Hallbeck, M. Susan

Surgeons are at high risk of developing long-term Work-Related Musculoskeletal Disorders (WMSDs) due to awkward sustained postures. Passive spine-supporting exoskeletons are a potential intervention to improve posture and reduce fatigue. The NekSpine ® was evaluated by 21 surgeons (15 male) across two hospital sites within a quaternary academic hospital system. Each surgeon performed at least two comparable procedures, one with the exoskeleton and one without. Surgeons completed pre- and postoperative surveys assessing NASA-TLX workload, usability, body-part discomfort, overall fatigue, and workflow disruptions. Eighty-two cases were evaluated (43 exoskeleton cases). Compared with baseline cases, surgeons reported reduced neck and upper back discomfort and lower overall fatigue when using the exoskeleton. The NekSpine ® exoskeleton may reduce spinal discomfort and fatigue during surgery, supporting its potential as an ergonomic intervention for surgeons.

Robotic surgery offers advantages over traditional open, laparoscopic, and endoscopic approaches, including faster patient recovery and reduced surgeon fatigue. The da Vinci 5 (DV5), is the newest system in the most widely used family of surgical robots. This pilot study examined the usability of the DV5 compared with the da Vinci Xi (DV Xi) from the perspective of the surgical team. A consulting surgeon, trainees, Certified Surgical Assistants (CSAs), and Certified Surgical Technicians (CSTs) were recruited during colorectal surgery cases using the DV5 or DV Xi. Team members completed pre- and postoperative surveys assessing discomfort, workload, and usability. Objective postural data were collected from the consulting surgeon and trainee. Nine cases were evaluated (DV5 = 5). The DV5 improved neck posture for surgeons and trainees, with no workload differences for other team members. The DV5 significantly improved physical ergonomic usability for the surgeon at the console.

Ear, nose, and throat (ENT) surgeons often perform multiple daily procedures requiring sustained postures while wearing headlights or loupes, increasing the risk of work-related musculoskeletal disorders (WMSDs). This in situ case study aimed to (1) evaluate ENT surgeon workload and (2) introduce ergonomic interventions through workflow changes, education, and personal protective equipment. Three trained ergonomists observed the intraoperative workflow of three ENT surgeons at a tertiary academic hospital, identifying awkward postures. Surgeons received education on surgical microbreaks and OR-Stretch before trialing passive exoskeletons. Exoskeleton effectiveness was evaluated using interviews and surveys. Workflow interventions improved neck posture. One surgeon reported reduced body-part discomfort but increased subjective workload when using the exoskeleton, while interviews identified aesthetic concerns. This exploratory case study identified workflow issues and introduced ergonomic interventions. Although one surgeon reported reduced discomfort with an exoskeleton, larger studies are needed to establish quantitative trends.

Hospital practitioners have a high prevalence of work-related musculoskeletal disorders due to manual patient transfers. Reducing patient transfers can improve safety for staff and patients, especially those with unstable spines. A study at our academic hospital with the Safe TrAnsfer Tray prototype (STAT Tray V1) found transfers could be reduced to the two unavoidable transfers at the beginning and end of care. Surveys from 37 practitioners identified clinical challenges. User feedback informed design requirements for STAT Tray V2. Candidate materials were tested for MRI and CT compatibility, and pressure mapping evaluated padding combinations to reduce pressure-related injuries. STAT Tray V2 was designed for MRI and CT compatibility, current lift systems, and patients ranging from the 5th percentile female to the 95th percentile male while reducing pressure injury risk. Following manufacturing, usability testing will evaluate performance in the Emergency Department, imaging, operating suite, and ICU.

A positive margin following tumor resection (i.e., surgical removal of a cancerous tumor) indicates that cancer may remain in the body and can require a re-operation. This study is part of a larger project designing a technology to support the intraoperative evaluation of margins. This study explores the goals, decisions, information needs, and system requirements of a surgeon performing breast cancer surgery. We conducted semi-structured interviews with 11 breast surgeons to understand how they currently perform resections and then performed a qualitative thematic analysis. We identified three main goals and 13 subgoals. The three main goals are: treating cancer, meeting patient needs, and meeting institutional needs. Surgeons made multiple decisions to accomplish each sub goal and required multiple information elements to make these decisions. Our results will inform the design of the new technology and a sociotechnical systems-based analysis to ensure the technology fits in surgeon workflow.

Human factors/ergonomics (HF/E) is increasingly recognized as critical to improve patient safety, quality of care and health care professional wellbeing; in particular, much HF/E work has focused on surgery and surgical teams. However, conducting research and practicing in health care broadly, and the operating room (OR) specifically, requires specialized knowledge, skills and experience. HF/E professionals trained in other application areas may face challenges in transitioning due to the specialized knowledge required, regulatory considerations, and complex sociotechnical systems in the OR. This panel is designed for HF/E students, practitioners and researchers who are interested in expanding their work to the OR, procedural suites or modeling these for usability studies. The panel will provide attendees with insights from established HF/E researchers and professionals who study the OR as well as a newcomer to the domain, offering perspectives on career transition challenges, opportunities, and strategies for success.

Achieving negative surgical margins is critical for patient outcomes in breast-conserving surgery (BCS), however positive margins require reoperation in 20% to 40% of cases currently. This study explores design criteria and current barriers and facilitators to margin definition and assessment as part of designing an intraoperative tool for margin assessment during BCS. We conducted observations of nine surgeries by four surgeons at a quaternary medical center. We analyzed the data using the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify barriers and facilitators to margin assessment. We identified 38 barriers and 62 facilitators, which we inductively categorized into dimensions. The dimensions included teamwork, information display design, intraoperative tool use, and tissue characteristics. Teamwork was the most frequently observed dimension, followed by information display design and intraoperative tool use. This study provides insights to support the design of workflow-adaptive solutions and improve margin accuracy and surgical performance in breast oncology procedures.

Breast-conserving surgery (BCS) is a standard treatment for breast cancer, but achieving clear negative margins to avoid re-excision remains a challenge. Current intraoperative margin assessment techniques, such as frozen section analysis and imprint cytology, are limited by resource demands and workflow integration challenges. This study explores the physical design considerations for a handheld intraoperative imaging probe to assess tumor cavity margins during BCS. Data were collected through 9 surgical observations, 11 semi-structured interviews with breast surgeons, and interdisciplinary team meetings. Inductive thematic analysis identified key design priorities, including ergonomic handling, flexible probe tips, consistent tissue contact, and compatibility with both direct and tunneled access. Surgeons emphasized the need for quick scanning times and binary margin outputs, with interest in supplementary real-time imaging. These findings offer foundational insights for the iterative development of a clinically viable margin assessment tool aimed at reducing re-excisions and improving surgical outcomes in breast cancer care.

Objective: To evaluate the effectiveness of an intraoperative exoskeleton that supports surgeons’ heads, necks, and backs to reduce neck discomfort. Background: Surgeons are at a considerable risk of developing neck pain and related injuries. Passive exoskeletons are a potential intervention to support surgeons’ body parts and alleviate strain and discomfort. Methods: The NekSpine (a passive neck exoskeleton) was trialed on 12 surgeons (7 males and 5 females) across 6 specialties. Each surgeon performed 4 surgical procedures, 2 with the NekSpine (exoskeleton) and 2 without (baseline). Exoskeleton and baseline surgeries were paired primarily by surgical procedure and secondarily by duration. Surgeons completed surveys that included the NASA-TLX and usability questions before and after surgical procedures to evaluate body part discomfort, overall fatigue, workload, and potential disruptions to the surgical workflow. Surgeons also wore inertial measurement units to objectively record their upper arms, neck, and torso postures. Results: Use of the exoskeleton yielded significant decreases in discomfort in the neck, left shoulder, right shoulder, and left arm. Reductions in percent surgical duration in risk 4 (extreme risk postures) coupled with increases spent in risk 2 (moderate risk postures) for the neck and torso were noted. Surgeons reported overall favorable usability results with the exoskeleton not interfering with the surgical workflow, and most stated that they would use the exoskeleton again. Conclusions: The NekSpine is a promising intervention to alleviate surgeons’ neck discomfort and improve their neck and torso postures.