Sara Monfared, MD1, Hamed Asadi, MS2, Denny Yu, PhD2, Dimitrios Stefanidis, PhD, MD1. 1Indiana University, 2Purdue University
Introduction: Work-related musculoskeletal injuries among surgeons are alarmingly high. Minimally invasive surgery, while popular with patients, is technically demanding and places increased ergonomic strain on the surgeon. The purpose of this study was to examine surgeon ergonomic risk during the performance of minimally invasive bariatric surgery operations.
Methods: An IRB-approved prospective study quantifying the intraoperative ergonomic risk factors during bariatric procedures was conducted. Ergonomic data from 5 bariatric surgery attendings and 2 fellows performing laparoscopic or robotic gastric bypass were collected. Surgeon ergonomic data, including workload, were recorded before, during, and after the procedures using subjective (Musculoskeletal Symptoms Response questionnaire and the National Aeronautics and Space Administration Task Load Index) and objective tools (electromyography to detect excessive muscle activity in the trapezius and deltoid muscles and inertial measurement units for motion tracking and body angulation). To determine the frequency of poor biomechanical postures during surgery, the relative frequency of static and demanding postures was calculated and compared to existing norms.
Results: Thirty surgeon participant observations were performed during 19 operations (13 laparoscopic and 6 robotic). All participants were right handed. Back stiffness was reported by 43% of surgeons before surgery and by 80% after surgery (p=0.004). Surgeons who experienced back stiffness had significantly higher right deltoid muscle activity during the procedures compared with those who did not (5.8 ± 2.8 vs. 4.5 ±2.2, respectively; p =0.03). The right deltoid and the right trapezius had the highest average muscle activity (8.5 and 5.7 respectively). At least 50% of operations were performed in static positions that require sustained muscle efforts. Neck postures were observed to be in demanding postures for 41% of the case that results in dangerously high joint loads (Table 1).
Conclusion: Minimally invasive bariatric surgery demands high static positioning with less weight shifting and significant strain on the back, specifically the right side. By determining direct body stresses during bariatric surgery, new technological advancements that can help reduce them can be tested or developed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93916
Program Number: P704
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster