From the Journals

Robot-assisted surgery can be a pain


It’s early days for research on the physical impact of robot-assisted surgery on operators. But a study of surgeons who regularly do this kind of work suggests that surgical robots can be the cause of workplace injuries, despite their reputation for good ergonomic design and low stress on surgeon hands, wrists, backs, and necks

More than half (236) of 432 surveyed surgeons with at least 10 robotic surgeries annually reported physical discomfort associated with robotics consoles, according to a study out of Johns Hopkins University, Baltimore.

Participant data was gathered through a 20-question survey emailed to members of the Society of Robotic Surgery, the American Association of Gynecologic Laparoscopists, and the Endourological Society during March-December 2013, according to Gyusung Lee, MS, PhD, director MIS & robotic education and ergonomics research instructor of surgery and his colleagues (Surg Endosc. 2017 Apr;31[4]:1697-706).

Most participants were male (71%) and averaged 48 years of age; their specialties comprised gynecology (68%), urology (20%), general surgery (8%), and others (3%).

Of the 432 participants, they reported physical discomfort in the following areas: fingers, 78%; necks, 74%; upper backs, 53%; and 43%, 34%, and 33% in the lower backs, eyes, and wrists, respectively.

Most of those who responded to the survey (80.8%) performed surgery with the da Vinci Si as their primary robotic system, with the rest using a different iteration of the da Vinci system.

Dr. Lee and his colleagues estimate the high rates of reported discomfort in fingers and necks are because of the structure of the robotics console.

“Due to the absence of tactile feedback at the master controller of the surgeon console, some robotic surgeons might close their fingers excessively when holding objects with instruments,” researchers said. “During the performance of suturing and knot-tying tasks, surgeons must squeeze their grip to hold a needle in place because there is no locking mechanism, which is present with open and laparoscopic needle holders.”

Researchers credit high rates of neck pain to the console as well, which “requires [surgeons] to maintain their neck position in a fixed place for extended period of time.”

While the rate of physical discomfort was 56%, participants rated the ergonomic functions of the console an average of 4 out of 5, with 5 being the highest score.

In contrast, surgeons gave low ratings to the communications systems used by the surgeon and the in-room supporting OR staff – an average of 2.87 out of 5 – noting an urgency for system updates.

Overall, researchers found that surgeons with high confidence in their ergonomic console settings were more likely to feel confident in the use of robotics in their surgical procedures and less likely to report physical discomfort. This finding led researchers to conclude the importance of surgeons new to robot-assisted surgery to receive education in ergonomic settings.

“Formal robotic surgery training programs should include this crucially important knowledge about optimal ergonomic guidelines so that any surgeon starting their training in robotic surgery would have the knowledge to maintain sound body posture and to minimize any physical strains while acquiring the best skill set,” according to Dr. Lee and his associates.

This study was limited by the self-reported data, which could create possible reporting bias, as well as by a small sample size. Since surgeons conducted more than one type of surgery annually, researchers found it difficult to identify what had caused the physical symptoms with complete confidence.

Researchers declared no relevant financial disclosures.

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