Surgeons as Educators A Guide for Academic Development and Teaching Excellence

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developing musculoskeletal pain by 83% [ 128 ]. For manual work, a working height
about 5  cm below the elbow is recommended with an acceptable range of 10  cm
below (for heavy work) to 5  cm above elbow height (for precision work) [ 129 ].
During open procedures, most surgeons adjust the table, so the patient is at elbow
height (Fig. 22.6). There are variations in table height based on procedure. For
example, during spine surgery requiring loupes, a working surface which is at the
midpoint between the umbilicus and sternum is optimal for reducing musculoskel-
etal fatigue [ 97 ]. With multiple surgeons, the table height should be adjusted to the
height of the tallest person on the operating team as the other team members may
use step stools to accommodate. Ideally, however, step stools should be avoided as
they limit the surgeon’s movement and make foot pedals more difficult to use given
the step’s small platform area [ 130 ].

Laparoscopic Surgery
Given the long length of laparoscopic instruments and elevation of the operating
surface with pneumoperitoneum, the operating table needs to be lower for

Elbow height

Fig. 22.6 Proper operating table height for open surgery is shown with the operating surface at
the level of the elbow

22 Surgical Ergonomics