Surgical Ergonomics and Preventing Work-Related Musculoskeletal Disorders Editorial Comment

A busy surgical career requires many intense years of training, practice, and education. The authors of this article postulate an urgent need for a significant paradigm shift to viewing surgeons as high-performance athletes, with a need for a new concept for their work environment to ensure mental acuity, and ergonomic changes to preserve physical dexterity and longevity. The health industry has one of the highest rates of work-related injury and illness (582,800 reported in 2017 alone), with 153,900 more cases than second-highest sector of manufacturing. The unnatural bent, flexed, or extended positions required of surgeons can lead to injuries, which, if occurring repeatedly over time, can become debilitating. These types of injuries can include carpal tunnel syndrome, cervical spine disease, shoulder/wrist tendinitis, lumbar degenerative disease, trigger finger, neck tension syndrome, and rotator cuff injury. Of a meta-analysis that featured a musculoskeletal survey taken by 5152 surgeons, 71% reported fatigue, 68% reported generalized pain, and 45% reported stiffness. Overall, 61% felt their pain was exacerbated by operating, and 30% considered their pain when recommending various surgery approaches. Despite these symptoms, only 29% of respondents had sought treatment. Only 20% of surgeons even reported their injuries to their institutions at all, with eventually 22% of surgeons missing work and 35% of surgeons performing fewer surgeries (adversely affecting health care availability). The awkward surgical positions required for gynecologic surgeries resulted in a report of an 87% rate of musculoskeletal disorders in providers surveyed. Although standing and sitting positions are both used for gynecological surgeries, both positions can result in pain in different muscle groups. Other factors can also negatively affect surgeons, such as accommodating standing around or avoiding cords in the OR, standing on 1 foot due to use of a foot pedal, or trunk flexion from extreme height or width of tables. Even improvements in surgical technology can affect surgeons negatively. Minimally invasive surgeries are associatedwith a unique risk of pain syndromes, such as fatigue and numbness, as well as more pain in the legs, arms, neck, hands, and shoulders. The gender of the surgeon performing laparoscopic surgery can have an effect: laparoscopic surgery tools are designed in a onesize-fits-all manner, meaning that tools designed for larger (usually male) hands are larger than comfortable for most female surgeons, causing additional strain. In addition, although laparoscopic surgery is associated with lower rates of patient pain, laparoscopic surgeons experience greater rates of eye strain, finger pain, hand pain, and neck pain. New guidance for surgeons is encouraging neutral rather than static positions, maintaining arms at a perpendicular position to the floor, with elbows at a 90-degree angle during surgery. A 20% neck flexion angle is recommended, with dropped shoulders and relaxed hands. Feet should remain about the width of hips apart, with knees unlocked. Height of the surgical patient should be adjusted to 70%-80% of the tallest surgeon's height, with the rest of the staff using stepstools if necessary. Sitting surgeries should adjust the table so that the surgeon is looking straight ahead. Robotic consoles should be ergonomically adjusted, with chair shape and settings critical to facilitate proper positioning. Proactive ergonomic education, including methods of stretching, exercise, and overall experience, can help to prevent strains and injuries. Just like athletes, surgeons use specialized groups of muscles repeatedly and require significant ergonomic care to protect them. Partnerships between industry and surgeons hold the promise for innovation to solve ergonomic design gaps, as well as assessing efficacy of any modifications to posture, environment, and equipment. Following in the footsteps of the 2020 founding the Society of Surgical Ergonomics by like-minded surgeons, as well as the ergonomic curriculum implemented during residency, the time for creation of similar curriculum in gynecology is now. Included should be curricula addressing stretching routines both before and during surgery, muscle-strengthening exercises for outside the operating room, and education around awkward postures for surgical approaches, which may lead to work-related musculoskeletal disorders. These approaches will help ensure surgeons maintain career longevity by minimizing the risk of injury.