Surgical Ergonomics: Preventing Injury and Enhancing Performance for Surgeons

Understanding Surgical Ergonomics

• 💡 Ergonomics in surgery, as described by Dr. Burgerer, encompasses visualization, manipulation, posture, mental and physical workload, and the operating room environment.
• 🧠 It's crucial to consider all these components to optimize surgeon performance and well-being.

The Overlooked Physical Demands of Surgery

• ⚠️ While cognitive and emotional demands are increasingly discussed, the physical demands of surgery remain significantly overlooked in literature and education.
• 📉 Surgeons often endure hours in static, uncomfortable positions, leading to musculoskeletal disorders, chronic pain, and potential career-ending injuries.
• 🏋️ Surgeons are compared to high-performance athletes, yet receive far less support and training for protecting their bodies.

Impact of Musculoskeletal Disorders on Surgeons

• 📈 Studies show a significant prevalence of spine disease among surgeons, with a notable percentage requiring leave, early retirement, or practice modifications.
• ♀️ Female surgeons report higher frequencies of musculoskeletal pain and fatigue, with instrument size and handling being a particular concern.
• 🤖 Even with robotic surgery, which can decrease pain, issues like thoracic pain and finger complaints persist due to console positioning and chair design.

Practical Ergonomic Strategies in the OR

• 📐 Adjust table height to elbow level, ensure neutral wrist positions, and use core and leg strength when bending.
• 👁️ Minimize static postures by shifting weight and stretching; ensure monitors are at eye level for laparoscopic cases.
• ✋ Bracing instruments against a fixed surface or the patient can stabilize hands, minimize tremors, and relieve back/neck strain.
• 🧘 Micro-breaks, including simple neck, shoulder, and torso stretches, can take less than a minute, improve posture, and offer a mental reset.

Pre-Case Preparation and Recovery

• 🍎 Pay attention to pre-case nutrition and hydration, combining protein, fat, and slow-absorbing carbs for sustained energy.
• ⚡ Keep a quick energy source, like a small bar, for moments of crashing or difficulty focusing.
• 🚶 Take standing breaks during procedures, especially during instrument swaps or redocking, to alleviate static strain.
• 💻 Utilize apps like Ergodroid to map and understand personal strains during surgery.

Addressing Injury and Promoting Longevity

• 🩹 Acknowledging pain is not weakness; it needs to be addressed by talking to colleagues, leadership, and utilizing hospital resources like physical therapists and PMR doctors.
• 🏃 Prioritizing physical exercise, including strength training, mobility, and balance work, is essential for managing the physical strains of surgery.
• 🗣️ Faculty must empower residents by modeling and encouraging ergonomic practices, such as adjusting equipment and speaking up about discomfort.
• 🏥 Institutions should incorporate ergonomics into education through workshops and hands-on activities to foster a culture of physical well-being.

Key Takeaways for Surgeons

• ⚠️ Ignoring pain does not build toughness; it leads to injury.
• ✨ Investing in personal physical well-being is essential for high-performance surgery.
• 🔧 Every OR setup is negotiable; speaking up and making adjustments is crucial.
• 🤸 Stretching and movement are integral parts of the work, not afterthoughts.