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Surgical ergonomics for urologists: a practical guide

Nature Reviews Urology volume 18, pages 160–169 (2021)Cite this article

Subjects

Abstract

Poor ergonomics in the operating room can have detrimental effects on a surgeon’s physical, psychological and economic well-being. This problem is of particular importance to urologists who are trained in nearly all operative approaches (open, laparoscopic, robotic-assisted, microscopic and endoscopic surgery), each with their own ergonomic considerations. The vast majority of urologists have experienced work-related musculoskeletal pain or injury at some point in their career, which can result in leaves of absence, medical and/or surgical treatment, burnout, changes of specialty and even early retirement. Surgical ergonomics in urology has been understudied and underemphasized. In this Review, we characterize the burden of musculoskeletal injury in urologists and focus on various ergonomic considerations relevant to the urology surgeon. Although the strength of evidence remains limited in this space, we highlight several practical recommendations stratified by operative approach that can be incorporated into practice without interrupting workflow whilst minimizing injury to the surgeon. These recommendations might also serve as the foundation for ergonomics training curricula in residency and continuing medical education programmes. With improved awareness of ergonomic principles and the sequelae of injury related to urological surgery, urologists can be more mindful of their operating room environment and identify ways of reducing their own symptoms and risk of injury.

Key points

  • Musculoskeletal pain and injury associated with performing surgery is highly prevalent amongst urologists and might potentiate physician burnout, shorten surgical careers and affect surgical outcomes.

  • Formal training in surgical ergonomics is rare amongst urologists, which has contributed to the high musculoskeletal disease burden in this population.

  • Several studies have identified practical ergonomic recommendations for each operative approach (open, laparoscopic, robotic-assisted, microscopic and endoscopic surgery) that might prevent injury and enhance surgical efficiency. These recommendations emphasize optimization of the operative room layout, surgical instrumentation and surgeon posture.

  • Surgical ergonomics should be incorporated into residency education and continuing medical education programmes to augment career longevity and reduce the risk of injury in urology surgeons.

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Fig. 1: Laparoscopic surgery.
Fig. 2: Robotic-assisted surgery.

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Acknowledgements

The authors thank Jennifer Fairman of the Johns Hopkins Medical Art Department for her assistance in creating the original figures.

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Authors and Affiliations

  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Andrew T. Gabrielson, Marisa M. Clifton, Christian P. Pavlovich, Michael J. Biles, Mitchell Huang, Phillip M. Pierorazio, Brian R. Matlaga & Zeyad R. Schwen

  2. Department of Environmental Health and Engineering, Johns Hopkins Education and Research Center for Occupational Safety and Health, Baltimore, MD, USA

    Jacqueline Agnew

  3. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Petar Bajic & Zeyad R. Schwen

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Contributions

A.T.G. and Z.R.S. researched data for the article, made a substantial contribution to discussion of content, wrote and reviewed/edited the manuscript before submission. M.M.C., M.J.B and M.H. reviewed/edited the manuscript before submission. C.P.P., J.A., P.M.P., B.R.M. and P.B. wrote and reviewed/edited the manuscript before submission.

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Nature Reviews Urology thanks Juan A. Sanchez-Margallo, Jens Rassweiler, Richard Goossens and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Glossary

Fulcrum effect

The point on which a lever rests or is supported and on which it pivots.

Supination

Rotation of the hand or forearm so that the palmar surface is facing upward (opposite to pronation).

Ulnar deviation

Pointing the wrists towards the feet while in the anatomical position.

Lordotic

Inward curve of the lumbar spine.

Working envelope

The area of space that can be reached by some point of a robotic arm.

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Gabrielson, A.T., Clifton, M.M., Pavlovich, C.P. et al. Surgical ergonomics for urologists: a practical guide. Nat Rev Urol 18, 160–169 (2021). https://doi.org/10.1038/s41585-020-00414-4

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