, Schier F (2013) Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg 48:1750–1756CrossRefPubMed

16.

Mohseni-Bandpei MA, Ahmad-Shirvani M, Golbabaei N, Behtash H, Shahinfar Z, Fernandez-De-Las-Penas C (2011) Prevalence and risk factors associated with low back pain in Iranian surgeons. J Manip Physiol Ther 34:362–370CrossRef

17.

Davis WT, Fletcher SA, Guillamondegui OD (2014) Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions. J Surg Res 189:207–212CrossRefPubMed

18.

Soueid A, Oudit D, Thiagarajah S, Laitung G (2010) The pain of surgery: pain experienced by surgeons while operating. Int J Surg 8:118–120CrossRefPubMed

19.

Albayrak A, Kazemier G, Meijer DW, Bonjer HJ (2004) Current state of ergonomics of operating rooms of Dutch hospitals in the endoscopic era. Minim Invasive Ther Allied Technol 13:156–160CrossRefPubMed

20.

Veelen MA, Jakimowicz JJ, Goossens RHM, Meijer DW, Bussmann JBJ (2002) Evaluation of the usability of two types of image display systems, during laparoscopy. Surg Endosc 16:674–678CrossRefPubMed

21.

Goossens RHM, Van Veelen MA (2001) Assessment of ergonomics in laparoscopic surgery. Minim Invasive Ther Allied Technol 10:175–179CrossRef

22.

Berguer R, Forkey DL, Smith WD (2001) The effect of laparoscopic instrument working angle on surgeons’ upper extremity workload. Surg Endosc 15:1027–1029CrossRefPubMed

23.

Van Det MJ, Meijerink WJHJ, Hoff C, Van Veelen MA, Pierie JPEN (2008) Ergonomic assessment of neck posture in the minimally invasive surgery suite during laparoscopic cholecystectomy. Surg Endosc 22:2421–2427CrossRefPubMed

24.

Koneczny S, Matern U (2004) Instruments for the evaluation of ergonomics in surgery. Minim Invasive Ther Allied Technol 13:167–177CrossRefPubMed

25.

Kaya OI, Moran M, Ozkardes AB, Taskin EY, Seker GE, Ozmen MM (2008) Ergonomic problems encountered by the surgical team during video endoscopic surgery. Surg Laparosc Endosc Percutan Tech 18:40–44CrossRefPubMed

26.

Liang B, Qi L, Yang J, Cao Z, Zu X, Liu L, Wang L (2013) Ergonomic status of laparoscopic urologic surgery: survey results from 241 urologic surgeons in China. PLoS ONE 8:e70423CrossRefPubMedPubMedCentral

27.

Miller K, Benden M, Pickens A, Shipp E, Zheng Q (2012) Ergonomics principles associated with laparoscopic surgeon injury/illness. Hum Factors 54:1087–1092CrossRefPubMed

28.

Elhage O, Challacombe B, Shortland A, Dasgupta P (2014) An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 115:274–281CrossRef

29.

Giberti C, Gallo F, Francini L, Signori A, Testa M (2014) Musculoskeletal disorders among robotic surgeons: a questionnaire analysis. Arch Ital Urol Androl 86:95–98CrossRefPubMed

30.

Tjiam IM, Goossens RH, Schout BM, Koldewijn EL, Hendrikx AJ, Muijtjens AM, Scherpbier AJ, Witjes JA (2014) Ergonomics in endourology and laparoscopy: an overview of musculoskeletal problems in urology. J Endo 28:605–611

31.

Liang CA, Levine VJ, Dusza SW, Hale EK, Nehal KS (2012) Musculoskeletal disorders and ergonomics in dermatologic surgery: a survey of Mohs surgeons in 2010. Dermatol Surg 38:240–248CrossRefPubMed

32.

Wauben LSGL, Van Veelen MA, Gossot D, Goossens RHM (2006) Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc 20:1268–1274CrossRefPubMed

33.

Sari V, Nieboer TE, Vierhout ME, Stegeman DF, Kluivers KB (2010) The operation room as a hostile environment for surgeons: physical complaints during and after laparoscopy. Minim Invasive Ther Allied Technol 19:105–109CrossRefPubMed

34.

De Nederlandse Vereniging voor Endoscopische Chirurgie (NVEC) (2015). http://www.nvec.nl/. Accessed 10 Mar 2016

35.

De Nederlandse Vereniging voor GastroIntestinale Chirurgie (NVGIC). http://nvgic.nl/. Accessed 10 Mar 2016

36.

De Nederlandse Vereniging voor Chirurgische Oncologie (NVCO). http://www.nvco.nl/. Accessed 10 Mar 2016

37.

Hopmans CJ, den Hoed PT, Wallenburg I, van der Laan L, van der Harst E, van der Elst M, Mannaerts GH, Dawson I, van Lanschot JJ, Ijzermans JN (2013) Surgeons’ attitude toward a competency-based training and assessment program: results of a multicenter survey. J Surg Educ 70:647–654CrossRefPubMed

38.

Hopmans CJ, den Hoed PT, van der Laan L, van der Harst E, van der Elst M, Mannaerts GH, Dawson I, Timman R, Wijnhoven BP, Ijzermans JN (2014) Assessment of surgery residents’ operative skills in the operating theater using a modified Objective Structured Assessment of Technical Skills (OSATS): a prospective multicenter study. Surgery 156:1078–1088CrossRefPubMed

39.

Hopmans CJ, den Hoed PT, van der Laan L, van der Harst E, van der Elst M, Mannaerts GH, Dawson I, Timman R, Wijnhoven BP, Ijzermans IJ (2015) Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents. Surgery 157:634–641CrossRefPubMed

40.

Elhage O, Challacombe B, Shortland A, Dasgupta P (2015) An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 115:274–281CrossRefPubMed

41.

Welcker K, Kesieme EB, Internullo E, Kranenburg Van Koppen LJC (2012) Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons. Interact CardioVasc Thorac Surg 15:197–200CrossRefPubMedPubMedCentral

42.

Berguer R (1998) Surgical technology and the ergonomics of laparoscopic instruments. Surg Endo 12:458–462CrossRef

43.

Matern U, Waller P (1999) Instruments for minimally invasive surgery: principles of ergonomic handles. Surg Endosc 13:174–182CrossRefPubMed

44.

Berguer R, Hreljac A (2004) The relationship between hand size and difficulty using surgical instruments: a survey of 726 laparoscopic surgeons. Surg Endosc 18:508–512CrossRefPubMed

45.

Reyes DAG, Tang B, Cuschieri A (2006) Minimal access surgery (MAS)-related surgeon morbidity syndromes. Surg Endo 20:1–13CrossRef

46.

Uehli K, Mehta AJ, Miedinger D, Hug K, Schindler C, Holsboer-Trachsler E, Leuppi JD, Künzli N (2014) Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med Rev 18:61–73CrossRefPubMed

47.

Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E (2015) Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep 38:843–844CrossRefPubMedPubMedCentral

Title: Ergonomics in the operating room
Authors: Shiromani Janki
Evalyn E. A. P. Mulder
Jan N. M. IJzermans
T. C. Khe Tran
Publication date: 01-06-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5247-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Ergonomics in the operating room

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2017

Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery

Less pain after transvaginal cholecystectomy: single-center pooled analysis

Assessment of colorectal polyp recognition skill: development and validation of an objective test

Laparoscopic duodenoduodenostomy with parallel anastomosis for duodenal atresia

Erratum to: The effect of a performance-based intra-procedural checklist on a simulated emergency laparoscopic task in novice surgeons

Erratum to: Laparoscopic gastrectomy for gastric cancer in the elderly patients