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What about the surgeon? The ergonomics of laparoscopic surgery

Gynaecology Professor Jason Abbott Associate
Laparoscopic surgery (keyhole surgery) has transformed surgical care for the patient but at what price to the surgeon?

Laparoscopic (keyhole) surgery has revolutionised patient surgical care with faster healing times and improved cosmetic results, however the physical demands that are placed upon the surgeon are frequently overlooked.  In other workplaces extensive lengths have been taken to reduce risk and improve workers postures and time in one position, whereas this is significantly lacking in laparoscopic surgery.  Laparoscopic surgeons must adapt around working with long, rigid instruments, monitor screens and foot switches with awkward static body postures that put strain on the joints and prolong loading on the muscles.

Recent surgeon surveys have shown 80-100% of laparoscopic surgeons reporting symptoms directly resulting from operating including pain in the neck, back, elbows, shoulders and hands, eye strain, headaches, carpel tunnel syndrome, tennis elbow and even 15% with vertebral disc prolapse.  With some surgeons operating for 12 hours a day, this is a significant issue that needs to be addressed in order to protect both surgeons and their patients.

Over the past seven months the team at Alana have been conducting research into surgeon postures during laparoscopic procedures.  Cameras have been set up in the operating theatre to capture surgeons’ movements during live surgery (we have gone to great lengths to make sure that patients are not seen in the cameras’ field of view – only the surgeon!).  There is very little science that has studied the timing and duration of certain joint angles in performing laparoscopic surgery.  Knowledge of this will ultimately help to improve laparoscopic surgical ergonomics in both surgeon behaviour and operating theatre environment to reduce occupation-induced injury and stress.

We have so far recorded over 120 laparoscopic gynaecological procedures between 15 different surgeons of varying experience.  Procedures recorded include laparoscopy for resection of endometriosis, hysterectomy, removal of ovarian cysts and removal of tubes and ovaries.  From the video recordings, using computer software to measure angles of limbs and joints, we have been able to calculate the most extreme joint angles for the neck, elbows and shoulders during different types of surgery.  The amount of time spent at neutral angles and spent away from neutral for each joint has also been recorded.

Importantly we also have asked each surgeon facts about themselves that may affect the study, such as the number of years they have been working as a laparoscopic surgeon, training level, height and arm length of the surgeon, which are likely to all have an impact.   We are also the first to have studied pregnant surgeons – in fact 4 of our team have been pregnant during their surgery and with an ever increasing number of female gynaecologists these data will be very important in years to come.  (Congratulations also to Haryun and baby Olivia, Erin and baby Persephone, Rebecca and baby Jeremy and Emma whose baby has not yet arrived but is coming soon!).

We expect to find that with increasing experience and training, the amounts of time surgeons spend in extreme positions will actually reduce – perhaps by learned behaviours (or maybe that they are just worn out…..).  If this is the case, then surgical training of trainees can be adapted to modify technique and avoid these hazardous movements.

So far, we have seen that the neck is frequently rotated and flexed so as to look at the monitor and the shoulders (particularly the left) are statically flexed for prolonged periods of time. This appears to be exaggerated in shorter surgeons and also for surgeons during pregnancy with a larger waist circumference.  We look forward to our final analysis in a few months time with all of the results of this land-mark study into the health of your doctors, so they can look after your health for a whole lot longer.