Surgeons Suffer Injuries Performing Minimally Invasive Techniques

The results of a large new study show that surgeons who engage in laparoscopic surgical procedures face physical symptoms that portend an impending ergonomic injury epidemic among surgeons.

Researchers at the University of Maryland Medical Center (UMMC; Baltimore, MD, USA) compiled a comprehensive 23-question survey and sent it to 2,000 U.S. board-certified gastrointestinal and endoscopic surgeons. The questions were grouped in four categories: demographics, physical symptoms, ergonomics, and environment or equipment. Of the 317 surgeons who completed the survey, 272 (86.9%) reported experiencing physical discomfort or symptoms they attributed to performing minimally invasive surgery. The discomfort ranged from eyestrain to problems in the surgeon's dominant hand, as well as neck, back, and leg pain. A few surgeons also reported headaches, finger calluses, disc problems, shoulder muscle spasm, and carpel tunnel syndrome. Age played a role in hand problems, with younger surgeons and those over 60 at highest risk, but there was no correlation between age and symptoms in other parts of the body.

The researchers also found that annual case volume emerged as a key predictor of physical symptoms, with neck, hand, and leg symptoms rising together with increased case volume. To minimize the problems, 84% said they had changed their position, while 30% said they changed instruments or took a break. Significantly, 40% of all participants said they would just ignore any such problem. Instrument design was listed as the main source of symptoms for more than 74% of the surgeons, while 40% cited operating room table setup and display monitor location. More than half of the surgeons (58.7%) said they were only slightly aware or not aware at all of current recommendations to reduce symptoms from researchers in the field of surgical ergonomics. The survey results were published early online on December 24, 2009, in the Journal of the American College of Surgeons.

"Sadly, it is easier for a surgeon to obtain an ergonomic assessment and direction to improve his golf swing than his posture or movement during surgery,” said lead author Adrian Park, M.D., chief of general surgery at UMMC. "If injuries among surgeons are not addressed significantly, we're going to face a problem in the near future of a shortage of surgeons as well as shortened career longevity among surgeons who enter, or are already in, the field.”

Ergonomics is a scientific discipline concerned with the understanding of interactions among humans and other elements of a system, as well as a profession that applies theory, principles, data, and methods to design in order to optimize human well being and overall system performance. Proper ergonomic design is necessary to prevent repetitive strain injuries, which can develop over time and can lead to long-term disability.

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University of Maryland Medical Center