Surgeons who engage in minimally invasive, laparoscopic surgery are providing great benefits to their patients, but possibly to their own detriment. That's the finding of the largest survey ever conducted of surgeons in North America who perform laparoscopic procedures.
The survey, developed at the University of Maryland School of Medicine in Baltimore, found that 87 percent of laparoscopic surgeons have experienced physical symptoms or discomfort. This was especially true among those with high case volumes. Previous surveys had found only a 20-30 percent incidence of occupational injury among these surgeons. Results of the survey will appear in the March 2010 Journal of the American College of Surgeons and are now available online.
Millions of patients around the world have benefited from minimally invasive surgical techniques introduced some 20 years ago. The benefits include increased safety, quicker recovery, shorter hospital stays and cosmetic advantages compared to open surgery techniques.
Despite these successes, the impact of minimally invasive techniques on those who perform them is little-known and under-appreciated. "We face a pending epidemic of occupational injuries to surgeons and we can no longer ignore their safety and health," says the survey's principal author, Adrian E. Park, M.D., chief of general surgery at the University of Maryland Medical Center and professor of surgery and vice chair of the Department of Surgery at the University of Maryland School of Medicine.
"Sadly, it is easier for a surgeon to obtain an ergonomic assessment and direction to improve his golf swing than his posture or movement during surgery," says Dr. Park, who is also executive director of the Maryland Advanced Simulation, Training, Research, and Innovation (MASTRI) Center at the University of Maryland Medical Center. It is the first facility in the world to focus on surgical movement. "If injuries among surgeons are not addressed significantly, we're going to face a problem in the near future of a shortage of surgeons as well as shortened career longevity among surgeons who enter, or are already in, the field."
Dr. Park says surgeons who perform laparoscopic surgery face constraints that are not part of open surgery. "In laparoscopic surgery, we are very limited in our degrees of movement, but in open surgery we have a big incision, we put our hands in, we're directly connected with the target anatomy. With laparoscopic surgery, we operate by looking at a video screen, often keeping our neck and posture in an awkward position for hours," says Dr. Park. "Also, we're standing for extended periods of time with our shoulders up and our arms out, holding and maneuvering long instruments through tiny, fixed ports."
Study design
A comprehensive 23-question survey was sent to 2,000 board-certified gastrointestinal and endoscopic surgeons in North America and abroad who are members of the Society of American Gastrointestinal and Endoscopic Surgeons, a diverse group of experienced laparoscopic practitioners. The questions were grouped in four categories: demographics, physical symptoms, ergonomics and environment or equipment. Some questions required single answers, such as "Have you ever had any physical discomfort or symptoms you would attribute to your laparoscopic operating? Yes/No." Other questions allowed selection of multiple applicable answers.
Study results
Of 317 surgeons completing the survey, 272 (86.9 percent) reported experiencing physical discomfort or symptoms they attributed to performing minimally invasive surgery. The discomfort ranged from eye strain to problems in the surgeon's dominant hand, to neck, back and leg pain. A few surgeons also reported headaches, finger calluses, disc problems, shoulder muscle spasm and carpel tunnel syndrome. Age played a role in hand problems, with younger surgeons and those over 60 at highest risk, but there was no correlation between age and symptoms in other parts of the body.