Research Article
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Ergonomics in surgery and work-related musculoskeletal disorders

Year 2025, EARLY ONLINE, 1 - 9
https://doi.org/10.18621/eurj.1568764

Abstract

Objectives: Our study aimed to determine surgeons' work-related musculoskeletal disorders, physical workload, location of the disorder, frequency, characteristics, and effects on daily life. Furthermore, we aimed to draw attention to ergonomics education by investigating surgeons' opinions and attitudes regarding ergonomics.

Methods: Data were collected using survey forms from 37 surgeons who met the appropriate criteria. Sociodemographic characteristics, The Physical Workload Questionnaire was used to evaluate physical workload, the Extended Nordic Musculoskeletal System Questionnaire was used to evaluate the characteristics of painful areas, and the Beck Depression Scale was used to evaluate the psychological status of the surgeons.

Results: Thirty-four (91.9%) of the surgeons reported that they experienced musculoskeletal disorders at least once in their careers due to their professional responsibilities. The most common causes of pain were poor posture, incorrect positioning, and standing too much. The neck, upper back, and waist were the most affected areas, and only 1 (2.7%) surgeon had received ergonomics training.

Conclusions: Musculoskeletal disorders caused by ergonomic difficulties are common in the surgical field. It is critical to developing evidence-based ergonomic training recommendations that hospitals and residency training programs should follow to protect surgeons from preventable injuries that have the potential to significantly harm their careers.

References

  • 1. Physician burnout: a global crisis. Lancet. 2019;394(10193):93. doi: 10.1016/S0140-6736(19)31573-9.
  • 2. Bernal D, Campos-Serna J, Tobias A, Vargas-Prada S, Benavides FG, Serra C. Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: a systematic review and meta-analysis. Int J Nurs Stud. 2015;52(2):635-648. doi: 10.1016/j.ijnurstu.2014.11.003.
  • 3. Hoe VC, Kelsall HL, Urquhart DM, Sim MR. Risk factors for musculoskeletal symptoms of the neck or shoulder alone or neck and shoulder among hospital nurses. Occup Environ Med. 2012;69(3):198-204. doi: 10.1136/oemed-2011-100302.
  • 4. Yasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian J Occup Environ Med. 2014;18(2):75-81. doi: 10.4103/0019-5278.146896.
  • 5. Luger T, Maher CG, Rieger MA, Steinhilber B. Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers. Cochrane Database Syst Rev. 2019;7(7):CD012886. doi: 10.1002/14651858.CD012886.pub2.
  • 6. Naidoo RN, Haq SA. Occupational use syndromes. Best Pract Res Clin Rheumatol. 2008;22(4):677-691. doi: 10.1016/j.berh.2008.04.001. PMID: 18783744.
  • 7. Stylopoulos N, Rattner D. Robotics and ergonomics. Surg Clin North Am. 2003 Dec;83(6):1321-37. doi: 10.1016/S0039-6109(03)00161-0.
  • 8. Epstein S, Sparer EH, Tran BN, et al. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(2):e174947. doi: 10.1001/jamasurg.2017.4947. Epub 2018 Feb 21.
  • 9. Catanzarite T, Tan-Kim J, Whitcomb EL, Menefee S. Ergonomics in Surgery: A Review. Female Pelvic Med Reconstr Surg. 201;24(1):1-12. doi: 10.1097/SPV.0000000000000456.
  • 10. Szeto GP, Cheng SW, Poon JT, Ting AC, Tsang RC, Ho P. Surgeons' static posture and movement repetitions in open and laparoscopic surgery. J Surg Res. 2012;172(1):e19-31. doi: 10.1016/j.jss.2011.08.004.
  • 11. Berguer R. Surgery and ergonomics. Arch Surg. 1999;134(9):1011-1016. doi: 10.1001/archsurg.134.9.1011.
  • 12. Stucky CH, Cromwell KD, Voss RK, et al. Surgeon symptoms, strain, and selections: Systematic review and meta-analysis of surgical ergonomics. Ann Med Surg (Lond). 2018;27:1-8. doi: 10.1016/j.amsu.2017.12.013.
  • 13. Voss RK, Chiang YJ, Cromwell KD, et al. Do No Harm, Except to Ourselves? A Survey of Symptoms and Injuries in Oncologic Surgeons and Pilot Study of an Intraoperative Ergonomic Intervention. J Am Coll Surg. 2017;224(1):16-25.e1. doi: 10.1016/j.jamcollsurg.2016.09.013.
  • 14. Howarth AL, Hallbeck S, Mahabir RC, Lemaine V, Evans GRD, Noland SS. Work-Related Musculoskeletal Discomfort and Injury in Microsurgeons. J Reconstr Microsurg. 2019;35(5):322-328. doi: 10.1055/s-0038-1675177.
  • 15. Vaisbuch Y, Aaron KA, Moore JM, et al. Ergonomic hazards in otolaryngology. Laryngoscope. 2019;129(2):370-376. doi: 10.1002/lary.27496.
  • 16. Hollmann S, Klimmer F, Schmidt KH, Kylian H. Validation of a questionnaire for assessing physical workload. Scand J Work Environ Health. 1999;25(2):105-114. doi: 10.5271/sjweh.412.
  • 17. Kahraman T, Göz E, Genç A. Validity and reliability of the Turkish version of the Physical Workload Questionnaire. Work. 2018;59(2):295-302. doi: 10.3233/WOR-172670.
  • 18. Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-237. doi: 10.1016/0003-6870(87)90010-x.
  • 19. Pugh JD, Gelder L, Williams AM, Twigg DE, Wilkinson AM, Blazevich AJ. Validity and reliability of an online extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E2) to measure nurses' fitness. J Clin Nurs. 2015;24(23-24):3550-3563. doi: 10.1111/jocn.12971.
  • 20. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-571. doi: 10.1001/archpsyc.1961.01710120031004.
  • 21. Hisli N. A reliability and validity study of Beck Depression Inventory in a university student sample. J Psychol, 1989;7:3-13.
  • 22. Kroemer KH. Cumulative trauma disorders: their recognition and ergonomics measures to avoid them. Appl Ergon. 1989;20(4):274-280. doi: 10.1016/0003-6870(89)90190-7.
  • 23. Kumar S. Trunk rotation: ergonomic and evolutionary perspective. Theor Issues Ergon Sci. 2002 3(3):235-256.
  • 24. Miller K, Benden M, Pickens A, Shipp E, Zheng Q. Ergonomics principles associated with laparoscopic surgeon injury/illness. Hum Factors. 2012;54(6):1087-92. doi: 10.1177/0018720812451046.
  • 25. Esposito C, El Ghoneimi A, Yamataka A, et al. Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg. 2013;48(8):1750-1756. doi: 10.1016/j.jpedsurg.2013.01.054.
  • 26. Franasiak J, Ko EM, Kidd J, et al. Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery. Gynecol Oncol. 2012;126(3):437-442. doi: 10.1016/j.ygyno.2012.05.016.
  • 27. Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D. Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg. 2010;210(3):306-313. doi: 10.1016/j.jamcollsurg.2009.10.017.
  • 28. Sari V, Nieboer TE, Vierhout ME, Stegeman DF, Kluivers KB. The operation room as a hostile environment for surgeons: physical complaints during and after laparoscopy. Minim Invasive Ther Allied Technol. 2010;19(2):105-109. doi: 10.3109/13645701003643972.
  • 29. Matern U, Koneczny S. Safety, hazards and ergonomics in the operating room. Surg Endosc. 2007;21(11):1965-1969. doi: 10.1007/s00464-007-9396-4.
  • 30. Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC. Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil. 2009;19(2):175-184. doi: 10.1007/s10926-009-9176-1.
  • 31. Wells AC, Kjellman M, Harper SJF, Forsman M, Hallbeck MS. Operating hurts: a study of EAES surgeons. Surg Endosc. 2019;33(3):933-940. doi: 10.1007/s00464-018-6574-5.
  • 32.Wauben LS, van Veelen MA, Gossot D, Goossens RH. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc. 2006;20(8):1268-1274. doi: 10.1007/s00464-005-0647-y.
  • 33. Davis WT, Fletcher SA, Guillamondegui OD. Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions. J Surg Res. 2014;189(2):207-212.e6. doi: 10.1016/j.jss.2014.03.013.
  • 34. Tetteh E, Wang T, Kim JY, et al. Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations. Am J Surg. 2024; 235:115551. doi: 10.1016/j.amjsurg.2023.11.005.
  • 35. Nguyen NT, Ho HS, Smith WD, Philipps C, et al. An ergonomic evaluation of surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery. Am J Surg. 2001;182(6):720-724. doi: 10.1016/s0002-9610(01)00801-7.
  • 36. Yang L, Money SR, Morrow MM, et al. Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort. J Am Coll Surg. 2020;230(4):554-560. doi: 10.1016/j.jamcollsurg.2019.12.035.
  • 37. Rosenblatt PL, McKinney J, Adams SR. Ergonomics in the operating room: protecting the surgeon. J Minim Invasive Gynecol. 2013;20(6):744. doi: 10.1016/j.jmig.2013.07.006.
Year 2025, EARLY ONLINE, 1 - 9
https://doi.org/10.18621/eurj.1568764

Abstract

References

  • 1. Physician burnout: a global crisis. Lancet. 2019;394(10193):93. doi: 10.1016/S0140-6736(19)31573-9.
  • 2. Bernal D, Campos-Serna J, Tobias A, Vargas-Prada S, Benavides FG, Serra C. Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: a systematic review and meta-analysis. Int J Nurs Stud. 2015;52(2):635-648. doi: 10.1016/j.ijnurstu.2014.11.003.
  • 3. Hoe VC, Kelsall HL, Urquhart DM, Sim MR. Risk factors for musculoskeletal symptoms of the neck or shoulder alone or neck and shoulder among hospital nurses. Occup Environ Med. 2012;69(3):198-204. doi: 10.1136/oemed-2011-100302.
  • 4. Yasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian J Occup Environ Med. 2014;18(2):75-81. doi: 10.4103/0019-5278.146896.
  • 5. Luger T, Maher CG, Rieger MA, Steinhilber B. Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers. Cochrane Database Syst Rev. 2019;7(7):CD012886. doi: 10.1002/14651858.CD012886.pub2.
  • 6. Naidoo RN, Haq SA. Occupational use syndromes. Best Pract Res Clin Rheumatol. 2008;22(4):677-691. doi: 10.1016/j.berh.2008.04.001. PMID: 18783744.
  • 7. Stylopoulos N, Rattner D. Robotics and ergonomics. Surg Clin North Am. 2003 Dec;83(6):1321-37. doi: 10.1016/S0039-6109(03)00161-0.
  • 8. Epstein S, Sparer EH, Tran BN, et al. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(2):e174947. doi: 10.1001/jamasurg.2017.4947. Epub 2018 Feb 21.
  • 9. Catanzarite T, Tan-Kim J, Whitcomb EL, Menefee S. Ergonomics in Surgery: A Review. Female Pelvic Med Reconstr Surg. 201;24(1):1-12. doi: 10.1097/SPV.0000000000000456.
  • 10. Szeto GP, Cheng SW, Poon JT, Ting AC, Tsang RC, Ho P. Surgeons' static posture and movement repetitions in open and laparoscopic surgery. J Surg Res. 2012;172(1):e19-31. doi: 10.1016/j.jss.2011.08.004.
  • 11. Berguer R. Surgery and ergonomics. Arch Surg. 1999;134(9):1011-1016. doi: 10.1001/archsurg.134.9.1011.
  • 12. Stucky CH, Cromwell KD, Voss RK, et al. Surgeon symptoms, strain, and selections: Systematic review and meta-analysis of surgical ergonomics. Ann Med Surg (Lond). 2018;27:1-8. doi: 10.1016/j.amsu.2017.12.013.
  • 13. Voss RK, Chiang YJ, Cromwell KD, et al. Do No Harm, Except to Ourselves? A Survey of Symptoms and Injuries in Oncologic Surgeons and Pilot Study of an Intraoperative Ergonomic Intervention. J Am Coll Surg. 2017;224(1):16-25.e1. doi: 10.1016/j.jamcollsurg.2016.09.013.
  • 14. Howarth AL, Hallbeck S, Mahabir RC, Lemaine V, Evans GRD, Noland SS. Work-Related Musculoskeletal Discomfort and Injury in Microsurgeons. J Reconstr Microsurg. 2019;35(5):322-328. doi: 10.1055/s-0038-1675177.
  • 15. Vaisbuch Y, Aaron KA, Moore JM, et al. Ergonomic hazards in otolaryngology. Laryngoscope. 2019;129(2):370-376. doi: 10.1002/lary.27496.
  • 16. Hollmann S, Klimmer F, Schmidt KH, Kylian H. Validation of a questionnaire for assessing physical workload. Scand J Work Environ Health. 1999;25(2):105-114. doi: 10.5271/sjweh.412.
  • 17. Kahraman T, Göz E, Genç A. Validity and reliability of the Turkish version of the Physical Workload Questionnaire. Work. 2018;59(2):295-302. doi: 10.3233/WOR-172670.
  • 18. Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-237. doi: 10.1016/0003-6870(87)90010-x.
  • 19. Pugh JD, Gelder L, Williams AM, Twigg DE, Wilkinson AM, Blazevich AJ. Validity and reliability of an online extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E2) to measure nurses' fitness. J Clin Nurs. 2015;24(23-24):3550-3563. doi: 10.1111/jocn.12971.
  • 20. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-571. doi: 10.1001/archpsyc.1961.01710120031004.
  • 21. Hisli N. A reliability and validity study of Beck Depression Inventory in a university student sample. J Psychol, 1989;7:3-13.
  • 22. Kroemer KH. Cumulative trauma disorders: their recognition and ergonomics measures to avoid them. Appl Ergon. 1989;20(4):274-280. doi: 10.1016/0003-6870(89)90190-7.
  • 23. Kumar S. Trunk rotation: ergonomic and evolutionary perspective. Theor Issues Ergon Sci. 2002 3(3):235-256.
  • 24. Miller K, Benden M, Pickens A, Shipp E, Zheng Q. Ergonomics principles associated with laparoscopic surgeon injury/illness. Hum Factors. 2012;54(6):1087-92. doi: 10.1177/0018720812451046.
  • 25. Esposito C, El Ghoneimi A, Yamataka A, et al. Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg. 2013;48(8):1750-1756. doi: 10.1016/j.jpedsurg.2013.01.054.
  • 26. Franasiak J, Ko EM, Kidd J, et al. Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery. Gynecol Oncol. 2012;126(3):437-442. doi: 10.1016/j.ygyno.2012.05.016.
  • 27. Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D. Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg. 2010;210(3):306-313. doi: 10.1016/j.jamcollsurg.2009.10.017.
  • 28. Sari V, Nieboer TE, Vierhout ME, Stegeman DF, Kluivers KB. The operation room as a hostile environment for surgeons: physical complaints during and after laparoscopy. Minim Invasive Ther Allied Technol. 2010;19(2):105-109. doi: 10.3109/13645701003643972.
  • 29. Matern U, Koneczny S. Safety, hazards and ergonomics in the operating room. Surg Endosc. 2007;21(11):1965-1969. doi: 10.1007/s00464-007-9396-4.
  • 30. Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC. Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil. 2009;19(2):175-184. doi: 10.1007/s10926-009-9176-1.
  • 31. Wells AC, Kjellman M, Harper SJF, Forsman M, Hallbeck MS. Operating hurts: a study of EAES surgeons. Surg Endosc. 2019;33(3):933-940. doi: 10.1007/s00464-018-6574-5.
  • 32.Wauben LS, van Veelen MA, Gossot D, Goossens RH. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc. 2006;20(8):1268-1274. doi: 10.1007/s00464-005-0647-y.
  • 33. Davis WT, Fletcher SA, Guillamondegui OD. Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions. J Surg Res. 2014;189(2):207-212.e6. doi: 10.1016/j.jss.2014.03.013.
  • 34. Tetteh E, Wang T, Kim JY, et al. Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations. Am J Surg. 2024; 235:115551. doi: 10.1016/j.amjsurg.2023.11.005.
  • 35. Nguyen NT, Ho HS, Smith WD, Philipps C, et al. An ergonomic evaluation of surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery. Am J Surg. 2001;182(6):720-724. doi: 10.1016/s0002-9610(01)00801-7.
  • 36. Yang L, Money SR, Morrow MM, et al. Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort. J Am Coll Surg. 2020;230(4):554-560. doi: 10.1016/j.jamcollsurg.2019.12.035.
  • 37. Rosenblatt PL, McKinney J, Adams SR. Ergonomics in the operating room: protecting the surgeon. J Minim Invasive Gynecol. 2013;20(6):744. doi: 10.1016/j.jmig.2013.07.006.
There are 37 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Articles
Authors

Sevinç Külekçioğlu 0000-0003-3248-4014

Evren Dilektaşlı 0000-0003-4357-0516

Erkam Kömürcü 0000-0003-3358-0358

Turgut Kuytu 0000-0002-0505-3027

Hande Uçak 0009-0002-0414-8777

Early Pub Date February 3, 2025
Publication Date
Submission Date October 23, 2024
Acceptance Date December 23, 2024
Published in Issue Year 2025 EARLY ONLINE

Cite

AMA Külekçioğlu S, Dilektaşlı E, Kömürcü E, Kuytu T, Uçak H. Ergonomics in surgery and work-related musculoskeletal disorders. Eur Res J. Published online February 1, 2025:1-9. doi:10.18621/eurj.1568764

e-ISSN: 2149-3189 


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