The burden of performing minimal access surgery: ergonomics survey results from 462 surgeons across Germany, the UK and the USA

Abstract

This international study aimed to understand, from the perspective of surgeons, their experience of performing minimal access surgery (MAS), to explore causes of discomfort while operating and the impact of poor ergonomics on surgeon welfare and career longevity across different specialties and techniques. A quantitative online survey was conducted in Germany, the UK and the USA from March to April 2019. The survey comprised 17 questions across four categories: demographics, intraoperative discomfort, effects on performance and anticipated consequences. In total, 462 surgeons completed the survey. Overall, 402 (87.0%) surgeons reported experiencing discomfort while operating at least ‘sometimes’. The peak professional performance age was perceived to be 45–49 years by 30.7% of surgeons, 50–54 by 26.4% and older than 55 by 10.1%. 86 (18.6%) surgeons felt it likely they would consider early retirement, of whom 83 were experiencing discomfort. Our findings highlight the continued unmet needs of surgeons performing MAS, with the overwhelming majority experiencing discomfort, frequently in the back, neck and shoulders, and many likely to consider early retirement consequently. Innovative solutions are needed to alleviate this physical burden and, in turn, prevent economic and societal impacts on healthcare systems resulting from MAS limiting surgeon longevity.

Early evaluation of a next‐generation surgical system in robot‐assisted total laparoscopic hysterectomy: A prospective clinical cohort study

“…In conventional MAS, constrained instrument movements and wrist articulation, tremor transmission, and two‐dimensional visual display make the surgical steps requiring precision especially challenging 4–6 . Conventional MAS may also be physically detrimental to surgeons because of the inherent ergonomic challenges 7,8 . These factors may have limited the adoption of MAS for common gynecological procedures such as hysterectomy and sacrocolpopexy 9,10 .…”

“… 4 , 5 , 6 Conventional MAS may also be physically detrimental to surgeons because of the inherent ergonomic challenges. 7 , 8 These factors may have limited the adoption of MAS for common gynecological procedures such as hysterectomy and sacrocolpopexy. 9 , 10 Robot‐assisted surgery offers improved dexterity, precision, and three‐dimensional visualization 11 , 12 and can extend MAS feasibility for patients with complex pathologies or higher body mass indices (BMIs).…”

Safe implementation of surgical innovation: a prospective registry of the Versius Robotic Surgical System

“…7 Several innovative features have been designed to address some of the limitations of conventional minimal access instruments and barriers to the uptake of robot-assisted MAS, with a view to improving system manoeuvrability, surgical access, visualisation and ergonomics. [8][9][10] The RSS also captures telemetry data that may provide insights into surgical performance and allow for refinements in surgical techniques. 11 These data include console start/ stop times, hand-controller movement patterns, robotic arm locking/release times, alarms and the number and type of instruments used.…”

“…The device underwent an iterative development process using feedback from surgeons and surgical teams to improve both end-user experience and surgical outcomes 7. Several innovative features have been designed to address some of the limitations of conventional minimal access instruments and barriers to the uptake of robot-assisted MAS, with a view to improving system manoeuvrability, surgical access, visualisation and ergonomics 8–10. The RSS also captures telemetry data that may provide insights into surgical performance and allow for refinements in surgical techniques 11.…”

Comment on the robot smoke suction technique

“…This could cause confusion in terms of eye-foot coordination, requiring maximum concentration and exercise. It could also negatively impact the stability and the ergonomics of the sit (Figure 1), which should not be underestimated at a time when articular issues are reported to be common with minimally invasive surgery [2]. Such sitting could endanger the stability of the surgeon, with potential inadvertent movements of the arms.…”