Surgeons' physical workload in open surgery versus robot-assisted surgery and nonsurgical tasks

Abstract

Background: Musculoskeletal disorders (MSDs) are common among surgeons, and its prevalence varies among surgical modalities. There are conflicting results concerning the correlation between adverse work exposures and MSD prevalence in different surgical modalities. The progress of rationalization in health care may lead to job intensification for surgeons, but the literature is scarce regarding to what extent such intensification influences the physical workload in surgery. The objectives of this study were to quantify the physical workload in open surgery and compare it to that in (1) nonsurgical tasks and (2) two surgeon roles in robot-assisted surgery (RAS).

Methods: The physical workload of 22 surgeons (12 performing open surgery and 10 RAS) was measured during surgical workdays, which includes trapezius muscle activity from electromyography, and posture and movement of the head, upper arms and trunk from inertial measurement units. The physical workload of surgeons in open surgery was compared to that in nonsurgical tasks, and to the chief and assistant surgeons in RAS, and to the corresponding proposed action levels. Mixed-effects models were used to analyze the differences.

Results: Open surgery constituted more than half of a surgical workday. It was associated with more awkward postures of the head and trunk than nonsurgical tasks. It was also associated with higher trapezius muscle activity levels, less muscle rest time and a higher proportion of sustained low muscle activity than nonsurgical tasks and the two roles in RAS. The head inclination and trapezius activity in open surgery exceeded the proposed action levels.

Conclusions: The physical workload of surgeons in open surgery, which exceeded the proposed action levels, was higher than that in RAS and that in nonsurgical tasks. Demands of increased operation time may result in higher physical workload for open surgeons, which poses an increased risk of MSDs. Risk-reducing measures are, therefore, needed.

Keywords: Inclinometry; Muscle activity; Musculoskeletal disorders; Rationalization; Surgical ergonomics; Task-based analysis.

Fig. 1

Maximal voluntary contraction (MVC) for normalization of EMG signals in trapezius

Fig. 2

Distribution of the average duration of work tasks

Fig. 3

Comparisons of muscle activity in the upper trapezius between individual tasks and between work and nonwork activities. The bars represent the mean value of the group and the filled circles represent the individual value of the group. The red dashed line denotes the action level proposed by Arvidsson, Dahlqvist [30]. p values are denoted as * < 0.05; ** < 0.01; *** < 0.001 (Color figure online)

Fig. 4

Comparisons of group means of postures between individual tasks and between work and nonwork activities. The bars represent the mean value of the group and the filled circles represent the individual value of the group. The red dashed line denotes the action level proposed by Arvidsson, Dahlqvist [30]. p values are denoted as * < 0.05; ** < 0.01; *** < 0.001 (Color figure online)

Fig. 5

Muscle activity in the trapezius in open surgery and in the two roles in robotic surgery. The bars represent the mean value of the group and the filled circles represent the individual value of the group. The red dashed line denotes the action level proposed by Arvidsson, Dahlqvist [30]. p values are denoted as * < 0.05; ** < 0.01; *** < 0.001 (Color figure online)