The Ergonomics of Women in Surgery

Erica R Sutton, MD, Myra Irvin, BS, Craig Ziegler, MA, Gyusung Lee, PhD, Adrian Park, MD

Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, Department of Surgery, Anne Arundel Medical Center, Annapolis, MD

Introduction: We hypothesize that women may be experiencing more ergonomic difficulties than men for whom the operating room and surgical instruments – though uniformly perilous- have more traditionally accommodated. Among surgeons who regularly perform minimally invasive surgery, as many as 87% report injuries or symptoms related to job performance. Operating room and instrument design have traditionally favored surgeons who are taller and who possess hands that are in general, large and strong. Thus, using a comprehensive survey assessing the physical impact of minimal access techniques, we looked specifically at the interaction of women and surgical ergonomics.

Methods: A 23-item web-based survey was offered via email to 2000 laparoscopic surgeons and fellows currently practicing. Subjects contacted were members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The survey addressed four categories: demographics, physical symptoms, ergonomics, and environment/equipment. Key questions allowed us to identify which body part (eyes, neck, shoulders, elbows, wrists, hands, back, lower body) experienced which symptoms (numbness, stiffness, fatigue, pain).

Results: There was a 15.7% overall response rate. Among respondents, 17% (54/314) were female. Women were significantly younger, shorter, had smaller glove size, and fewer years in practice than men surveyed (all p values < 0.0001). Of women reporting, 86.5%—comparable to men—attribute physical discomfort to laparoscopic operating.

Statistical analysis using odds ratio calculations were performed on the survey’s data to compare female and male surgeon’s symptoms and treatments of body areas related to doing surgical procedures. The analysis showed that female surgeons are more likely to receive treatment for their hands, which includes the wrist, thumb, and fingers (OR 3.5, p=0.028). When men and women of the same glove size were compared, women with a larger glove size (7-8.5) reported more cases of treatment for their hands than men of the same glove size. (21% vs. 3%, p=0.016). Women who wore a size (5.5-6.5) surgical glove reported significantly more cases of discomfort in their shoulder area (neck, shoulder, upper back) than men who wore the same size surgical glove (77% vs. 27%, p=0.004). When asked about the cause of their symptoms, 84% percent of women surgeons (40/48) and 73% of male surgeons (161/222) cite instrument design as a reason for their physical symptoms. Forty-three percent of men (95/222) and an equal percentage of women (21/48) attribute their physical symptoms to OR table height. Women, more so than men, were more likely to report laparoscopic staplers as being too big for their hands (78% and 28%, respectively, OR 8.85, p<0.001).

Conclusions: Women surgeons are experiencing more discomfort and treatment in their hands than male surgeons, though they report fewer years in surgical practice. Lacking is the anthropometric data required to design ORs and instruments that will meet the needs of all surgeons- a group that includes an increasing proportion of women, who on average are shorter and wear a smaller glove size. Redesign of laparoscopic instrument handles and improvements to table height comprise the most promising solutions to these ergonomic challenges.

Session: Podium Presentation

Program Number: S082