Physician pain and discomfort during minimally invasive gynecologic cancer surgery

Abstract

Objective Despite increasing awareness of physical strain to surgeons associated with minimally invasive surgery (MIS), its use continues to expand. We sought to gather information from gynecologic oncologists regarding physical discomfort due to MIS. Methods Anonymous surveys were e-mailed to 1,279 Society of Gynecologic Oncology (SGO) members. Physical symptoms (numbness, pain, stiffness, and fatigue) and surgical and demographic factors were assessed. Univariate and multivariate analyses were performed to determine risk factors for physical symptoms. Results We analyzed responses of 350 SGO members who completed the survey and currently performed >50% of procedures robotically (n=122), laparoscopically (n=67), or abdominally (n=61). Sixty-one percent of members reported physical symptoms related to MIS. The rate of symptoms was higher in the robotic group (72%) than the laparoscopic (57%) or abdominal group (49%) (p=0.0052). Stiffness (p=0.0373) and fatigue (p=0.0125) were more common in the robotic group. Female sex (p<0.0001), higher caseload, (p=0.0007) and academic practice (p=0.0186) were associated with increased symptoms. On multivariate analysis, robotic surgery (odds ratio [OR] 2.38, 95% CI 1.20-4.69) and female sex (OR 4.20, 95% CI 2.13-8.29) were significant predictors of symptoms. There was no correlation between seeking treatment and surgical modality (laparotomy 11%, robotic 20%, laparoscopy 25%, p= 0.12). Conclusions Gynecologic oncologists report physical symptoms due to MIS at an alarming rate. Robotic surgery and female sex appear to be risk factors for physical discomfort. As we strive to improve patient outcomes and decrease patient morbidity with MIS, we must also work to improve the ergonomics of MIS for surgeons.

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

“…Since its introduction robotic technology has been reported to have greater benefits for surgeons' musculoskeletal health as compared to SS [21,22], although it is not without ergonomics issues typically from fixed position at the console [19,23], compared to SS [24], which instead has a greater impact on shoulder and arm movement [25]. Newer robotic platforms are currently under development that have worked on this aspect with open consoles that will hopefully help address this issue.…”

Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery

“…This study did not differentiate the physical strains caused by robotic surgery or laparoscopic surgery. McDonald et al [ 23 ] completed a similar ergonomic survey study for comparing the physical ergonomics of robotic, laparoscopic, or abdominal surgery. They reported that physical symptom rate of the robotic surgery group was higher (72%) than those of laparoscopic (57%) and abdominal surgery group (49%).…”

Make New Friends But Keep the Old: Minimally Invasive Surgery Training in Gynecologic Oncology Fellowship Programs

“…25 Furthermore, the only study evaluating surgeon pain in gynecologic oncology did not support improved ergonomics for surgeons with the robotic system: in fact, gynecologic oncologists reported increased pain with use of the robotic system. 26 Several studies have shown that TL is more cost-effective than RAS and open laparotomy for the treatment of endometrial cancer. 27,28 Barnett et al showed that laparoscopic hysterectomy was associated with an average cost savings of $1347 compared to robotic-assisted hysterectomy and $2719 compared to open hysterectomy.…”