Conference Coverage

VIDEO: When surgery hurts the surgeon: Intervening to prevent ergonomic injuries



– Work-related musculoskeletal disorders are practically inevitable for surgeons, eventually occurring in more than 90%, no matter what type of surgery they practice.

At the annual clinical congress of the American College of Surgeons, this eyebrow-raising fact was presented with a sobering addendum: No one seems to be doing much about it.

“There are some ergonomic guidelines for surgeons out there, but most surgeons don’t know about them,” said Tatiana Catanzarite, MD, who has conducted research on this topic. When she began looking into the problem of work-related injuries among surgeons, she was surprised at the dearth of published research. It’s no wonder then, said Dr. Catanzarite and other panel members, that most surgeons learn proper work posture on the fly and may or may not be using the most efficient and mechanically sound instrumentation angles when performing surgery.

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Dr. Catanzarite, a female pelvic medicine and reconstructive surgery fellow at the University of California, San Diego, has just published a literature review on surgeon ergonomics. But reading about how to stand, how to hold instruments, and even how to sit at a robotic surgical console is no match for having an observer on the ground guiding and reinforcing work posture, she said. Unfortunately, that’s an unrealistic expectation for most surgeons, so Dr. Catanzarite is borrowing video-gaming technology to address the situation, she said in an interview.

She has adapted a popular video game motion-capture system that uses an infrared laser projector and a computer sensor to capture video data in three dimensions. The sensing range of the depth sensor is adjustable, and the software is capable of automatically calibrating the sensor based on the physical environment, accommodating the presence of obstacles and using infrared and depth cameras to capture a subject’s 3-D movements. The system doesn’t require bulky wearable components, “making it an ideal technology for the live operating room setting,” Dr. Catanzarite said. “In order to effectively assess surgical ergonomics, a less intrusive approach is needed, which can deliver precise reports on the body movements of the surgeons, as well as capturing the temporal distribution of different postures and limb angles.”

Dr. Catanzarite is using the system to launch an ergonomics assessment tool she calls Ergo-Kinect. The system will record surgeons’ movements in real time, gathering data about how they stand, move, and operate their instruments.

“Three-D interactive visualizations allow us to rotate and investigate specific motor activities from the collected data,” she said. The technology enables them to capture the movements of the surgeon and assign an ergonomic score for each movement. “Eventually we may be able to develop a system that can warn surgeons in real time if they are performing an activity which may be harmful from an ergonomics standpoint,” Dr. Catanzarite said.

The research is in its earliest phase – Dr. Catanzarite has only scanned a few surgeons. But she will continue to accrue data in order to eventually construct a system that could help surgeons of the future avoid the painful, and sometimes debilitating, physical costs of their career.

Dr. Catanzarite reported having no financial disclosures.

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