Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery

Abstract

Purpose of reviewTo evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery.Recent findingsFactors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics.SummaryConsidering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.

Influence of Intraoperative Active and Passive Breaks in Simulated Minimally Invasive Procedures on Surgeons’ Perceived Discomfort, Performance, and Workload

“…The hypothesis was not confirmed with perceived discomfort ratings at the end of the simulation ranging (mean) from 0.7 (passive) to 0.9 (without) and 1.1 (active), which were not statistically significantly different from each other (p = 0.439). Our study population showed a positive attitude towards active breaks plus a 65% likelihood of implementing self-initiated active work breaks during laparoscopies lasting ≥90 min, which is in line with the recommendations of recent overview articles [43,44]. Our secondary aim was to examine potential differences in work performance and perceived workload among the conditions without passive and active work breaks.…”