Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM

Abstract

Background. Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures. Methods. From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed. Results. Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p \ 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02). Conclusion. Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons' left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.

Residual breast tissue after robot-assisted nipple sparing mastectomy

“…Surgeons experience greater physical symptoms such as neck and lower back pain, mental strain, and fatigue from performing open NSM compared to skin sparing mastectomy [ 6 , 29 ]. Thus, a more ergonomically sound technique with greater visualization is needed to improve surgeon working conditions and to improve the ease of the operation during open NSM.…”

Factors Affecting Total Operating Time in Patients Undergoing Mastectomy With and Without Reconstruction

“…These tend to be more challenging to perform than conventional mastectomies, which likely account for the increased OR time. Indeed, Hallbeck et al 6 reported that among 172 procedures, skin-sparing and nipple-sparing mastectomies had longer operating times than other procedure types.…”

ASO Author Reflections: How Do We Improve Ergonomics for the Breast Surgeon During Nipple-Sparing Mastectomies?

“…Nipple-sparing mastectomies (NSM) are an extremely demanding procedure for the surgeon. [1][2][3] The mental and physical workload for these surgeries is significant. As the nipple-sparing mastectomy procedure becomes more prevalent, 4 we cannot help but wonder the toll this will take on the surgeon.…”