Surgeon Postures during Deep Inferior Epigastric Perforator Flap Breast Reconstruction Procedures: A Pilot Study

Tetteh

Proceedings of the Human Factors and Ergonomics Society Annual

et al. 2022

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Two attending surgeons (surgeon at abdomen and surgeon at chest) and nine surgical trainees completed electronic surveys after deep inferior epigastric perforator (DIEP) flap surgical procedures. The survey included workload and teamwork subscales. The results indicated that DIEP flap surgery is a highly demanding surgical procedure both physically and cognitively. For the surgeon at abdomen, most of workload subscales were significantly higher than the paired trainees (p<0.05), while their teamwork subscales were not significantly different. The surgical trainees should know that the attending surgeon’s self-perceived workload could be higher than theirs even when their self-perceived teamwork is similar. For the surgeon at chest, most of teamwork subscales were significantly higher than the paired trainees (p<0.05), while their workload subscales were not significantly different. The attending surgeons should know that even when their self-evaluation of workload is similar to their trainees, the trainee’s evaluation of teamwork could be less than theirs.

Section: Discussionsupporting

confidence: 89%

Intraoperative teamwork and workload among surgeons and surgical trainees during DIEP flap surgery

Tetteh

Proceedings of the Human Factors and Ergonomics Society Annual

et al. 2022

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“…During the abdominal flap harvest phase, the neck and torso risk scores in the exoscope cases were significantly reduced compared with the baseline. Using a threshold average RULA value of 2.5 or higher to determine high-risk postures, 29 the neck angles during the baseline abdominal flap harvest and chest dissection can be categorized as posing a high ergonomic risk to participants. Use of the exoscope improved postures and reduced the ergonomic risks during these procedures such that the high-risk neck angles observed during the baseline abdominal flap harvest and chest dissection phases were no longer observed during the exoscope cases.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Ergonomic Assessment of Exoscopes versus Conventional DIEP Flap

Nguyen

et al. 2022

J Reconstr Microsurg

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Background This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics. Methods Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected. Results The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the “surgeon at abdomen” showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the “surgeon at chest” showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference. Conclusion Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.

“…A complex surgical procedure that is commonly performed is the deep inferior epigastric perforator (DIEP) flap surgery as a well-known breast reconstruction approach (Blondeel, 1999;Massey et al, 2009;Acosta et al, 2010). DIEP flap surgery is known as a long and complicated surgical procedure and often requires the cooperation of two plastic surgeons and the surgical team (Law et al, 2020) to work on different sections of the surgery including abdominal flap harvest, chest dissection, and anastomosis (Blondeel, 1999;Wang et al, 2020) and is typically 9-12 hours long. In the teaching hospital that this study was conducted, the DIEP flap surgical team included residents in addition to the regular members (e.g., plastic surgeons, surgical assistants, surgical technicians, and circulating nurse).…”

Section: Introductionmentioning

confidence: 99%

Correlation between workload and teamwork among residents in DIEP Flap surgery

Proceedings of the Human Factors and Ergonomics Society Annual

Law

et al. 2021

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The goal of this study was to evaluate residents’ workload and teamwork and the correlation between their workload and teamwork subscales during deep inferior epigastric perforator (DIEP) flap surgery. Ten residents who assisted during DIEP flap procedures completed an electronic survey following each DIEP flap procedure from July 2019 to August 2020. The survey contained items from the NASA-TLX and SURG-TLX and questions to measure teamwork subscales. Across 29 surgical cases, 38 surveys were recorded. Overall, the means of workload subscales were mostly greater than 10 and less than 15 (range=020) and the means of all teamwork subscales were greater than 15 (range=0-20). Good teamwork was correlated with lower distractions (Rs= -0.36 to -0.48) and better performance (Rs=0.35 to 0.52). Also, all the teamwork subscales were highly correlated (Rs= 0.59 to 0.92). Our findings suggest that good teamwork, low distractions, and successful performance are generally observed together; however, a causative relationship could not be established based on these results.