395In addition, assisting during laparoscopic surgery, a common resident role,
comes with unique disadvantages. Specifically, assistants have been found to dis-
proportionately bear 70–80% of their body weight on one leg during laparoscopic
surgery while retracting or holding the camera, leading to postural instability and
asymmetric muscle activation [ 95 , 96 ]. Therefore, since residents have less experi-
ence and are often required to perform physically demanding tasks such as retract-
ing, they could be at an increased risk of musculoskeletal pain and occupational
injury.
The fact that less-experienced surgeons report more complaints justifies an
enhanced focus on ergonomics during surgical residency. Junior surgeons are less
familiar with operative procedures and may intrinsically experience higher mental
and physical stress levels. Consequently, their main intraoperative focus will be on
the surgical procedure, with less attention paid to their own physical status, surgical
setup, or other ergonomic conditions. Implementing ergonomic training for surgical
residents will increase their understanding of the human-system interactions in the
operating room.
Lack of Ergonomic Education
One of the most important risk factors for surgeon injury appears to be lack of
awareness of ergonomic principles. Up to 90% of surgeons have no prior training in
ergonomics [ 14 , 35 ], and a lack of ergonomic training has been directly linked to
occupational injury in surgeons [ 10 , 14 , 83 , 97 ]. Without an understanding of ergo-
nomic factors to prevent strain, surgeons are at a greater risk for injury. Surgeons as
educators may alleviate this risk by implementing and educating residents in ergo-
nomic principles that can be easily applied to the surgeon’s work within and outside
the operating room. Learning ideal ergonomic practices could improve physical
health and well-being for surgeons as well as support career longevity.
Prevention of Injury in the Operating Room
Using knowledge of human-system interactions to one’s advantage in the operating
room has been shown to reduce musculoskeletal strain and injuries and increase per-
formance [ 91 , 98 , 99 ]. Surgeons as educators are provided many opportunities to
implement ergonomic practices in the operating room such as awareness of body
position, posture, and how the body interacts with equipment in the room. The sur-
geon may also include a warm-up prior to the first case, take scheduled breaks during
surgery, and add variety to operative days. The following are high-yield ergonomic
interventions that may be used to prevent injuries and enhance performance.
Surgeon Posture
The importance of posture cannot be overstated, yet it is often overlooked. While
operating, surgeons are often found in awkward positions that create
22 Surgical Ergonomics