Impact of Obesity on Surgeon Ergonomics in Robotic and Straight-Stick Laparoscopic Surgery

Abstract

for their help in setting up the experiments and analysis of the results. Funding: No funding was obtained for this study. Intuitive Surgical provided the robotic instruments and the abdominal model on which the exercises were performed.

The impact of patient body mass index on surgeon posture during simulated laparoscopy

“…The upper body posture of surgeons was assessed by classifying motion capture data using the LUBA ergonomic framework. This study contributes to the growing literature concerning the impact of patient BMI on surgeons performing laparoscopy [9,13,17,19,20].…”

“…Musculoskeletal disorders amongst laparoscopic surgeons and the wider surgical community are well recognised, with the adoption of non-neutral postures during surgery often attributed as a major task-related cause [7,10,11,37,40]. Surgeons often perceive patients with obesity to be an aggravator of this task-related cause [13,17]; however, there remains little objective analysis to support this. The purpose of this study was to objectively quantify the effect of different levels of simulated patients with obesity (30 kg/m 2 ) and severe obesity (40 – 50 kg/m 2 ) on the posture of laparoscopic surgeons with varying levels of surgical experience.…”

“…Laparoscopic surgery is recognised as the optimal interventional technique for many obesity related pathologies. While literature suggests that Class 1 -2 obesity has a minimal impact on surgeon posture during LS [13,17], there is mounting evidence that indicates patients with Class 3 obesity have a suboptimal impact on surgeon posture, promoting non-neutral postures in the problem areas previously raised [9,[18][19][20]. Moreover, an impending shortage of experienced surgeons would mean greater patient workloads per surgeon and less experienced surgeons within the workforce, which has the potential to further increase the prevalence of MSDs in surgeons [21].…”

“…The emergence and impact of patients with obesity (BMI ≥ 30 kg/m 2 ) is an issue that has been linked with further deterioration of surgeon posture during LS [13]. Obesity classification is subdivided into three categories: Class 1, 30 kg/m 2 < BMI ≤ 35 kg/m 2 , Class 2, 35 kg/m 2 < BMI ≤ 40 kg/m 2 and Class 3, BMI > 40 kg/m 2 often termed as ‘severe’[14].…”

Uptake and outcomes of robotic gynaecological surgery in England (2006-2018): a study using administrative hospital data.

“…Since then, gynaecology has been the second leading speciality after urology utilising robotic surgery worldwide 2 . In addition to proven patient benefits of minimally invasive surgery, such as reduced bleeding, quick recovery and improved cosmesis, robotic surgery also offers surgical benefits of wristed instruments, three-dimensional vision and comfortable surgeon ergonomics [3][4][5] . It has been used to perform hysterectomy for benign and malignant disease, myomectomy, and tubal surgery with a full abdominal approach as well as to perform prolapse and fistula repairs with a combined abdomino-vaginal approach, producing outcomes that are comparable to laparoscopic surgery [6][7][8] .…”