Patients Benefit While Surgeons Suffer: An Impending Epidemic
Presented at the American College of Surgeons 94th Annual Clinical Congress, San Francisco, CA, October 2008.
Received 12 September 2009; received in revised form 22 October 2009; accepted 27 October 2009. published online 24 December 2009.
Background
The widely held belief that laparoscopy causes greater strain on surgeons' bodies than open surgery is not well documented in scope or magnitude. In the largest North American survey to date, we investigated the association of demographics, ergonomics, and environment and equipment with physical symptoms reported by laparoscopic surgeons.
Study Design
There were 317 surgeons identified as involved in laparoscopic practices who completed the online survey. Data collected from this comprehensive 23-question survey were analyzed using chi-square.
Results
There were 272 laparoscopic surgeons (86.9%) who reported physical symptoms or discomfort. The strongest predictor of symptoms was high case volume, with the surprising exceptions of eye and back symptoms, which were consistently reported even with low case volumes. High rates of neck, hand, and lower extremity symptoms correlated with fellowship training, which is strongly associated with high case volume. Surprisingly, symptoms were little related to age, height, or practice length. The level of surgeons' awareness of ergonomic guidelines proved to be somewhere between slightly and somewhat aware. A substantial number of respondents requested improvements in regard to both the positioning and resolution of the monitor.
Conclusions
Far beyond previous reports of 20% to 30% incidence of occupational injury, we present evidence that 87% of surgeons who regularly perform minimally invasive surgery suffer such symptoms or injuries, primarily high case load-associated. Additional data accrual and analysis are necessary, as laparoscopic procedures become more prevalent, for improvement of surgeon-patient and surgeon-technology interfaces to reverse this trend and halt the epidemic before it is upon us.
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
Correspondence address: Adrian Edward Park, MD, FACS, University of Maryland Med Center, Room S4B14, 22 South Greene St, Baltimore, MD 21201-1595
ABSTRACT