...glove size is an imperfect measure of hand anthropometry and grasp force exertion. ...hand dimension is only one factor in hand-held surgical/procedural instrument design. Wrist position ...influences grip force as well, so intraoperative use of an instrument with a large handle span when the wrist is out of neutral position reduces the surgeon's ability to close the span by up to 43%, in addition to the span issue.4 Additionally, women's grip strength, on average, is between 50 and 75% that of men's.4 This in turn, can lead to the small-handed surgeon's self-report of difficulty of use for laparoscopic instruments, endoscopes and Harmonic® scalpels (Table 4) in Weinrich, et al.1 A recent paper by Armijo et al.5 studied the muscular effort required for intraoperative laparoscopic instrumentation, demonstrating that women had significantly higher wrist and shoulder muscle activation while using intraoperative instrumentation, after correcting for surgeon height.
Surgeons are at high risk of developing musculoskeletal disorders.
This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective ...measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed.
Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures.
This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons’ intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ergonomic risk factors is of paramount importance to protect the well-being of the surgical workforce.
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Background
Surgeon workload is significant both mentally and physically and may differ by procedure type. When comparing laparoscopic surgery and open surgery, studies have reported contrasting ...results on the physical and mental workload assessed.
Methods
Wearable posture sensors and pre-/post-surgical questionnaires were employed to assess intraoperative workload and to identify risk factors for surgeons using objective and subjective measures.
Results
Data from 49 cases (27 open and 22 laparoscopic surgeries performed by 13 male and 11 female surgeons) were assessed. More than half the surgeons reported a clinically relevant post-surgical fatigue score. The surgeons also self-reported a significant increase in pain for the neck, upper back, and lower back during/after surgery. Procedural time had significant impacts on fatigue, body part pain, and subjective (NASA-TLX) workload. The objectively assessed intraoperative work postures using wearable sensors showed a high musculoskeletal risk for neck and lower back based on their posture overall. Open surgeries had significantly larger neck angles (median IQR: 40 28–47°) compared with laparoscopic surgeries (median IQR: 23 16–29°),
p
< 0.001) and torso (median IQR: 17 14–22° vs. 13 10–17°,
p
= 0.006).
Conclusion
Surgeons reported significantly higher levels of fatigue and pain in the neck and lower back during or after performing a surgical case. Longer procedural time resulted in more self-rated fatigue, pain, and subjective workload. Open surgery had higher postural risk. Overall, surgeons spent a disturbingly high percentage of time during surgery in high-risk musculoskeletal postures, especially the neck. These results show that intraoperative postural risk is very high and that interventions are necessary to protect surgeon musculoskeletal health for optimal surgeon performance and career longevity.
This article reviews studies conducted “in the wild” that explore the “ironies of automation” in Robotic Assisted Surgery (RAS). Workload may be reduced for the surgeon, but increased for other team ...members, with postural stress relocated rather than reduced, and the introduction of a range of new challenges, for example, in the need to control multiple arms, with multiple instruments; and the increased demands of being physically separated from the team. Workflow disruptions were not compared with other surgeries; however, the prevalence of equipment and training disruptions differs from other types of surgeries. A consistent observation is that communication and coordination problems are relatively frequent, suggesting that the surgical team may need to be trained to use specific verbal and non-verbal cues during surgery. RAS also changes the necessary size of the operating room instrument cleaning processes. These studies demonstrate the value of clinically-based human factors engineers working alongside surgical teams to improve the delivery of RAS.
•A wide range of system components influence, and are influenced by, robot assisted surgery (RAS).•Workload is redistributed through the team while musculoskeletal stressors remain.•RAS surgeries experience technology, communication, coordination, and training problems.•New verbal communication forms and machine-mediated gestures may be required.•Surgical and human factors collaborations can improve the delivery of RAS.
AbstractObjectiveVascular surgeons may experience physical discomfort during open and endovascular procedures. We aimed to understand and quantify the timing, severity, and location of the pain, as ...well as to identify how pain correlates with other factors. MethodsAn electronic survey was distributed to 1164 members of the Society for Clinical Vascular Surgery during the summer of 2016. There were 1089 (93.6%) surveys that were successfully delivered and 263 responses received (response rate of 24.2%). The survey was designed to quantify pain before, during, and after surgical procedures using the modified Borg scale. Questions aimed at determining surgeon workload, type of practice, burnout, and professional satisfaction were also included. ResultsOf the 263 total responses, 184 responders were male (82.1%). Workload data revealed that more than 87% of surgeons operate 3 or more days per week and 4 or more hours per day. Lead garments were worn by 48.4% these surgeons every day, with 91.4% wearing lead at least once per week. Pain was present in 74.7% of surgeons before beginning an operation, in 92.3% during an operation, and in 96.8% at completion. Before, during, and after surgery, 12.2% of vascular surgeons (n = 32) experience at least moderate pain. Years in practice had no effect on these results, and although not reaching statistical significance, there was a trend correlating surgeons who wear lead experiencing more pain immediately after performing an operation ( P = .090). Of these surgeons, 31.4% acknowledged seeking medical help, although only 4.4% reported pain to their institutions. Professional satisfaction among vascular surgeons was inversely correlated with pain. Those expressing satisfaction with their profession had less pain before and two days after performing surgery ( P ≤ .005). Self-reported burnout among surgeons positively correlated with increased pain. Burned out surgeons reported more pain while performing surgery ( P ≤ .001), immediately after performing surgery ( P ≤ .001), and persistent pain ( P ≤ .001). ConclusionsPhysical discomfort during the performance of daily duties by vascular surgeons is ubiquitous. Our survey shows a correlation between self-reported workplace burnout and an increased severity of work-related pain. Additional studies are needed to determine the causality of these correlations and what potential interventions can be undertaken to decrease all work-related pain.
Exoskeletons have shown significant impact at reducing the biomechanical demand on muscles during repetitive lifting and overhead tasks in non-healthcare industries. However, the benefits of ...exoskeletons are yet to be realized in the operating room, particularly as work-related musculoskeletal disorders continue to be a concern for surgeons. This study quantified the effect of using neck, arm, and trunk exoskeletons on muscle activity while assuming typical postures held in the operating room. Fourteen participants were recruited to participate in this study. In this two-part experiment participants were asked to 1) hold a series of neck flexion, arm abduction and trunk flexion postures seen in surgical procedures, and 2) perform a simulated surgical task requiring five different trunk flexion posture levels. Participants were required to complete these tasks with and without passive exoskeleton(s). This study showed that even for postures held short time periods, exoskeletons are beneficial at reducing the demand on muscles; however, the reduction in muscle demand depends on body segment and postural angle, as intended with these passive exoskeletons. Furthermore, for the simulated surgical task with awkward trunk flexion postures (10–65°), the trunk exoskeletons showed a significant reduction in the rate of rise in back muscle sEMG (+1.365%MVC/min vs. +0.769%MVC/min for non-dominant lumbar extensor muscles, p = 0.0108; +1.377%MVC/min vs. +0.770%MVC/min for the dominant lumbar extensor muscles, p = 0.0196) over 25 min, consequently resulting in improved trunk subjective discomfort scores (7.34 vs. 4.30, p < 0.05), with no impact on the neck and shoulder biomechanical demand. The results from this study indicate that exoskeletons may be a potential intervention to reduce biomechanical loading during surgery.
•Exoskeletons reduce low back muscle activity in simulated surgical tasks.•The benefit derived from exoskeleton intervention may be related to surgical task and body segment posture.•Further studies are needed to validate the benefits of exoskeletons in the operating room.
The rise of high-definition imaging and robotic surgery has independently been associated with improved postoperative outcomes. However, steep learning curves and finite human cognitive ability limit ...the facility in imaging interpretation and interaction with the robotic surgery console interfaces. This review presents innovative ways in which artificial intelligence integrates preoperative imaging and surgery to help overcome these limitations and to further advance robotic operations.
PubMed was queried for “artificial intelligence,” “machine learning,” and “robotic surgery.” From the 182 publications in English, a further in-depth review of the cited literature was performed.
Artificial intelligence boasts efficiency and proclivity for large amounts of unwieldy and unstructured data. Its wide adoption has significant practice-changing implications throughout the perioperative period. Assessment of preoperative imaging can augment preoperative surgeon knowledge by accessing pathology data that have been traditionally only available postoperatively through analysis of preoperative imaging. Intraoperatively, the interaction of artificial intelligence with augmented reality through the dynamic overlay of preoperative anatomical knowledge atop the robotic operative field can outline safe dissection planes, helping surgeons make critical real-time intraoperative decisions. Finally, semi-independent artificial intelligence–assisted robotic operations may one day be performed by artificial intelligence with limited human intervention.
As artificial intelligence has allowed machines to think and problem-solve like humans, it promises further advancement of existing technologies and a revolution of individualized patient care. Further research and ethical precautions are necessary before the full implementation of artificial intelligence in robotic surgery.
Higher workload is associated with burnout and lower performance. Therefore, we aim to assess shift-related factors associated with higher workload on EGS, ICU, and trauma surgery services.
In this ...prospective cohort study, faculty surgeons and surgery residents completed a survey after each EGS, ICU, or trauma shift, including shift details and a modified NASA-TLX.
Seventeen faculty and 12 residents completed 174 and 48 surveys after working scheduled 12-h and 24-h shifts, respectively (response rates: faculty – 62%, residents – 42%). NASA-TLX was significantly increased with a higher physician subjective fatigue level. Further, seeing more consults or performing more operations than average significantly increased workload. Finally, NASA-TLX was significantly higher for faculty when they felt their shift was more difficult than expected.
Higher volume clinical responsibilities and higher subjective fatigue levels are independently associated with higher workload. Designing shift coverage to expand on busier days may decrease workload, impacting burnout and shift performance.
•Faculty physician workload was increased when shifts were more difficult than expected.•Physician workload was increased after shifts with a higher patient care volume.•Subjective fatigue level was associated with increased physician workload.
OBJECTIVE:The aim of this study was to investigate the effect of intraoperative targeted stretching micro breaks (TSMBs) on the experienced pain and fatigue, physical functions, and mental focus of ...surgeons.
BACKGROUND:Surgeons are routinely subject to mental and physical stresses through the course of their work in the operating room. One of the factors most contributory to the shortening of a surgeonʼs career is work-related pain and its effects on patient safety and personal relationships.
METHODS:Surgeons and operating room staff from 4 medical centers rated pain/fatigue, physical, and mental performance using validated scales during 2 operative days1 day without implementing TSMB, the other including standardized (1.5 to 2 minutes) guided TSMB at appropriate 20 to 40-minute intervals throughout each case. Case type and duration were recorded as were surgeon pain data before and after each procedure and at the end of the surgical day. Individual body part pre/postdiscomfort difference was modeled, controlling for clinical center. Random coefficient mixed models accounted for surgeon variability.
RESULTS:Sixty-six participants (69% men, 31% women; mean 47 years) completed 193 “non-TSMB” and 148 “TSMB” procedures. Forty-seven percent of surgeons were concerned that musculoskeletal pain may shorten their career. TSMB improved surgeon postprocedure pain scores in the neck, lower back, shoulders, upper back, wrists/hands, knees, and ankles. Operative duration did not differ (P> 0.05). Improved pain scores with TSMB were statistically equivalent (P > 0.05) for laparoscopic and open procedures. Surgeons perceived improvements in physical performance (57%) and mental focus (38%); 87% of respondents planned to continue TSMB.
CONCLUSIONS:Many surgeons are concerned about career-ending or limiting musculoskeletal pain. Intraoperative TSMB may represent a practical, effective means to reduce surgeon pain, enhance performance, and increase mental focus without extending operative time.
The aim of this study was to investigate the effect of intraoperative targeted stretching micro breaks (TSMBs) on the experienced pain and fatigue, physical functions, and mental focus of surgeons.
...Surgeons are routinely subject to mental and physical stresses through the course of their work in the operating room. One of the factors most contributory to the shortening of a surgeon's career is work-related pain and its effects on patient safety and personal relationships.
Surgeons and operating room staff from 4 medical centers rated pain/fatigue, physical, and mental performance using validated scales during 2 operative days: 1 day without implementing TSMB, the other including standardized (1.5 to 2 minutes) guided TSMB at appropriate 20 to 40-minute intervals throughout each case. Case type and duration were recorded as were surgeon pain data before and after each procedure and at the end of the surgical day. Individual body part pre/postdiscomfort difference was modeled, controlling for clinical center. Random coefficient mixed models accounted for surgeon variability.
Sixty-six participants (69% men, 31% women; mean 47 years) completed 193 "non-TSMB" and 148 "TSMB" procedures. Forty-seven percent of surgeons were concerned that musculoskeletal pain may shorten their career. TSMB improved surgeon postprocedure pain scores in the neck, lower back, shoulders, upper back, wrists/hands, knees, and ankles. Operative duration did not differ (P> 0.05). Improved pain scores with TSMB were statistically equivalent (P > 0.05) for laparoscopic and open procedures. Surgeons perceived improvements in physical performance (57%) and mental focus (38%); 87% of respondents planned to continue TSMB.
Many surgeons are concerned about career-ending or limiting musculoskeletal pain. Intraoperative TSMB may represent a practical, effective means to reduce surgeon pain, enhance performance, and increase mental focus without extending operative time.
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