The impact of intraoperative microbreaks with exercises on surgeons: A multi-center cohort study

Hallbeck, M. Susan; Lowndes, Bethany R.; Bingener, Juliane; Abdelrahman, Amro M.; Yu, Denny; Bartley, Adam C.; Park, A. E.

doi:10.1016/j.apergo.2016.12.006

Cited by 155 publications

(115 citation statements)

References 58 publications

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“…Having microbreaks during surgery has been found to have a significant positive effect on musculoskeletal pain. Microbreaks may interrupt long‐lasting epochs of low‐level intensity, thereby enhancing the recovery of metabolic changes in the muscle associated with muscle fatigue and musculoskeletal pain.…”

Section: Discussionmentioning

confidence: 99%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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Background: It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.Methods: Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMG max ). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.Results: The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.Conclusion: Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture. MethodsColorectal surgeons from two Danish hospitals participated. The surgeons were eligible if certified in both surgical modalities, had performed LAP and RALS almost equally, and had a high weekly caseload. The surgeons gave written informed consent to participate, and the Danish Data Protection Agency approved the study (record number 2015-57-0008). Approval from the regional ethics committee was sought, but the present study was exempted. Measurements were conducted on site during normal work procedures. Each surgeon performed two operations -one with LAP and one with RALS. Each of the procedures

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Section: Discussionmentioning

confidence: 99%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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“…31,32 Microbreaks encourage the surgeon and the surgical team to change position and stretch at designated periods throughout a procedure and they have been shown to increase physical function and mental focus. 33 Our data indicate that these interventions may not be necessary during lumpectomy or excisional biopsy procedures, but more appropriate for skin-sparing and nipple-sparing mastectomies-the longer and more fatiguing procedures. The poor neck position seen during both NSM and SSM procedures can also be exacerbated with the additional weight of a head light.…”

Section: Discussionmentioning

confidence: 64%

Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM

et al. 2020

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Background. Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures. Methods. From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed. Results. Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p \ 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02). Conclusion. Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons' left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.

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“…A potential solution adapted from office [41,42] and industry [43] ergonomics is the use of periodic work breaks suggested by Engelmann (2011) [44] and Dorion and Darveau (2013) [45]. We recently completed a study on the feasibility of incorporating simple callisthenic stretching exercises into a one minute microbreak every 20-40 minutes during MIS procedures [46,47]. While the microbreaks were widely accepted by surgeons and indicated as helpful, the issues that they have recognized as causing pain, dysfunction, and fatigue were not directly addressed.…”

Section: Introductionmentioning

confidence: 99%