SAN FRANCISCO — Nearly 9 out of 10 laparoscopic surgeons said they experienced physical discomfort or symptoms related to performing surgery, according to the results of an online survey.
Feedback from 317 laparoscopic surgeons in North America and Europe who responded to the anonymous survey showed a marked increase in symptoms, compared with a 1999 study, Dr. Adrian Park said at the annual clinical congress of the American College of Surgeons.
According to that study, 8%–12% of laparoscopic surgeons reported pain or numbness and 9%–18% reported stiffness in the neck, shoulder, arm, or wrist (Surg. Endosc. 1999;13:466–8). In contrast, 42% of 2008 survey respondents reported neck stiffness. Other common complaints were numbness in the left and right hands (28% and 32%, respectively); stiffness and pain in the back (31% and 36%, respectively); and fatigue in the eyes (27%), neck (23%), left arm (24%), right arm (33%), and back (26%).
“If we were subjected to any of the kinds of worksite inspections that manufacturing facilities are … the surgical work space would be shut down,” said Dr. Park of the University of Maryland, Baltimore. “There's no question that we need to study further the ergonomics of the perioperative environment, and we need absolutely to be [studying] the surgeon-patient and the surgeon-equipment interface. It's a bit of a conjecture, but I would suggest that no less than surgical career longevity may be at risk.”
Dr. Park said the response rate was a bit under 30%; the respondents' average age was 44.3 years, and 83% were male. On average they had been in practice for 9.8 years and performed 212 laparoscopic procedures annually.
Surgeons with high caseloads were significantly more likely to report physical symptoms than those with low caseloads. Right-handed surgeons were significantly more likely to report right-hand symptoms than left-hand symptoms (54% vs. 40%). But left-handed and ambidextrous surgeons showed no significant differences in symptoms between hands.
More than 80% of the symptoms occurred during or immediately after a case, but about 15% of surgeons said that their symptoms were persistent. Unfortunately, little work has been done to identify which surgical movements are causing the problems. “Our base knowledge of surgical movement is abysmal. You can have your backhand evaluated, you can have your golf swing evaluated, but we can't tell you what optimal surgical movement is,” he said.
Dr. Park highlighted several areas that may be causing problems. Open surgery allows a surgeon to move with about 20 degrees of freedom, but in laparoscopic surgery there are only 4–6 degrees of freedom. The surgeon has a three-dimensional view in open surgery, but only a two-dimensional view in laparoscopic surgery. Laparoscopic surgeons enjoy less tactile feedback than open surgeons, and laparoscopic instruments provide less force transmission than open instruments. And the “fulcrum effect,” which requires the surgeon to move the instrument handle in the direction opposite from the desired direction of the instrument tip, may play a role.
“I've practiced minimally invasive surgery my entire career. I've already had one wrist operated on, and I'm waiting for the next wrist to be operated on,” said Dr. Park.
He disclosed that he has financial relationships with Stryker Endoscopy, Surgiquest Inc., Apollo Endosurgery Inc., and W.L. Gore & Associates.
'I've already had one wrist operated on, and I'm waiting for the next wrist [to be done].' DR. PARK