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.
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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The authors thank Jennifer Fairman of the Johns Hopkins Medical Art Department for her assistance in creating the original figures.
The authors declare no competing interests.
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- Fulcrum effect
The point on which a lever rests or is supported and on which it pivots.
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.
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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