Hallbeck, M. Susan

Abstract Background This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics. Methods Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected. Results The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the “surgeon at abdomen” showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the “surgeon at chest” showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference. Conclusion Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.

Musculoskeletal disorders and intraoperative pain are prevalent among vascular surgeons which can negatively affect their surgical performance and quality of life. The effectiveness of a lower back support exoskeleton to reduce discomfort of the back, subjective fatigue, and the workload associated with performing vascular surgery was evaluated, as well as the participants’ intraoperative upper body postures. Three vascular surgeons were asked to rate their discomfort and fatigue before, during and after performing surgery, and their subjective workload post-operatively. Inertial measurement units (IMUs) were used to measure their intraoperative body postures. No significant differences were found between exoskeleton and baseline discomfort, fatigue, workload, or intraoperative postures. This indicates that although the exoskeleton did not restrict the vascular surgeons’ postures, this exoskeleton was ineffective at reducing their discomfort or workload. Future studies with exoskeletons specifically designed for healthcare applications may show more efficacy in reducing the ergonomic risks to surgeons.

Ames, IA Cardiac sonographers suffer from high prevalence of work-related upper extremity musculoskeletal pain due to awkward postures and fatigue accumulation. Sonographers can choose either left- or right-hand scanning, or alternate between both, however, the impact of each scanning technique on the upper extremity muscles remains unknown. Four ambidextrous cardiac sonographers performed between four to six cardiac scans using left- and right-hand while postural and muscle activity were collected from specific muscles on the upper extremities. A comparison of the posture showed that apart from forearm pitch and 90 th percentile upper arm deviation, upper extremity postures between the two scanning techniques did not differ significantly. Furthermore, while right-hand scanning (RHS) appeared to induce slightly higher muscle activity in the deltoids compared to left-hand scanning (LHS), the difference between the two techniques was not significant. We recommend alternating between these two techniques to distribute muscle stress evenly to prevent muscle overuse.

Two attending surgeons (surgeon at abdomen and surgeon at chest) and nine surgical trainees completed electronic surveys after deep inferior epigastric perforator (DIEP) flap surgical procedures. The survey included workload and teamwork subscales. The results indicated that DIEP flap surgery is a highly demanding surgical procedure both physically and cognitively. For the surgeon at abdomen, most of workload subscales were significantly higher than the paired trainees (p<0.05), while their teamwork subscales were not significantly different. The surgical trainees should know that the attending surgeon’s self-perceived workload could be higher than theirs even when their self-perceived teamwork is similar. For the surgeon at chest, most of teamwork subscales were significantly higher than the paired trainees (p<0.05), while their workload subscales were not significantly different. The attending surgeons should know that even when their self-evaluation of workload is similar to their trainees, the trainee’s evaluation of teamwork could be less than theirs.

Operating room throughput variability with spinal procedures revealed task inefficiency and potential safety concerns. Using the DMAIC framework (Define, Measure, Analyze, Improve, Control), a transdisciplinary team conducted a quality improvement (QI) research project to identify and address safety concerns with prone patient positioning. The main problem with patient positioning was undefined standard practice. Clinicians reported prone patient positioning for spinal surgery patients is physically demanding. Thus, the team conducted a rapid upper limb assessment for injury risk during patient positioning and identified a greater risk of clinician injury in the manual transfer process. The QI research team recommended the mechanical process of rotating patients with the Jackson Table to improve workload for the Surgical Team and developed training and design enhancements to support this workflow. The DMAIC quality framework enabled clinician collaboration with researchers to develop interventions to support a standardized process during prone patient positioning with the Jackson Table.

The main goal of this pilot study was to create, implement and evaluate a strategy for introducing exoskeletons in the operating room (OR) at a quaternary care academic hospital. The strategy consisted of operating-room-specific considerations, introducing exoskeletons to surgeons, and a post-surgery survey. Three male attending vascular surgeons participated in eleven data collections to date. Low interference with surgeon’s ability to perform surgery was found for all surgical procedures, except for two open abdominal aortic procedures. The surgeons reported little to no limit on range of motion, except for one open abdominal aortic procedure. Lower than expected perceived improvement of ability to perform surgery and increase of physical comfort was self-reported. The responses indicate that the surgeons are willing to keep trying an exoskeleton intervention. In conclusion, a feasible process was created to introduce passive exoskeleton as an ergonomic intervention to vascular surgeons in their ORs.

The goal of this study was to evaluate residents’ workload and teamwork and the correlation between their workload and teamwork subscales during deep inferior epigastric perforator (DIEP) flap surgery. Ten residents who assisted during DIEP flap procedures completed an electronic survey following each DIEP flap procedure from July 2019 to August 2020. The survey contained items from the NASA-TLX and SURG-TLX and questions to measure teamwork subscales. Across 29 surgical cases, 38 surveys were recorded. Overall, the means of workload subscales were mostly greater than 10 and less than 15 (range=020) and the means of all teamwork subscales were greater than 15 (range=0-20). Good teamwork was correlated with lower distractions (Rs= -0.36 to -0.48) and better performance (Rs=0.35 to 0.52). Also, all the teamwork subscales were highly correlated (Rs= 0.59 to 0.92). Our findings suggest that good teamwork, low distractions, and successful performance are generally observed together; however, a causative relationship could not be established based on these results.

More and more breast cancer patients are turning to autologous options for reconstruction. Deep Inferior Epigastric Perforator (DIEP) flap reconstruction is considered the gold standard flap breast reconstruction procedure; however, it requires a significant number of resources, including two surgeons and microsurgical equipment. A multidisciplinary group was tasked with reducing operative time of DIEP flap procedures by 25% so that complex surgeries can become more routine and accessible to patients. Using participatory ergonomics, members of the operative team were engaged to identify interventions. Following implementation, 22 DIEP flap cases were evaluated using workload surveys and patient outcomes to determine the success of the interventions. DIEP flap surgical durations were reduced by 25% on average (M=12.9 hours, SD=5.7 to M=9.7 hours, SD=1.4). When cases lasted longer than 9 hours, surgeons reported 31% more physical demand and 78% more fatigue than cases that were 9 hours or less. Survey results linked positive team characteristics to reduced frustrations and distractions.