Human factors in pelvic surgery

Work Related Pain in Gynecologic Surgeons - A National Survey

STUDY OBJECTIVE

This study aimed to: (1) ascertain the prevalence of work-related pain among gynecologic surgeons, (2) describe the risk factors and sequelae of pain, and (3) assess the need for an ergonomic curriculum.

DESIGN

Survey study.

SETTING

The survey was electronically administered.

PARTICIPANTS

Gynecologic surgery subspecialists and fellows in training, and Obstetrics and Gynecology specialists who performed gynecologic surgery were included.

MEASUREMENTS AND MAIN RESULTS

A 38-question anonymous survey was developed from the available ergonomic literature and had 3 main sections: (1) demographic information, (2) pain history, and (3) ergonomic education. A total of 305 gynecologic surgeons participated in the study. Of these, 76.7% were female. Most respondents were Minimally Invasive Gynecologic Surgeons (64.6%) with conventional laparoscopy as the primary surgical modality (65.6%). Of the respondents, 95.7% reported experiencing pain during or after surgery. Female surgeons (p = .018), shorter surgeons (OR = 2.4, 95% confidence interval [1.1, 5.4]), and those with a smaller gloves (p = .025) were more likely to report severe pain. Surgeons who reported worse pain were more likely to seek treatment (p = .007) and to take time off from operating (p <.001). Among the respondents, 79.4% reported engaging in various interventions to treat surgery-related pain. Due to pain, 23.9% reported changing the surgical modality, and 62.5% were concerned about their ability to operate in the future. Of the surgeons, 61.3% did not feel confident in their ability to set up their operating room ergonomically. 98.0% recommend formal ergonomic training for residents.

CONCLUSIONS

Surgeons are at risk of work-related pain. Gynecologic surgeons have been understudied and face specific ergonomic challenges. In this national survey of high-volume gynecologic surgeons of various subspecialties, we report a high rate of surgery-related pain and significant clinical and nonclinical sequelae of pain, and demonstrate the need to implement and improve ergonomic training for Obstetrics and Gynecology trainees.

Improving surgical technical skills for emergency fixation of unstable pelvic ring fractures: an experimental study using a pelvic ring fracture simulator

BACKGROUND

The management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement. Given the infrequent performance of these procedures, regular training is imperative to ensure readiness for emergencies. Our pre- post simulation study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries, facilitating participants' knowledge retention and procedural confidence enhancement.

METHODS

A standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint was developed. Trauma surgeons of a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated as secondary outcome measures.

RESULTS

Fifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The mean total operation time was 20.34 ± 6.06 min, without significant differences between consultants and residents (p = 0.604). The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before = 3.8 ± 3.08 vs. After = 5.67 ± 2.35; p = 0.002) as well as after external fixation (10-LS: Before = 3.93 ± 2.79 vs. After = 6.07 ± 2.52; p = 0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before = 4.60 ± 3.0 vs. After = 6.53 ± 2.39; p = 0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS = 7.87 ± 1.13).

CONCLUSIONS

Our unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging. Further studies are required to validate the objective benefits and improvements that participants undergo through frequent training.

Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery

PURPOSE OF REVIEW

To evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery.

RECENT FINDINGS

Factors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics.

SUMMARY

Considering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.

Needs assessment for patient-centered education and outcome metrics in robotic surgery

BACKGROUND

From clinical experience, many patients undergoing robotic assisted surgery (RAS) have a poor understanding of the technology. To ensure informed consent and appropriate expectations, a needs assessment for patient-centered education and outcome metrics in RAS is warranted. Our goal was to perform an assessment of patient understanding, comfort with robotic technology, and ability to obtain critical information from their surgeon when undergoing RAS.

METHODS

Twenty patients planned for RAS by three surgeons were asked to complete a six-item Likert agreement scale survey prior to signing informed consent. The study coordinator administered surveys, while the surgeon left the room. Indicator statements were crafted to reduce bias and two-way evaluated for consistency. The surgeons were additionally asked their perception of each patient's understanding and comfort with RAS. Frequency statistics and tendencies were analyzed.

RESULTS

Surgeons strongly agreed all patients appropriately understood how RAS functioned and would ask more questions before signing consent, if needed. Patients were predominately not familiar with RAS and felt surgeons did not explain how RAS worked. There was wide variability on if patients understood how RAS worked for their treatment. Overall, patients were not completely comfortable with RAS for their care, did not understand the risks of RAS compared to other approaches, and did not feel their surgeon understood what they needed to know to make informed decisions.

CONCLUSIONS

This needs assessment demonstrated critical gaps in patient knowledge about RAS, surgeon communication skills, and the ability of surgeons to know what was important from the patient perspective. The development of RAS patient-centered education and outcome metrics could help address these gaps.