Optimal laparoscopic ergonomics in gynaecology

Abstract

Laparoscopic surgery in gynaecology is mainstream and widely practised. While this brings many benefits to the patient, injury to the surgeon is often under-reported. Careful theatre layout and correct instruments minimise the risk to the surgeon. There is a lack of gynaecology-specific guidelines/training in optimal theatre layout and surgeon positioning. This article examines the current available evidence and suggests changes that clinicians can make in order to optimise their working environment. Learning objectivesTo appreciate the many ways the operating theatre can be changed to facilitate optimal ergonomics. To be aware of the different equipment available to facilitate comfort when operating. To recognise the short-term and long-term repercussions of poor ergonomics. Ethical issuesShould this form part of every surgeon's training? Despite obvious benefits for patients, should employers pay closer attention to the health of their staff?

Prevalence of musculoskeletal pain among gynecologic surgeons performing laparoscopic procedures: A systematic review and meta‐analysis

“…The estimated prevalence of musculoskeletal symptoms among gynecologic laparoscopic surgeons was 82% (95% CI, 70%–89%; I 2 , 92%), calculated from a pooled sample size of 1619 surgeons among the 12 studies included (Figure 4). 3,4,8–17 As studies varied in the type of prevalence reported, subgroup analyses were performed to estimate the lifetime, 12‐month, and point prevalence (Figure 5). The estimated lifetime prevalence was 90% (95% CI, 76%–96%; I 2 , 91%), based on data from six studies with a combined sample size of 626 3,4,10,12,13,15 .…”

“… 3,4,8–17 As studies varied in the type of prevalence reported, subgroup analyses were performed to estimate the lifetime, 12‐month, and point prevalence (Figure 5). The estimated lifetime prevalence was 90% (95% CI, 76%–96%; I 2 , 91%), based on data from six studies with a combined sample size of 626 3,4,10,12,13,15 . The 12‐month prevalence, reported in only one study with a sample size of 67 surgeons, was 63% (95% CI, 51%–73%) 11 .…”

“…Although several studies have reported on musculoskeletal symptoms among gynecologic surgeons performing minimally invasive surgery, 3,4,8–17 a systematic appraisal of the available literature is warranted to adequately estimate the scope and burden of the problem. This evidence is necessary to improve the long‐term occupational health of gynecologic surgeons.…”

Excision of endometriosis – optimising surgical techniques

“…Ergonomics in laparoscopic surgery is another fundamental principle, which has been described in detail elsewhere. 10…”

Awareness and practice of ergonomics by gynecological laparoscopists in Turkey

“…Appropriate monitor height and position, table height, port placement, and design of handheld instruments can improve poor posture [6][7][8]. Correct ergonomics decreases musculoskeletal disorders, suturing time, and complications [9,10]. Operating rooms can be inhospitable for laparoscopists if ergonomic rules for laparoscopy are not followed.…”