Feasibility and Acceptance of a Robotic Surgery Ergonomic Training Program

Abstract

Background and Objectives:Assessment of ergonomic strain during robotic surgery indicates there is a need for intervention. However, limited data exist detailing the feasibility and acceptance of ergonomic training (ET) for robotic surgeons. This prospective, observational pilot study evaluates the implementation of an evidence-based ET module.Methods:A two-part survey was conducted. The first survey assessed robotic strain using the Nordic Musculoskeletal Questionnaire (NMQ). Participants were given the option to participate in either an online or an in-person ET session. The ET was derived from Occupational Safety and Health Administration guidelines and developed by a human factors engineer experienced with health care ergonomics. After ET, a follow-up survey including the NMQ and an assessment of the ET were completed.Results:The survey was sent to 67 robotic surgeons. Forty-two (62.7%) responded, including 18 residents, 8 fellows, and 16 attending physicians. Forty-five percent experienced strain resulting from performing robotic surgery and 26.3% reported persistent strain. Only 16.6% of surgeons reported prior ET in robotic surgery. Thirty-five (78%) surgeons elected to have in-person ET, which was successfully arranged for 32 surgeons (91.4%). Thirty-seven surgeons (88.1%) completed the follow-up survey. All surgeons participating in the in-person ET found it helpful and felt formal ET should be standard, 88% changed their practice as a result of the training, and 74% of those reporting strain noticed a decrease after their ET.Conclusion:Thus, at a high-volume robotics center, evidence-based ET was easily implemented, well-received, changed some surgeons' practice, and decreased self-reported strain related to robotic surgery.

Ergonomics and Musculoskeletal Health of the Surgeon

“…The authors identified that only 16% of surgeons underwent any formal ergonomic training; however, when an educational program was implemented, 74% noted a decrease in strain when implementing the recommended positions. 20 Although the robotic surgical platform addresses and alleviates many of the ergonomic deficiencies associated with conventional laparoscopy, this modality has not fully alleviated the risk of MSK discomfort among surgeons. 64 During robotic procedures, the surgeon should always focus on a neutral position to avoid static loading on the body.…”

“…The chair and console height can be readjusted at any time to provide a more comfortable position. 20,65 Due to the paucity of research comparing the ergonomics of robotassisted surgery versus conventional laparoscopy, further investigations are required to fully elucidate the surgeon's risk of work-related injury when using this technology. 66…”

“…8,19 Unfortunately, many surgeons never receive a formal education or are even aware that guidelines exist to help prevent these prevalent occupational injuries. 9,20,21 Even more disappointing, when properly trained and educated, only 60% of surgeons actually incorporate appropriate ergonomic designs in their surgical practices. 21…”

Work-Related Musculoskeletal Disorders among Plastic Surgeons: A Systematic Review

“…8 Studies in other surgical specialties suggest that injuries requiring surgical intervention and time away from work occur as early residency training, with one study stating that one trainee was required to prolong their training for 3 months due to occupational injury. [35][36][37][38][39] During an American College of Surgeons webinar, one attending stated that two of their trainees in recent years have required laminectomies and one of their colleagues was disabled from operating in their early 40s due to work-related MSDs. In addition to missed work, work-related MSDs and poor ergonomics have been shown to reduce productivity [40][41][42] leading to inferior operative performance.…”

Applications of the Standardized Nordic Questionnaire: A Review

“…Franasiak et al [95] used the NMQ to evaluate the MSD of surgeons during robotic surgery before and after an ergonomic improvement. The improvement programme was easily implemented and was well received.…”