Reported pain at work is a risk factor for vascular surgery trainee burnout.

BACKGROUND: Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS: A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS: We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS: Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.

First reported human use of wireless laparoscopic system: is it ready for prime time?

OBJECTIVE: During the advent of laparoscopy, surgeons directly explored the abdominal cavity with a telescope-like device through a small incision. Since then, numerous technological advances have transformed minimally invasive surgery (MIS). Yet, in our wireless world, various devices crowd the surgical field, with long wires and light sources posing fall and fire risks. The primary objective of this study was to analyze the first reported human use of a novel wireless laparoscopy system or WLS (ArthroFree™, Lazurite®, Cleveland, Ohio). METHODS: The utility and convenience of the WLS was assessed via two avenues: (1) by analyzing surgical outcomes from first human use and (2) by surveying healthcare professionals regarding its quality and utility. RESULTS: Eighteen patients (mean age 44.2, 83.3% female, mean BMI 33.4) underwent operations with the WLS. Operations included gynecologic and general surgical procedures. There were no intraoperative or postoperative complications, and no conversions to traditional laparoscopy or laparotomy. Mean operating time was 71.94 ± 20.41 min, and estimated blood loss was minimal. Survey results revealed varied individual experiences. Strengths included adequate illumination, improved ergonomics, and simplicity of setup and ease of operation. One respondent criticized the image resolution. Feedback indicated an overall positive impact, and 67% of respondents supported inclusion of the device at their facility. Moreover, its deployment in resource-limited settings abroad has demonstrated its efficacy in global surgery, indicating its potential in various healthcare environments. CONCLUSIONS: This is the first reported human use of a novel WLS. Clinical results supported efficiency and safety of the technology. The successful deployment of the WLS in diverse surgical environments, including resource-limited settings, highlights its potential as a universally adaptable tool in global surgery. This report represents a strong first step toward a wireless operating room with the promise of redefining surgical standards as well as bridging gaps in surgical care worldwide.

Ergonomic Considerations in Urologic Surgery.

PURPOSE OF REVIEW: This paper aims to discuss the various work-related musculoskeletal disorders (WRMDs) among urologists and provide an overview of the latest recommendations to improve awareness of ergonomic principles that can be applied in the operating room, with special consideration of challenges faced during pregnancy. RECENT FINDINGS: Urologists suffer from a large burden of WRMDs. The main drivers of pain associated with the various surgical approaches include repetitive movements, static and awkward body positions, and the use of burdensome equipment. Pregnant surgeons are at an even greater risk of WRMDs and face high rates of pregnancy complications. Laparoscopy, endoscopy, robot-assisted surgeries, and open surgeries present unique ergonomic challenges for the practicing urologist. Proper posture and equipment use, optimal operating room setup, intraoperative stretching breaks, and an emphasis on teaching ergonomic principles can reduce the risk of WRMDs. Surgeons are also at increased risk of WRMDs during pregnancy but may continue to operate while taking measures to limit physical exertion and fatigue. Improving awareness of and incorporating ergonomic principles early in a urologist's career may reduce the risk of injury and improve operative performance and longevity.

Does "Just in Time" teaching of ergonomic principles improve posture of trainees during otologic microscopic surgery?

PURPOSE: Musculoskeletal disorders are prevalent among otolaryngologists and otologists with symptoms starting during residency. Prior data suggested that high-risk joint angles were often adopted at procedure onset, suggesting a detrimental "natural" operating position. Despite its importance, dedicated ergonomic teaching is not systematically introduced into residency training. The objective of this study was to compare initial ergonomic positioning during microscopic temporal bone surgery between those who receive "Just in Time" ergonomic teaching prior to starting dissection with those who did not. MATERIALS AND METHODS: This was a pilot, prospective trial in which otolaryngology residents at an urban, multicenter tertiary care academic institution (n = 14) wore ergonomic sensors (inertial measurement units) during microscopic temporal bone lab drilling. Prior to recording, participants were randomized to receive an instructional presentation on ergonomic principles (n = 8, intervention group) or not (n = 6, control group). The inertial measurement units analyzed neck and back angles for the initial 5 min of drilling. RESULTS: Of 14 trainees, 78.6 % had prior experience with otologic microscopic cases and 14.3 % reported prior surgical ergonomic training or instruction. The groups were matched in trainee height (P = 0.54), handedness (P = 0.83), stage of otolaryngology training (P = 0.64), prior otologic microscopic surgery experience (P = 0.35), prior temporal bone drilling experience (P = 0.35), and prior teaching in ergonomic principles (P = 0.47). Junior trainees (PGY 1-3) who did not receive "Just in Time" teaching adopted a posture with significantly higher risk back flexion compared to junior trainees who received the training (25.3° vs. 5.7°, P = 0.04). There was no difference in back positioning among senior trainees (12.6° vs. -5.7°, P = 0.13). While there was a trend towards those in the intervention group adopting safer procedural posture, there was no significant difference in the overall cohort between the intervention and control groups in both neck positioning (-11.0° vs. -19.1°, P = 0.17) and back positioning (8.6° vs. 19.1°, P = 0.18). CONCLUSIONS: Musculoskeletal related pain is prevalent among otolaryngologists and otologists with data suggesting that symptoms begin during residency. Targeted "Just in Time" teaching of ergonomic principles is feasible and may be effective for development of healthy postural habits, especially among junior trainees.

Effects of a Passive Back-Support Exosuit on Erector Spinae and Abdominal Muscle Activity During Short-Duration, Asymmetric Trunk Posture Maintenance Tasks.

OBJECTIVE: To examine the effects of asymmetry and lower extremity mobility restrictions on the effectiveness of a passive back-support exosuit in short-duration, static trunk flexion postures. BACKGROUND: The effectiveness of trunk exoskeletons/suits for sagittally symmetric trunk posture maintenance has been investigated, but there has been limited study of the effects of asymmetric trunk postures or lower extremity motion restriction. METHOD: Sixteen participants held trunk flexion postures involving trunk flexion (20°, 40°, 60°), asymmetry (0°, 30°), and lower extremity mobility (Free, Restricted) for 3 s. Participants held these postures with and without an exosuit while erector spinae and abdominal muscle activities were collected. RESULTS: There were no significant interactions between exosuit and asymmetry or exosuit and lower extremity motion restrictions, indicating no significant effects of these factors on the effectiveness of the exosuit at reducing trunk muscle activity. The exosuit was found to be effective at reducing erector spinae muscle activity regardless of asymmetry of posture or lower extremity restrictions (average 21%, from 11.2% MVC to 8.8% MVC). The magnitude of the erector spinae activity at 60° of trunk flexion with the exosuit was similar to that seen at 20° without the exosuit. CONCLUSION: The exosuit consistently provided biomechanical benefit through reduced activation of the erector spinae muscles and neither asymmetry of trunk posture nor lower extremity restriction influenced this effectiveness. APPLICATION: Trunk exoskeletons/suits can reduce trunk muscle activation and understanding how characteristics of the trunk postures assumed impact these responses may help target tasks wherein these devices may be effective.

Surgeons' physical workload in open surgery versus robot-assisted surgery and nonsurgical tasks.

BACKGROUND: Musculoskeletal disorders (MSDs) are common among surgeons, and its prevalence varies among surgical modalities. There are conflicting results concerning the correlation between adverse work exposures and MSD prevalence in different surgical modalities. The progress of rationalization in health care may lead to job intensification for surgeons, but the literature is scarce regarding to what extent such intensification influences the physical workload in surgery. The objectives of this study were to quantify the physical workload in open surgery and compare it to that in (1) nonsurgical tasks and (2) two surgeon roles in robot-assisted surgery (RAS). METHODS: The physical workload of 22 surgeons (12 performing open surgery and 10 RAS) was measured during surgical workdays, which includes trapezius muscle activity from electromyography, and posture and movement of the head, upper arms and trunk from inertial measurement units. The physical workload of surgeons in open surgery was compared to that in nonsurgical tasks, and to the chief and assistant surgeons in RAS, and to the corresponding proposed action levels. Mixed-effects models were used to analyze the differences. RESULTS: Open surgery constituted more than half of a surgical workday. It was associated with more awkward postures of the head and trunk than nonsurgical tasks. It was also associated with higher trapezius muscle activity levels, less muscle rest time and a higher proportion of sustained low muscle activity than nonsurgical tasks and the two roles in RAS. The head inclination and trapezius activity in open surgery exceeded the proposed action levels. CONCLUSIONS: The physical workload of surgeons in open surgery, which exceeded the proposed action levels, was higher than that in RAS and that in nonsurgical tasks. Demands of increased operation time may result in higher physical workload for open surgeons, which poses an increased risk of MSDs. Risk-reducing measures are, therefore, needed.

Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery.

BACKGROUND: Surgeon workload is significant both mentally and physically and may differ by procedure type. When comparing laparoscopic surgery and open surgery, studies have reported contrasting results on the physical and mental workload assessed. METHODS: Wearable posture sensors and pre-/post-surgical questionnaires were employed to assess intraoperative workload and to identify risk factors for surgeons using objective and subjective measures. RESULTS: Data from 49 cases (27 open and 22 laparoscopic surgeries performed by 13 male and 11 female surgeons) were assessed. More than half the surgeons reported a clinically relevant post-surgical fatigue score. The surgeons also self-reported a significant increase in pain for the neck, upper back, and lower back during/after surgery. Procedural time had significant impacts on fatigue, body part pain, and subjective (NASA-TLX) workload. The objectively assessed intraoperative work postures using wearable sensors showed a high musculoskeletal risk for neck and lower back based on their posture overall. Open surgeries had significantly larger neck angles (median [IQR]: 40 [28-47]°) compared with laparoscopic surgeries (median [IQR]: 23 [16-29]°), p < 0.001) and torso (median [IQR]: 17 [14-22]° vs. 13 [10-17]°, p = 0.006). CONCLUSION: Surgeons reported significantly higher levels of fatigue and pain in the neck and lower back during or after performing a surgical case. Longer procedural time resulted in more self-rated fatigue, pain, and subjective workload. Open surgery had higher postural risk. Overall, surgeons spent a disturbingly high percentage of time during surgery in high-risk musculoskeletal postures, especially the neck. These results show that intraoperative postural risk is very high and that interventions are necessary to protect surgeon musculoskeletal health for optimal surgeon performance and career longevity.

Operating hurts: a study of EAES surgeons.

BACKGROUND: Work-related pain and discomfort experienced by surgeons is widely reported in the literature. A survey was, therefore, conducted to explore this issue among members of the European Association for Endoscopic Surgery (EAES). METHODS: The survey was emailed to 2980 EAES members in 2017 enquiring about their working practice, musculoskeletal (MSK) pain and burnout. RESULTS: A total of 569 (19%) surgeons responded, of whom 556 were practicing surgeons; 86% were consultants, 84% were male, and 94% were right-handed. Respondents operated on average 3.3 days/week with 27% of their procedures lasting longer than 3 h. The 386 endoscopists surveyed reported performing an average of 5.3 procedures/day with 83% performing endoscopy at least once per week. Over half of practicing surgeons (62%) reported their worst pain score was 3 or higher (10-point scale) in the past 7 working days, encompassing 71% of their open, 72% laparoscopic, 48% robot-assisted cases and 52% of their endoscopies. Of the 120 surgeons who had ever sought medical help for aches, pain or discomfort, 38% were currently in pain and 16% had considered leaving surgery due to their MSK pain, 26% had reported work-related pain to their employer, 26% had been on short-term disability during their career and 4% long-term disability due to MSK disorders. A significant proportion of the respondents (49%) felt their physical discomfort would influence the ability to perform or assist with surgical procedures in the future. These surgeons reported significantly lower satisfaction from their work (p = 0.024), higher burnout (p = 0.005) and significantly higher callousness toward people (p < 0.001) than those not fearing loss of career longevity. CONCLUSION: The results show that MSK pain is prevalent amongst EAES members. Nearly half the respondents had career longevity fears from pain/discomfort which, in turn, correlated with more prevalent feelings of burnout. More emphasis should be placed on the aetiology, prevention and management of musculoskeletal pain in the surgical workforce.

Is robotic-assisted radical cystectomy (RARC) with intracorporeal diversion becoming the new gold standard of care?

BACKGROUND: Totally intracorporeal robotic-assisted radical cystectomy (RARC) has perceived difficulties compared to open radical cystectomy (ORC). As the technique is increasingly adopted around the world, the benefits of RARC with intra- or extracorporeal urinary diversion or ORC for the patients are still unclear. In this article, we consider the current evidence for this issue. METHODS: We assessed two questions through using expert opinion and the medical literature: (A) Is RARC better than ORC for removing the cancer surgery and outcome? (B) Is RARC better than ORC for the urinary diversion? OUTCOMES: (A) RARC is better than ORC for shorter length of stay, blood loss and complication rates. (B) Intracorporeal orthotopic neobladder may have a significant physiological and surgical benefit to the patient recovery. CONCLUSIONS: RARC with total intracorporeal reconstruction has potential benefits to the patient. We recommend that all surgeons document patient-related outcome measures, urodynamics and enhanced recovery protocols for cystectomy patients to help us understand the real improvements within bladder cancer surgery and reconstruction.

The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments.

BACKGROUND: Laparoscopic surgery presents multiple ergonomic difficulties for the surgeon, requiring awkward body postures and prolonged static muscle loading that increases risk of musculoskeletal strain and injury. This prospective study quantitatively measures the biomechanical movements of surgeons during laparoscopic procedures to determine at-risk movements from prolonged static muscle loading and repetitive motions that may lead to injury. METHODS: A total of 150 video recordings of 18 surgeons, standing at the patient's left, were captured from three fixed camera positions during live gynecological laparoscopic surgery. Postoperative processing quantified surgeon movements at the neck, shoulders and elbows using computer software to measure extreme joint angles and time spent within defined joint angle ranges. RESULTS: Surgeons spent a median of 98 % (range 77-100 %) of surgical time with their neck rotated at 21° (range 0°-52°). The non-dominant arm was subjected to more extreme positions for significantly longer periods of time compared to the dominant, with shoulder flexion at 45°-90° for 35 vs. 0 % (p < 0.001) and elbow flexion at >120° for 31 vs. 0 % (p < 0.001) of total surgical time. Procedures involving power morcellation required significantly greater number of instrument insertion/removals-119 (range 56-182) compared with 12 (range 2-122) when morcellation was not used (p < 0.001). Shorter surgeons maintained significantly greater degrees of neck rotation when viewing the monitor (p < 0.003) and surgeons with shorter arm lengths spent longer in extreme positions with their non-dominant shoulder at >90° (p = 0.04) and elbow at >120° (p < 0.001) compared with taller surgeons. No significant correlations were found between BMI or surgical experience and more extreme joint positions. CONCLUSIONS: Four primary areas have been identified where surgeons are consistently demonstrating movements that increase their risk of harm: (1) extended periods of neck rotation; (2) asymmetrical loading between the dominant and non-dominant shoulders; (3) power morcellation and frequent insertions/removals of laparoscopic instruments resulting in repetitions of the most extreme shoulder positions and (4) a negative correlation between height and percentage time spent in more extreme positions.

A feasibility study determining surgical ergonomics in a live surgical setting.

STUDY OBJECTIVE: To identify the biomechanical movements of laparoscopic surgeons during laparoscopic gynecologic procedures, and to determine whether such movements can be assessed and measured both temporally and biomechanically. DESIGN: Prospective descriptive kinematic study (Canadian Task Force classification II-3). SETTING: A tertiary referral hospital in Sydney, Australia. STUDY SUBJECTS: Five gynecologic laparoscopic surgeons. INTERVENTIONS: Video recording from a variety of fixed positions to assess surgeon stance, time spent in specific postures, and relative change of limb angles during laparoscopic surgical procedures. MEASUREMENTS AND MAIN RESULTS: Postoperative review of surgical movements during laparoscopic surgery was able to provide quantitative data. Motion and timing could be classified by angle banding ranges among surgeons. The most extreme shoulder abduction angles occurred during trocar insertion (61°) and insertion or removal of laparoscopic instruments (63.5°), with procedures involving morcellation requiring the greatest number of instrument insertions or removals (n = 57). The elbow is most frequently in a neutral position in TLH, and the shoulder spends the most time in abduction during myomectomy. CONCLUSION: This proof-of-concept study confirms that detailed ergonomic assessment is possible within live surgical settings, with identified limitations. This study may allow for a larger-scale study to determine at-risk movements during the various phases of a laparoscopic surgery and possibly control for some of these hazardous behaviors.

Reducing Surgeon Fatigue Through Ergonomics: Importance and Benefits in Laparoscopic Surgeries.

Laparoscopy, despite enhancing surgical outcomes, presents ergonomic challenges, such as visual-motor axis dissociation and increased cognitive load, leading to inefficiency and fatigue. Ergonomics, optimizing tasks and environments to fit human capabilities, can address these issues by designing user-friendly instruments, improving surgeon positioning, and enhancing operating room setups. These interventions reduce suturing time, alleviate discomfort, and decrease musculoskeletal disorders among surgeons. Ergonomic training for surgical teams further minimizes risk factors and promotes better body mechanics. Prioritizing ergonomics in surgical environments may lead to improved patient outcomes, greater surgeon well-being, and increased job satisfaction, highlighting its critical importance in modern surgery.

Passive Exoskeletons During Live Surgeries: Supporting Forward Head Postures Among Veterinary Surgeons.

TECHNICAL ABSTRACTBackground: Musculoskeletal symptoms (MSS) are prevalent among veterinary surgeons. Recent research has proposed exoskeletons as potential solutions in reducing the risk of musculoskeletal disorders among surgeons, but no studies have addressed the neck forward postures (opposite of overhead work), a unique ergonomic neck risk, commonly required during live, open surgery. Purpose: We explored the effectiveness of a passive neck-support exoskeleton during live veterinary surgical procedures with experienced surgeons. Methods: We employed a within-subject crossover design involving surgeons who participated in procedures across specialties including soft tissue and orthopedics. Participants performed entire surgeries with and without a front head posture support prototype exoskeleton, and they completed pre- and post-surgical surveys to assess MSS and perceived effort. The Wilcoxon Signed Rank Test was used to compare median values of MSS and the perceived effort of each participant when they operated with and without the exoskeleton. Results: We collected data during 28 procedures involving eight surgeons, with each subject performing at least one surgery with (intervention) and at least one surgery without (control) the exoskeleton (randomized order). The number of control and intervention cases for each participant was balanced. We found that the difference in neck stiffness before and after surgery was greater in the control surgeries compared to when using the exoskeleton intervention. Increases in neck pain and neck stiffness were only observed in control cases, whereas no participant reported increased neck pain or neck stiffness when the exoskeleton was used. Conclusion: Our results indicate that a passive forward head posture support exoskeleton is a promising intervention for reducing the risk of MSS in live surgical procedures.

Surgeons, including veterinary surgeons, are exposed to many ergonomic challenges due to their work settings. The prolonged, sustained neck flexion necessary during surgeries can lead to muscle fatigue and discomfort, potentially causing musculoskeletal disorders. Our research explored the use of a passive exoskeleton to provide support for forward head posture (FHP) during live veterinary surgeries in the field. Our findings indicate that the passive FHP support exoskeleton can potentially reduce musculoskeletal symptoms among surgeons. Further studies, though, are needed to continue generating biomechanical evidence to objectively assess the effectiveness of the exoskeleton in prolonged use.

Left-Handed Palming of the Needle Driver: A Technical Report for Surgical Trainees.

Left-handed surgical trainees are uniquely challenged when learning how to suture using standard needle drivers designed for right-handed individuals and often feel disadvantaged in comparison to their right-handed peers. "Palming," a suturing technique that improves suturing mechanics and efficiency, cannot be achieved in the standard manner using the left hand. This paper proposes a previously undescribed technique for palming using the left hand that provides many of the same benefits as standard palming methods using the right hand, potentially reducing a common source of inequity in surgical training.

Ergonomics, musculoskeletal disorders, and surgeon gender in spine surgery: a survey of practicing spine surgeons.

OBJECTIVE: The objective of this study was to gain a greater understanding of the burden of musculoskeletal disorders (MSDs) in spine surgeons, their impact on practice, and risk factors contributing to MSDs, including surgical instrument design and surgical ergonomics. METHODS: An anonymous REDCap survey was distributed via email to the departments of several academic and private centers across the United States, as well as to the AANS/CNS Women in Neurosurgery Section email list. Chi-square tests and Wilcoxon rank-sum tests were used to compare responses by gender. Multivariable linear regression analysis was performed to identify predictors of discomfort in instrument utilization. RESULTS: Survey responses were received from 120 spine surgeons (29.1% response rate), of which 73 were included in the analysis. A very high number of respondents had experienced an MSD (70.4%), 38.2% had undergone treatment for at least one MSD, and 13.4% had lost time at work for at least one MSD. Women were more likely than men to have lost time at work due to an MSD (22.6% vs 5.6%, p = 0.04). Women were more likely than men to report difficulty in instrument grip, comfort, and use on a 20-point Likert scale (mean 10.7 vs 15.2 points, p < 0.0001). This effect persisted when adjusting for glove size and days per week spent operating (p = 0.002). Specifically, women were less likely to agree that the handles of surgical instruments were an appropriate grip (p < 0.0001), that they rarely experienced difficulty when using them (p < 0.0001), and that they rarely needed to use two hands with instruments meant to be used with one hand (p = 0.0002). CONCLUSIONS: The MSD burden in spine surgeons is substantial. While there was no evidence of gender differences in MSD rates and severity, female surgeons report significantly more discomfort with the use of surgical instruments. There is a need for more investigation of MSD risk factors in spine surgeons and mitigation strategies. Gender differences in comfort in instrument use should be further explored and addressed by spine surgeons and device manufacturers.

Ergonomics in Facial Plastic and Reconstructive Surgery: A Clinical Evaluation.

OBJECTIVES: Surgeons experience a risk for physical strain and injury secondary to physical demands in the workplace. To minimize injury and maximize career longevity, physicians should be aware of ergonomics pitfalls and postural correction methods. This study investigates ergonomic trends in Facial Plastic and Reconstructive Surgery (FPRS) clinic by quantifying surgeons' and trainees' cervicothoracic spine posture. METHODS: Participants completed a 22-item questionnaire to evaluate current ergonomic practices. A lightweight device was calibrated and attached to the mid-scapular region of participants, providing real-time posture feedback. The percentage of time in upright posture was recorded during clinical and operative workdays. Upright posture was defined as neutral spine positioning with acceptable mild to moderate deviations. RESULTS: Two FPRS attending surgeons, 1 FPRS fellow, and 11 otolaryngology residents participated over 12 months. Discomfort was most commonly reported in the neck, shoulders, and upper back during clinic. Symptoms were self-treated by changing body position, wearing specialized footwear, adjusting height of the chair or examination table, or ignoring discomfort. Eighty-two percent were unaware of ergonomic guidelines or appropriate considerations. Time spent in upright posture was significantly higher in clinic (84.9%) than in the OR (53.5%) (p < 0.001). Upright posture declined after reaching 6 work hours (p = 0.029); no such patterns were observed in the OR (p = 0.946). CONCLUSION: Although time spent in upright posture was objectively poorer in the OR, these data suggest ergonomics are an important consideration in the outpatient setting, with surgeons experiencing discomfort during and after clinic. Further investigation is warranted to identify actionable changes and promote healthy ergonomics. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

Indian surgery Trainee's perspective on surgical ergonomics principles and education: A long road ahead.

INTRODUCTION: This study aimed to determine the baseline knowledge and beliefs, along with the impact of incorporating surgical ergonomics lectures during a residency. METHODS: A cohort of 123 Indian surgical residents participated in this educational intervention, which consisted of two educational webinars on ergonomics. Both pre- and post-intervention surveys were electronically sent to the participants. These included questions related to their demographics, prevalence of musculoskeletal (MSK) symptoms, and factors affecting participant awareness of ergonomic recommendations. RESULTS: Seventy-one residents responded to the pre-webinar survey. Eighty-five percent of respondents reported MSK symptoms, with the most common being pain (70%) and stiffness (40%), which the residents attributed to their surgical training. Forty-six residents completed the post-webinar survey. The majority of respondents strongly agreed or agreed that surgical ergonomic educational sessions improved their understanding of the fundamental causes of MSK symptoms and increased their awareness of options available for prevention MSK injuries. CONCLUSION: The rate of MSK symptoms and/or injury was high among this cohort of surgical residents. These surveys and educational session demonstrated there is limited awareness of the comprehension of ergonomics related to surgical procedures. Our study shows that a simple surgical ergonomic educational intervention can lead to improved understanding of prevention and ergonomic changes.

Expanding access to microneurosurgery in low-resource settings: Feasibility of a low-cost exoscope in transforaminal lumbar interbody fusion.

Objectives: Less than a quarter of the world population has access to microneurosurgical care within a range of 2 h. We introduce a simplified exoscopic visualization system for low-resource settings. Materials and Methods: We purchased a 48 megapixels microscope camera with a c-mount lens and a ring light at a total cost of US$ 125. Sixteen patients with lumbar degenerative disk disease were divided into an exoscope group and a microscope group. In each group, we performed four open and four minimally invasive transforaminal lumbar interbody fusions (TLIF). We conducted a questionnaire-based assessment of the user experience. Results: The exoscope achieved similar outcomes with comparable blood loss and operating time as the microscope. It provided similar image quality and magnification. Yet, it lacked stereoscopic perception and the adjustability of the camera position was cumbersome. Most users strongly agreed the exoscope would significantly improve surgical teaching. Over 75% reported that they would recommend the exoscope to colleagues and all users saw its great potential for low-resource environments. Conclusion: Our low-budget exoscope is safe and feasible for TLIF and purchasable at a fraction of the cost of conventional microscopes. It may thus help expand access to neurosurgical care and training worldwide.

Artificial intelligence based real-time video ergonomic assessment and training improves resident ergonomics.

BACKGROUND: Surgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents. METHODS: Surgery residents performed simulated laparoscopic tasks before and after a review of the SCORE ergonomics curriculum while filmed with a sensorless app from Kinetica Labs that calculates joint angles as a metric of ergonomics. A survey was completed before the session and a focus group was conducted after. RESULTS: Thirteen surgical residents participated in the study. The brief intervention took little time and residents improved their ergonomic scores in neck and right shoulder angles. Residents expressed increased awareness of ergonomics based on the session content and AI information. All trainees desired more training in ergonomics. CONCLUSIONS: Ergonomic assessment AI software can provide immediate feedback to surgical trainees to improve ergonomics. Additional studies using sensorless AI technology are needed.

Ergonomics and performance of using prismatic loupes in simulated surgical tasks among surgeons - a randomized controlled, cross-over trial.

Introduction: Recently developed prismatic loupes may mitigate the high physical workload and risk of neck disorders associated with traditional surgical loupes among surgeons. However, research in this area, particularly among surgeons, is sparse. This study examines the impact of prismatic loupes on surgeons' physical workload, musculoskeletal discomfort, and performance during simulated surgical tasks. Materials and methods: Nineteen out of twenty recruited surgeons performed three tasks in a fixed-order with their own loupes and both low-tilt (LT) and high-tilt (HT) prismatic loupes, in a randomized order. The primary outcomes were the median inclination angles and velocities of the head, trunk, and upper arms, along with the median muscle activity of the cervical erector spinae (CES), upper trapezius (UT), and lumbar erector spinae (LES) for each pair of loupes. The secondary outcomes included performance (completion time and errors), perceived body-part discomfort, and subjective evaluation of the three pairs of loupes. Results: Using prismatic loupes, either LT or HT, compared with the surgeons' own loupes yielded lower head inclinations (all p < 0.001), lower neck muscle activity (all p < 0.05), and lower neck discomfort in indirect comparisons (p < 0.01) with no significant difference in surgical errors (p = 0.628). However, HT loupes resulted in a longer task completion time in two tasks (p < 0.001). Most surgeons preferred LT loupes (N = 12) for their comfort and visual functions. Discussion: The results indicate that prismatic loupes can reduce physical workload in the neck during simulated surgical task, with no significant difference in surgical errors. Future studies are needed to investigate the long-term effects of prismatic loupes among surgeons.