Laparoscopic Procedures Hurting Surgeons
In a University of Maryland School of Medicine survey of this profession, the largest such survey to date, 87 percent of them reported experiencing discomfort.
Minimally invasive surgical procedures are extensively advertised as a breakthrough option that causes little pain and allows for fast recovery. The surgeons who perform them are not as fortunate.
In the largest survey yet done of North American surgeons who perform laparoscopic procedures, 87 percent of the respondents reported experiencing discomfort. The survey was developed at the University of Maryland School of Medicine in Baltimore. Surgeons with the highest case volumes had the most pain, it found. Results are being published in the March 2010 issue of the Journal of the American College of Surgeons and are available here.
"We face a pending epidemic of occupational injuries to surgeons, and we can no longer ignore their safety and health," said the survey's principal author, Dr. Adrian E. Park, chief of general surgery at the University of Maryland Medical Center and professor of surgery and vice chair of the Department of Surgery at the University of Maryland School of Medicine. "Sadly, it is easier for a surgeon to obtain an ergonomic assessment and direction to improve his golf swing than his posture or movement during surgery. If injuries among surgeons are not addressed significantly, we're going to face a problem in the near future of a shortage of surgeons, as well as shortened career longevity among surgeons who enter, or are already in, the field."
Park is also executive director of the Maryland Advanced Simulation, Training, Research, and Innovation Center at the medical center; it is the world's first facility focused on surgical movement. He said performing laparoscopic surgery presents unique challenges. "In laparoscopic surgery, we are very limited in our degrees of movement, but in open surgery we have a big incision, we put our hands in, we're directly connected with the target anatomy. With laparoscopic surgery, we operate by looking at a video screen, often keeping our neck and posture in an awkward position for hours," Park said. "Also, we're standing for extended periods of time with our shoulders up and our arms out, holding and maneuvering long instruments through tiny, fixed ports."
The 23-question survey was sent to 2,000 board-certified gastrointestinal and endoscopic surgeons in North America and abroad who are members of the Society of American Gastrointestinal and Endoscopic Surgeons. Among 317 surgeons who completed the survey, 272 (86.9 percent) reported experiencing physical discomfort or symptoms, such as eye strain, neck pain, or hand pain, that they attributed to performing minimally invasive surgeries.
"If surgeons had more than 150-200 cases a year, they were at a much higher risk," Park said. "However, if the surgeon did long, complex cases, they only needed half that number to increase the risk."
Instrument design was listed as the main source of symptoms for more than 74 percent of the surgeons. Forty percent said the operating room table setup and display monitor location were the cause.