The impact of patient body mass index on surgeon posture during simulated laparoscopy

Laparoscopy is a cornerstone of modern surgical care. Despite clear advantages for the patients, it has been associated with inducing upper body musculoskeletal disorders amongst surgeons due to the propensity of non-neutral postures. Furthermore, there is a perception that patients with obesity exacerbate these factors. Therefore, novice, intermediate and expert surgeon upper body posture was objectively quantified using inertial measurement units and the LUBA ergonomic framework was used to assess the subsequent postural data during laparoscopic training on patient models that simulated BMI’s of 20, 30, 40 and 50 kg/m2. In all experience groups, the posture of the upper body significantly worsened during simulated surgery on the BMI 50 kg/m2 model as compared to on the baseline BMI model of 20 kg/m2. These findings suggest that performing laparoscopic surgery on patients with severe obesity increases the prevalence of non-neutral upper body posture and may further increase the risk of musculoskeletal disorders in surgeons. ### Competing Interest Statement Esther Moss performs da Vinci robotic gynecological surgery (Intuitive Surgical) and is a member of the British and Irish Association of Robotic Surgeons (BIARGS), which is supported by robotic/laparoscopic companies to hold education/training events. Esther Moss has received research grants from Hope Against Cancer and Intuitive Surgical for unrelated work. ### Funding Statement This work has been partially supported by the LU-HEFCE Catalyst grant, the LU-EESE startup grant, and by the Research Studentship awarded to R. Sers by the Doctoral College of Loughborough University, UK. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical clearance for this study was attained from the Loughborough University Ethics Approvals Sub-Committee and all participants provided voluntary informed consent before testing commenced. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Restriction on data availability until publication and the inherent embargo period has elapsed