DescriptionSurgeons are dedicated to improving the well-being of their patients. However, in the process of carrying out this vision, many experience threats to their own well-being due to pain and injuries acquired from years of operating in poorly designed surgical environments with poorly designed surgical tools. Furthermore, despite the exponential growth and development of surgical technology, the environment in which surgery is performed has remained relatively unchanged, presenting a range of threats to the surgeon.1 Surgical instruments, for example, have been refined and adapted to optimize performance based on specific procedures or situations; however, rarely are refinements based on surgeon hand size, strength, or other individual factors that could impact comfort and performance.
A 2018 meta-analysis evaluating surgeons’ work-related pain and musculoskeletal symptoms found that 68% of surgeons surveyed (across 40 articles including 5152 surgeons) reported generalized pain. Operating intensified pain in over 60% of surgeons.2 Unfortunately, fewer than a third sought treatment for their symptoms, and instead, suffered severe work-related injuries, including lumbar disc herniation, carpal tunnel syndrome, rotator cuff disease, and cervical spinal stenosis.2-4 This is likely due to the historical personal and institutional acceptance of pain and injury in healthcare workers. The cumulative effect is that many surgeons have required surgery themselves, leading to extended time away from work and, in some cases, early retirement.
High rates of work-related musculoskeletal disorders in surgeons occur for a variety of reasons. Surgeons routinely violate ergonomic principles regarding the maintenance of neutral postures when operating. They often hold static postures for extended periods of time, at improper heights, while holding or wearing heavy equipment. Although operations can last for several hours, surgeons make every effort to minimize procedure length, to improve outcomes and reduce costs, and as a result, are often reluctant to take necessary breaks.1 Moreover, instruments are designed to meet regulatory requirements (e.g., non-disposable instruments must be developed so they can be safely cleaned, restricting the materials and geometry of design), and the demands of the greatest user pool (e.g., most common surgeon hand size). Although a handful of solutions have been proposed, including the redesign of tools and technology, the use of environmental controls such as anti-fatigue mats, and the introduction of intraoperative microbreaks and stretching, their implementation and adoption is limited. A major barrier may be a lack of awareness and education surrounding challenges to surgical ergonomics.
Now more than ever, surgeons are actively seeking solutions to improve surgical ergonomics. This panel will address the challenges facing surgeons in their interactions with surgical environments and discuss opportunities to improve surgeon well-being, quality of life, and career longevity.
We will hear from a multidisciplinary panel of experts. Dr. Shao will begin by discussing the problem of surgical ergonomics, work-related musculoskeletal disorders, and the effect of different surgical modalities, specialties, and trainees on performance and comfort in the operating room. Dr. Cohen will then describe the pitfalls of the operating room environment as well as current challenges with industry instrument and device design. Dr. Haigh will introduce the new Society of Surgical Ergonomics, a non-profit organization founded by surgeons and human factors experts to increase ergonomics awareness and decrease injuries to surgeons. Dr. Hallbeck will then discuss opportunities to improve ergonomics in the operating room, using OR-STRETCHTM, an online application aimed to help surgeons implement intraoperative microbreaks with targeted stretching routines, as an exemplar. Finally, Dr. Jain will discuss additional opportunities to intervene and improve surgical ergonomics, including the recruitment of surgeon champions, curricula development, and other research and education efforts.