Ergonomic Deficits in Robotic Gynecologic Oncology Surgery: A Need for Intervention

Craven, Renatta; Franasiak, Jason M.; Mosaly, Prithima; Gehrig, Paola A.

doi:10.1016/j.jmig.2013.04.008

Cited by 64 publications

(38 citation statements)

References 30 publications

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“…Previous studies looking at possible alleviating effects of ergonomic initiatives in LAP and RALS had contradictory results. The lack of a significant effect of ergonomic improvements may be explained by a number of studies reporting that surgeons do not utilize the ergonomic possibilities, or are even unaware of good ergonomic work practice. Several studies also pinpointed that, despite all the good initiatives, surgeons do not prioritize their comfort or consider future health consequences in the complex setting of the surgical theatre.…”

Section: Discussionmentioning

confidence: 99%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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Background: It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.Methods: Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMG max ). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.Results: The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.Conclusion: Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture. MethodsColorectal surgeons from two Danish hospitals participated. The surgeons were eligible if certified in both surgical modalities, had performed LAP and RALS almost equally, and had a high weekly caseload. The surgeons gave written informed consent to participate, and the Danish Data Protection Agency approved the study (record number 2015-57-0008). Approval from the regional ethics committee was sought, but the present study was exempted. Measurements were conducted on site during normal work procedures. Each surgeon performed two operations -one with LAP and one with RALS. Each of the procedures

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Section: Discussionmentioning

confidence: 99%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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“…In a 2012 study, only 8% of surgeons who reported physical discomfort with surgical procedures attributed it to robotic surgery, whereas 55% of surgeons who reported physical discomfort attributed it to traditional laparoscopy [10]. However, a more recent study suggested serious deficiencies within robotic surgery in regards to ergonomics of upper body positioning that may pose a great risk for musculoskeletal injury in surgeons [11]. …”

Section: Introductionmentioning

confidence: 99%

Physician pain and discomfort during minimally invasive gynecologic cancer surgery

McDonald

Ramírez

Munsell

et al. 2014

Gynecologic Oncology

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Objective Despite increasing awareness of physical strain to surgeons associated with minimally invasive surgery (MIS), its use continues to expand. We sought to gather information from gynecologic oncologists regarding physical discomfort due to MIS. Methods Anonymous surveys were e-mailed to 1,279 Society of Gynecologic Oncology (SGO) members. Physical symptoms (numbness, pain, stiffness, and fatigue) and surgical and demographic factors were assessed. Univariate and multivariate analyses were performed to determine risk factors for physical symptoms. Results We analyzed responses of 350 SGO members who completed the survey and currently performed >50% of procedures robotically (n=122), laparoscopically (n=67), or abdominally (n=61). Sixty-one percent of members reported physical symptoms related to MIS. The rate of symptoms was higher in the robotic group (72%) than the laparoscopic (57%) or abdominal group (49%) (p=0.0052). Stiffness (p=0.0373) and fatigue (p=0.0125) were more common in the robotic group. Female sex (p<0.0001), higher caseload, (p=0.0007) and academic practice (p=0.0186) were associated with increased symptoms. On multivariate analysis, robotic surgery (odds ratio [OR] 2.38, 95% CI 1.20-4.69) and female sex (OR 4.20, 95% CI 2.13-8.29) were significant predictors of symptoms. There was no correlation between seeking treatment and surgical modality (laparotomy 11%, robotic 20%, laparoscopy 25%, p= 0.12). Conclusions Gynecologic oncologists report physical symptoms due to MIS at an alarming rate. Robotic surgery and female sex appear to be risk factors for physical discomfort. As we strive to improve patient outcomes and decrease patient morbidity with MIS, we must also work to improve the ergonomics of MIS for surgeons.

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“…The RULA survey is an ergonomic assessment and prioritization method for determining posture, force and frequency concerns with focus on the upper limb, while the SI uses multiplicative interactions to identify jobs that are potentially hazardous. They concluded that the deficits were hazardous to the surgeons and suggested a need for modification and intervention [95]. However the ability to generalize based on studies for specific surgical indications is limited, as the advantage of robotic-assisted surgery significantly depends on the type of the procedure [92].…”

Section: Which Approach Is Best For Surgeonmentioning

confidence: 99%

Gynecological Surgery and the Robot

O’Sullivan¹,

O’Reilly²

2014

ENG

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As the only robotic device with FDA approval for gynecological surgery, the da Vinci ® Surgical System dominates robot-assisted surgery in the field. Benefits to the Surgeon include decreased risk of neck and back injury secondary to improved ergonomics. However, patients benefit greatly due to decreased length of stay, decreased blood loss and analgesic requirements. Unfortunately the initial economic impact of purchasing and maintaining a robot is great but must be balanced with the potential savings from reduced length of stay and earlier return to normal activity. This article looks at the indications for robot-assisted surgery in gynecology. Assessing the efficacy of this modality compared to both straight stick (Laparoscopy) and open procedures. We discuss the impact and implications for surgical training imposed by robotic surgery. Furthermore, we assess the safety of robotic surgery from both the surgeons prospective and as a surgical modality.

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Ergonomic Deficits in Robotic Gynecologic Oncology Surgery: A Need for Intervention

Cited by 64 publications

References 30 publications

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Physician pain and discomfort during minimally invasive gynecologic cancer surgery

Gynecological Surgery and the Robot

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