397reason, surgeons should frequently clutch so that the forearms are supported in a
neutral position.
Postural Resets
It is difficult to maintain good posture, especially if it is not a habit. It may be neces-
sary to employ a postural reset, a moment to check in with your posture and readjust
as necessary [ 108 ]. The postural reset could be implemented during intraoperative
breaks or at any natural transitions during the procedure. As a surgeon educator,
direct feedback may be given in the operating room or in training facilities regard-
ing the resident’s posture in the same way that one would comment on proper surgi-
cal technique. For some, it may be necessary to provide visual feedback by
videotaping the surgeon or resident and reviewing the video for correct body
alignment.
Operating Room Setup
One important step to preventing injury while operating is proper setup of the oper-
ating room. In 2012, Miller et al. reported that surgeons who agree with the state-
ment, “The equipment and overall layout of my operating room is designed for and
encourages surgeon comfort,” are less likely to experience neck, shoulder, and arm
pain or stiffness [ 10 ]. It takes only a few moments before cases, and at natural tran-
sitions during cases, to properly adjust operating room equipment. Yet the benefits
may be significant.
Proper Monitor Placement
Incorrect monitor placement is one of the factors most likely to cause discomfort in
the operating room [ 11 , 114 ] and is associated with neck and upper back discomfort
as well as eye strain [ 72 , 74 , 115 ]. Many problems arise when monitors are placed
on top of a high instrument tower. Ceiling-suspended monitors and those on easily
adjustable arms are ideal as they allow for versatile positioning [ 116 , 117 ]. Optimal
monitor placement is dependent on the location, height, and distance of the monitor
in relation to the surgeon so that the surgeon’s neck, back, and eye musculatures
maintain neutral positions.
In regard to location, the monitors should be placed directly in front of each sur-
geon and assistant so that there is a straight line between the surgeon and assistant’s
body orientation, target organ, and monitor [ 91 , 98 , 118 ]. This is shown in Fig. 22.3
and is described as the straight-line principle. To accomplish this, there should
always be at least two monitors in the operating room [ 107 ]. This positioning helps
to avoid repetitive or prolonged spine rotation which leads to asymmetric contrac-
tion of the spinal musculature and may increase the risk for vertebral disc prolapse
[ 67 , 68 ]. Often, perfect positioning of the monitor directly in front of the surgeon is
not possible due to the location of the first assistant or intervening equipment. In
these cases, the surgeon may need to change his or her body orientation to avoid
rotation of the spine [ 91 ].
22 Surgical Ergonomics