Human factors in pelvic surgery

Keller, Deborah S.

doi:10.1016/j.ejso.2021.12.468

Cited by 4 publications

(6 citation statements)

References 51 publications

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“…The participant in this case study confirmed the claims of Symer and Keller (2022), indicating that rectal surgeries in which there is a need to access the surgical site via the pelvis causes more strain on the surgeon’s body compared to procedures performed abdominally. This is due to the requirement to work in asymmetric postures to access the pelvic region when using open or laparoscopic surgical techniques.…”

Section: Discussionsupporting

confidence: 60%

A case-study comparison of qualitative and quantitative techniques for assessing surgeon ergonomics

Johnson,

Husain,

Lavender

et al. 2023

Proceedings of the Human Factors and Ergonomics Society Annual

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Surgeons are often exposed to many ergonomic risk factors during open, laparoscopic, and robotic-assisted surgical procedures, which lead to pain or discomfort in alarmingly high percentages of surgeons. Ergonomic risk factors specific to colon and rectal surgery subspecialty have been hypothesized, but little research has been done on this topic. To investigate this, an ergonomics-centered case study was performed with an experienced colon and rectal surgeon at a teaching hospital to investigate their experiences with surgery, ergonomics, and musculoskeletal pain. Specifically, a semi-structured interview was performed with the participant, and skin surface electromyography electrodes were placed on the participant to record muscle activity data as they performed rectal surgeries using open, laparoscopic, and robotic-assisted surgical techniques. The results of this case study indicate that for this participant, robotic surgery may provide the most relief from current pain and discomfort; however, the relationship between muscle activation and surgical modality is complex, and both qualitative and quantitative methods are needed to provide a complete ergonomic analysis of colon and rectal surgery in a teaching hospital setting.

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Section: Discussionsupporting

confidence: 60%

A case-study comparison of qualitative and quantitative techniques for assessing surgeon ergonomics

Johnson,

Husain,

Lavender

et al. 2023

Proceedings of the Human Factors and Ergonomics Society Annual

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“…Surgeons are at increased risk for WMSDs because of poor ergonomics from repetitive performance of static, extreme, and awkward positions for prolonged periods of time [3 && ]. Gynecologists face unique ergonomic challenges from operating in the pelvis, as it requires an oblique approach, which inherently inhibits appropriate ergonomics [4]. As minimally invasive surgery (MIS) has increasingly become the standard of care in gynecology, studies have shown high rates of associated surgeon discomfort during these procedures [5].…”

Section: Introductionmentioning

confidence: 99%

“…Gynecologists face unique ergonomic challenges from operating in the pelvis, as it requires an oblique approach, which inherently inhibits appropriate ergonomics [4]. As minimally invasive surgery (MIS) has increasingly become the standard of care in gynecology, studies have shown high rates of associated surgeon discomfort during these procedures [5].…”

Section: Introductionmentioning

confidence: 99%

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

Lin

Young

Shields

et al. 2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTo 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 findingsFactors 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.SummaryConsidering 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.

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“…Colorectal is one subspecialty with particularly strong growth, as the robot's technology facilitates a high-definition view for meticulous dissection and greater flexibility maneuvering in the deep pelvis [3][4][5]. There are concerns that the growth of RAS outpaces the evidence to support its use and additional costs [2].…”

mentioning

confidence: 99%

“…Since 2012, utilization of robotic-assisted surgery (RAS) increased dramatically across all procedures, and certain operations shifted by an order of magnitude towards greater robotics use [ 2 ]. Colorectal is one subspecialty with particularly strong growth, as the robot’s technology facilitates a high-definition view for meticulous dissection and greater flexibility maneuvering in the deep pelvis [ 3 – 5 ]. There are concerns that the growth of RAS outpaces the evidence to support its use and additional costs [ 2 ].…”

mentioning

confidence: 99%

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

2022

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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.

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Human factors in pelvic surgery

Cited by 4 publications

References 51 publications

A case-study comparison of qualitative and quantitative techniques for assessing surgeon ergonomics

A case-study comparison of qualitative and quantitative techniques for assessing surgeon ergonomics

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

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

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