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system, and the profession that applies theory, principles, data, and methods to
design in order to optimize human well-being and overall system performance” [ 1 ].
Ergonomic principles may be applied to many aspects of the surgeon’s work includ-
ing operating room layout, equipment design, and surgeon posture with the goal to
enhance safety, effectiveness, and quality of life and to decrease the risk of work-
place injury.
Prevalence of Musculoskeletal Injuries Among Surgeons
The US Bureau of Labor Statistics publishes data annually reviewing the distri-
bution of nonfatal occupational injuries and illnesses stratified by private sector.
In 2015, the Health Care and Social Assistance sector ranked number one for
total number of injuries with 5,623,000 reported that year alone [ 2 ]. To put in
proper context, more injuries were reported in the Health Care and Social
Assistance private sector than the combined private sectors of construction,
transportation, agriculture, and mining. Despite the recognition of employment
in health care as high risk for occupational injury, relatively few studies focused
on injuries sustained by surgeons until the advent of minimally invasive
techniques in the late 1980s [ 3 – 5 ].
With the introduction of laparoscopic surgery, patients enjoyed the benefits of
less postoperative pain, fewer surgical site infections, and shorter hospital stays [ 6 ].
These benefits, however, came with drawbacks for surgeons [ 7 ]. Shortly after the
incorporation of minimally invasive techniques in the operating room, a rise in sur-
geon musculoskeletal strain and injury was noted. Surveys show that 77–100% of
laparoscopic surgeons experience physical symptoms or discomfort attributed to
operating [ 8 – 15 ]. Table 22.1 further describes pain by surgical modality. Common
sites of pain include the neck, shoulder, and upper and lower back [ 5 , 7 , 17 , 18 ].
Table 22.2 demonstrates specialty-specific prevalence and location of pain.
Table 22.1 Prevalence and location of musculoskeletal pain by surgical modality
Surgical modalityPrevalence of musculoskeletal
pain attributed to operating Location of discomfort
Open surgery 75% [ 8 ] Neck: 6% [ 16 ], 50% [ 17 ]
Shoulder: 10% [ 16 ]
Laparoscopic surgery/
MIS77–100% [ 8 – 15 ] Neck: 78% [ 14 ], 56% [ 17 ], 52% [ 5 ],
42% [ 18 ], 15% [ 7 ]
Back: 77% [ 14 ], 72% [ 18 ], 26% [ 7 ]
Shoulder: 77% [ 14 ], 55% [ 5 ], 45%
[ 7 ], 43% [ 18 ]
Wrist/hand: 47% [ 5 ]
Leg: 37% [ 18 ]
Robotic 41–53% [ 8 , 19 , 20 ] Neck: 74% [ 20 ], 23% [ 17 ]
Shoulder: 53% [ 20 ]
Lower back: 42% [ 20 ]
Wrist/hand: 37% [ 20 ]C. Ronstrom et al.