ERUS 2018: Who Cares About the Surgeon? Health Aspects of an Ergonomic Working Environment

Marseille, France ( Dr. Maubon gave a talk on a topic rarely discussed in professional meetings. His talk focused on the physical and mental injuries sustained by surgeons during their work.  He began with a definition of Ergonomics, which is a scientific discipline that studies interactions among human and other elements of a system. It applies theory and principles, data and methods to design and optimize human well-being and overall system performance. It supports the concept of designing the working environment to fit the worker, rather than forcing the worker to fit into the working environment.

Ergonomics is divided into three parts:

  1. Organizational – environment workload
  2. Cognitive – mental workload
  3. Physical – physical workload
Ergonomic interventions positively affect health outcomes and its resulting economic consequences. They help maintain workplace efficiency, decrease waste of materials and equipment, enhance corporate image, and increase employee satisfaction.

Ergonomics in surgery has become more important following the introduction of minimally invasive surgery. Although minimally invasive surgery is advantageous for patients, it is known to increase surgeon discomfort. However, formal recommendations and interventions on this topic currently do not exist. There is still a lack of knowledge and proper training of surgeons in ergonomic basics. Lastly, it is known that there is underreporting of injuries by surgeons.

Dr. Maubon moved on to discuss the physical workload during surgery. Work-related musculoskeletal disorders are a group of preventable disorders affecting the muscles, nerves, tendons, joints, cartilage, and spinal disks. These are all affected by the work environment and performance and are made worse or persist longer due to work conditions. The most common syndromes include carpal tunnel syndrome, epicondylitis, neck tension syndrome, pronator teres syndrome, shoulder tendonitis, and rotator cuff injury, wrist tendonitis, thoracic outlet syndrome, trigger finger, and ulnar nerve entrapment. Work-related musculoskeletal disorders are reported in 66-94% of open procedures, 73-100% of laparoscopic procedures, and 23-80% of robotic procedures. Physical workload has various significant impacts. These include early retirement, leave of absence, practice restriction or modification, and decreased volume and quality of patient care. Economically, it leads to an enormous impact on work absenteeism and reduced productivity, with an estimated annual 20 billion dollars of cost in the US alone. Therefore, the ergonomics study and injury prevention among surgeons is crucial.

Next, the mental and environment workload were discussed. Workflow disruptions are events that disrupt the natural progression of a case. This impacts the efficiency, quality of care and can signal deeper problems within the system of work. Studies have shown that workflow disruption occurs on average 12 times per hour. This can be significantly reduced with proper training, improvement of communication and enhanced coordination.

It is crucial to we learn how to evaluate ergonomic in surgery. A variety of research tools and technologies have been used to study ergonomics in surgery. These can be categorized into subjective tools (surveys and questionnaires), and objective tools (using validated technologies to measure surgeon postures and parameters).

In conclusion, ergonomics provide better human well-being and performance at work. The medical culture needs to change from a “No pain – No gain” mentality to a more realistic and humane approach. Physicians have the right to practice their profession in a safe environment. Therefore, ergonomics in surgery should be a well-known and utilized concept. Appropriate training should be provided to all physicians in their respective work environment, and they should be taught how to maintain the best possible and safest environment for themselves. This hopefully will reduce the high prevalence of musculoskeletal disorders, decrease burnout phenomena among physicians and reduce the percentage of physician afflicted with depression. Due to the fact that surgery is losing its attractiveness, and because of the growing shortage of physicians, this issue warrants prompt attention and action.

Presented by: Thomas Maubon, Marseille, France

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the EAU Robotic Urology Section (ERUS) Meeting - September 5 - 7, 2018 - Marseille, France