18 SPRING | 2014 ALN World | alnmag.com
Aproper but relaxed posture is important for a surgeon, therefore standard surgical tables are adjustable in height and have the ability to tilt for a reason. A surgeon should not be expected
to hunch over a patient for three hours during a surgery,
for not only would their back and neck be under incredible
strain, but they would only be able to perform one prolonged
procedure a day due to exhaustion. In addition, their surgical
technique would suffer due to pain, fatigue and rushing to
get the procedure finished due to discomfort. Ergonomics, or
the study of people’s efficiency in their working environment,
is very important in all sectors of employment, but arguably
nowhere more important than in the surgical arena, where
mistakes caused by fatigue and strain can be extremely costly.
In this article, we will discuss the importance of proper
ergonomics in microsurgery and laparoscopy, where even the
smallest movements can have substantial impact.
First, types of ergonomics will be addressed, and then we
will address how each of these affects microsurgeons and
surgeons performing laparoscopy.
Physical ergonomics deals with the posture of the
surgeon, biomechanics, repetitive motions, layout of the
surgical area and handling of instruments and suture1, 8.
Cognitive ergonomics encompasses things such as the
mental stress on the surgeon, both with workload and
decision-making, as well as having a skilful surgical outcome.
Cognitive ergonomics also includes the relationship that the
surgeon has with the equipment (laparoscope, microscope,
video screen)1, 8. Organisational ergonomics includes
communication with the surgical and investigation team,
quality assurance, proper delegation of duties to members of
the surgical or research team and even the“culture” of the
workplace environment1, 8.
If one has never performed surgery and is not aware
of the physical and mental fatigue that the surgeon must
withstand to complete procedures, it may be difficult to
grasp the importance of ergonomically comfortable surgical
instruments to the outcome of the surgical procedure. A
sobering fact was published by the United States Food and
Drug Administration that stated that poor design of medical
instruments may account for 50% of the estimated 1.3 million
unintentional patient injuries per year in American hospitals2.
There are multiple factors within physical ergonomics to
consider prior to setting up a surgical area or performing
microsurgery or laparoscopy. If using a viewing screen, either
for microsurgery or laparoscopy, the location of the screen
is critically important. It is generally accepted that the most
comfortable viewing angle for a video screen (in a typical
work environment, e.g. sitting at a desk) is 10-25 degrees
below the line of sight3. This position lessens the amount of
strain on the neck and shoulders. If you can imagine having
the video monitor at this height for surgery, it would make
placement of the monitor difficult in a surgical setup. Add to
that the fact that microsurgeons are sitting, and it is difficult
to imagine a scenario where an appropriate viewing angle
can be achieved. For laparoscopy, the ideal monitor height
is 25 degrees below the horizontal plane of the eye6, and for
procedures where surgeons change positions and ports, then
a second monitor is advised6.
As we just mentioned, rodent microsurgeons are typically
seated while performing procedures. This is due to the fact
that the surgical subjects or subject matter is sufficiently small
as to require magnification, and these small subjects need
small instrument tips, small movements, typically increased
time and hence, a seated surgeon. There are times when a
surgeon could perform microsurgery while standing, but
it has been recognised that sitting is the preferred position
especially for delicate manipulative work, as it reduces the
Szczepan Baran, Elizabeth Johnson and Matthew Flegal
Studying people’s efficiency in their work environment
can minimise mistakes caused by fatigue and strain.