OGBN O02 Ergonomics in laparoscopic cholecystectomy. Do we need to change our practice to look after ourselves?

Abstract

Abstract Background Up to 80% of surgeons report musculoskeletal problems which significantly affect their personal and professional lives. The cost of back pain alone in the NHS costs £400 million per year (for all staff), and surveyed surgeons report 40% have sustained an injury at work. Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures but the musculoskeletal impact of this procedure on surgeons is unknown, though anecdotally it is likely to be high. Methods We observed the positions held by surgeons undertaking laparoscopic cholecystectomy and measured them against the Rapid Entire Body Assessment (REBA) score, which is widely used to assess the risk of an activity causing musculoskeletal injury. The higher the score, the less ergonomic the posture and the higher the risk of long term harm. Photographs were taken of the operating surgeon with consent (excluding views of the patient) and then measured against the score to assess the risk. Operations were graded to give an average risk score which represents the need for a change of process to safeguard staff. Results Eight laparoscopic cholecystectomies, undertaken by 6 different surgeons were analysed. Scores for trunk posture were generally low but score for upper limb position were higher. The mean and median REBA scores were both 4 and the maximum score during one operation was 6. Conclusions The scores measured in this small study were very consistent and suggest that the practice of laparoscopic cholecystectomy as currently practised has a medium risk of causing operator harm; practice change is recommended to safeguard staff. Further research is needed with larger sample sizes as well as different arms for techniques such as position changes or robotic surgery, while observing outcomes for patients and time taken.