TORG-MAG Vol 1 Issue 1, PP. 37-38
Abstract
Prolonged surgical procedures can lead to ergonomic strains and injuries among members of operating room teams. This article reviews common ergonomic issues faced by surgeons, nurses, and other personnel during surgeries. Problems stemming from non-neutral body postures, repetitive motions, inadequate equipment, and workspace design are discussed.
The physical taxing of minimally invasive surgeries and robotic procedures are also explored. Established guidelines are summarized and potential solutions such as equipment modifications, positioning aids, training protocols and scheduling changes are proposed to address the unique ergonomic challenges posed by the surgical environment. Preventing occupational ergonomic hazards can improve the performance, safety, and work life of surgical staff.
Keywords: Surgery, ergonomics, occupational injuries, operating room personnel.
Introduction
The operating room provides a complex, technologically advanced and demanding work environment for multiple medical specialists and support staff. Modern advances in surgical techniques, technologies and minimally invasive approaches have enabled the treatment of more complex cases and improved patient outcomes. However, the awkward postures, static positioning, repetitive motions, and prolonged procedures required place substantial ergonomic strains upon surgical teams. Proper ergonomic design can enhance efficiency, reduce fatigue, and minimize the risk of musculoskeletal disorders among surgical teams. While saving and improving patient lives is justifiably the central focus the wellbeing, safety, and work life quality of operating room personnel must also be considered. Cumulative occupational ergonomic stresses can negatively impact their health, cause injuries, and degrade surgical performance if left unchecked.
Common Ergonomic Hazards
A number of studies have examined the ergonomic hazards posed by surgical procedures across specialties. Key problem areas include non-neutral body postures, repetitive movements, inadequate equipment, and workspace design as well as general physical demands of complex minimally invasive and robotic techniques.
Inconsistencies in operating table height and positioning can lead to awkward postures for surgeons and their assistants, contributing to discomfort and fatigue especially during long procedures. Investing in adjustable operating tables and chairs allows surgical teams to customize their workspaces, promoting better posture and reducing strain. Prolonged static postures are widely reported among surgeons, with over 70% indicating neck, back or shoulder pain. Surgeons habitually adopt asymmetric stances and lean over the patient which taxes muscles and leads to fatigue. Similarly, nurses often bend to adjust equipment or access patients at the operating table. Without proper movement and variation, held body positions can reduce blood flow and oxygen, directly causing tissue damage. Incorporating anti-fatigue mats on the operating room floor can alleviate pressure on the surgical team members legs and lower back. The use of heavy lead aprons for radiographic procedures further compounds strain (especially in neurosurgery and orthopedic surgery).
Operating lights should be well focused as poor lighting in the operating room can strain the eyes of surgical teams, affecting their concentration and precision. Anatomical structures cannot be accurately identified intraoperatively if the lighting and illumination is not adequate. Shadow formation in the surgical field can occur if operating lights are inconsistently or improperly directed leading to obscured vision. Effective operating room circulators should always assist in the proper focusing of operating lights, Sterile light handles should be used so that the surgical team can always re-focus the lights to suit their needs intra-operatively. Implementing advanced lighting systems (LED lighting systems) with adjustable, intensity and color temperature can improve visibility and reduce eye strain for surgical teams. Integration of lighting systems with surgical equipment and instruments can assist in reducing awkward positioning and enhance visibility. In procedures involving screens and monitors, glare from lights can affect the visibility of digital displays, potentially impacting communication, and coordination among surgical team members.
The design and weight of surgical instruments can impact the comfort of the surgeon’s grip and posture. Ergonomically designed instruments can reduce the strain on the surgeon’s hands and wrists, reducing hand fatigue and improving overall performance. Comfortable instruments contribute to better control and precision. Handles of instruments should be shaped to fit the hand comfortably to minimize awkward wrist positions, length of instruments should be appropriate to avoid overstretching. Instruments with textured or non-slip grips also minimize fatigue by reducing the need for excessive force. For long surgeries light weight instruments are recommended, without compromising the strength and quality of the surgical instruments as heavy weight instruments lead to muscle fatigue that may lead to inappropriate posture to the surgeon. In operations where powered instruments and equipment are used, it is recommended to use instruments that incorporate mechanisms to dampen vibrations as to reduce the impact on the surgeons’ hands and wrist. Collaboration between surgeons and instrument manufacturers is crucial to developing instruments that prioritize comfort and functionality, minimizing the risk of hand and wrist fatigue. The repetitive nature of surgical tasks, combined with suboptimal ergonomic conditions during lengthy operations,
can contribute to the development of musculoskeletal disorders (MSDs) among surgical professionals as there is strain on specific muscle groups. Laparoscopic procedures require making continuous small movements using distal upper extremities to manipulate long instruments. This can irritate tendons and nerves over just 30-60 minutes of surgery. Robotic console operation also involves small repetitive motions of the hands and fingers which have been associated with numbness and cramping. Inflexible, crowded environments further introduce ergonomic pressures. Many studies indicate a high prevalence of MSDs among surgical teams due to repetitive nature of tasks such as instrument manipulation, typing on a computer, prolonged standing, and awkward positions. These musculoskeletal disorders can range from back pain, neck and shoulder pain to carpal tunnel syndrome, affecting the long-term health and career sustainability of medical practitioners. Adequate ergonomic training and awareness can positively impact the prevalence of MSDs. Surgical teams educated on proper body mechanisms and techniques may be better equipped to mitigate risks. Regular assessments, interventions, and a focus on ergonomic improvements in the surgical environment are essential to addressing these issues in the operating room.
Cognitive and Mental Workload
In addition to physical factors, the mental and cognitive demands of surgery present ergonomic considerations. Surgical procedures require intense concentration for extended durations. Studies have shown higher incidences of fatigue, stress and burnout among surgeons compared to the general population. Complex or unexpected decision-making, time pressures, distractions and multitasking all contribute to mental workload. New technologies like robotics and navigation systems also impose learning curves and interface challenges that increase cognitive load. By the end of long operations, mental exhaustion can lead to lapses in judgment and technical errors.
Organization and Communication Issues and Individual Risk Factors
Breakdowns in teamwork, communication and organizational systems in the OR also introduce ergonomic pressures. Disorganized environments with cluttered suites and missing equipment disrupts workflow and causes frustration. Similarly, tense dynamics or inconsistent communication forces staff to constantly negotiate needs rather than focus on tasks.
Inadequate training and preparation as well as undefined roles have also been linked to physical and mental strains during procedures. Clear protocols, efficient team coordination and information sharing may help mitigate these issues. Underlying health conditions, fitness level, age and experience influence how surgical personnel are affected by ergonomic loads.
Conclusion
Addressing ergonomic challenges in surgical environments is paramount to ensuring the well-being of surgical teams and optimizing patient outcomes. By recognizing and implementing ergonomic improvements, healthcare facilities can create a safer and more sustainable working environment for the dedicated professionals who play a vital role in patient care.
References
- Trevino, A., et al. “Ergonomic Issues Related to Laparoscopic Surgery.” Surgical Endoscopy 36.1 (2022): 1-7.
- Davis, Claire, et al. “Surgeon Ergonomics During Minimally Invasive Surgery.” Annals of Medicine and Surgery 72 (2022): 103254.
- Nguyen, Ninh T., et al. “Occupational Health Hazards of Surgeons.” Journal of Surgical Research 153.2 (2009): 236-241.
- Checca et al. Assessment of Ergonomic Risk Factors in Real and Simulated Surgical Training Environments: A Comparative Study. 2020.
- Trevino et al. Ergonomic Issues Related to Laparoscopic Surgery. 2022.
- Muckler et al. Ergonomic Deficiencies in the Operating Room: An Assessment of Surgical Tray Configurations and Recommended Improvements. 2016.
- Gohil et al. Ergonomic Problems Associated with Laparoscopic Surgery. 2012.
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- Uppal et al. Ergonomic Evaluation of the Operating Theatre Environment in a Tertiary Care Hospital. 2019.
- Davis et al. Surgeon Ergonomics During Minimally Invasive Surgery. 2022.
- Nguyen et al. Occupational Health Hazards of Surgeons. 2009.
- Berguer et al. Strain and Sprain Injuries in Surgeons. 2021.
- Seter et al. Ergonomic Deficiencies in Robotic Console Working Environment. 2020.
- Shanafelt et al. Burnout and Satisfaction with Work-Life Integration Among US Surgeons. 2017.
- Antoniadis et al. Correlation of Surgeons’ Workload with Increased Risk of Major Surgical Errors. 2014.
- Manjourides et al. Cognitive Load and In Situ Simulation: Impact on Surgical Task Performance. 2018.
- Zhu et al. Neuroergonomic Analysis of Mental Workload in Robotic Surgery. 2021.
- Christian et al. Operating Room Debriefing (ORD) in Surgery Teams: Implementation Toolkit. 2008.
- Hull et al. Impact of Communication and Interpersonal Relationships on Surgical Team Performance. 2022.
- Azarmehr et al. Ergonomics Training Reduces Musculoskeletal Disorders Among Orthopaedic Surgery Residents. 2017.
- Wiegmann et al. Improving Cardiac Surgical Care Team Coordination and Communication. 2007.
Author: Ropafadzo Joyce Dzveta, a seasoned healthcare professional with 21 years as a Registered General Nurse (OTN), specializes in operating room care. Currently the Chairperson of TORG Eswatini Chapter and the Theatre Unit Manager at Ezulwini Private Hospital in the Kingdom of Eswatini. She balances clinical expertise with managerial finesse, showcasing dedication to patient care and surgical excellence. Ropafadzo is resilient, passionate, and committed to continuous growth in healthcare.
TORG Magazine (TORG-MAG)
Maiden Edition: Surgical Symphony, Issue 1 Vol 1 Aug 2024
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