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Ergonomics in gynecologic surgery

Catanzarite, Tatianaa,b; Tan-Kim, Jasmineb; Menefee, Shawn Adamb

Current Opinion in Obstetrics and Gynecology: December 2018 - Volume 30 - Issue 6 - p 432–440
doi: 10.1097/GCO.0000000000000502
UROGYNECOLOGY: Edited by Kavita Mishra

Purpose of review Work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons and result in significant disability. We aimed to review the English-language literature regarding ergonomic risk, prevalence of WMSDs, and unique ergonomic considerations of gynecologic surgery.

Recent findings Surgeon WMSDs are prevalent, with rates ranging from 66 to 94% for open surgery, 73–100% for conventional laparoscopy, 54–87% for vaginal surgery, and 23–80% for robotic-assisted surgery. Risk factors for injury in open surgery include use of loupes, headlamps, and microscopes. Unique risks in laparoscopic surgery include table and monitor position, long-shafted instruments, and poor instrument handle design. In vaginal surgery, improper table height and twisted trunk position create injury risk. Although robotic surgery offers some advantages in neck and shoulder strain, it remains associated with trunk, wrist, and finger strain.

Summary WMSDs are prevalent among surgeons but have received little attention because of under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed and implemented in order to protect surgeons from preventable, potentially career-altering injuries.

aDivision of Female Pelvic Medicine and Reconstructive Surgery, Department of Reproductive Medicine, University of California

bDivision of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, Kaiser Permanente, San Diego, USA

Correspondence to Tatiana Catanzarite, MD, MAS, 3250 Fordham Street, San Diego, CA 92110, USA. Tel: +1 619 221-6274; fax: +1 619 221 6086; e-mail:

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