Postural Differences between Expert Laparoscopic and Naïve Surgeons: Implications for Ergonomic Assessment in Surgical Education

Abstract

<h3>Study Objective</h3> Poor ergonomics can contribute to musculoskeletal disorders and chronic pain for many surgeons which threatens career longevity. This proof-of-concept study sought to quantify upper body postural differences in expert laparoscopic surgeons and naïve surgeons using 3D motion capture during a standardized simulated surgical task. <h3>Design</h3> Observational case-control. <h3>Setting</h3> Motion capture laboratory; Surgical simulation setting. <h3>Patients or Participants</h3> Expert laparoscopic surgeons (n=6) and naïve surgeons (n=9). <h3>Interventions</h3> All participants watched an instructional video prior to data collection and completed the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task three times. The box trainer's height and distance were adjusted to the participants' preference. A 3D motion capture system recorded trajectories of retroreflective markers placed on the participants at various anatomical landmarks. <h3>Measurements and Main Results</h3> Outcome variables of neck, shoulder, elbow, wrist, and trunk angles were computed using a 3D kinematic model. The mean (X) and variance (2 standard deviations from the mean (2SD)) were extracted for each trial and then averaged across trials. Independent T-tests evaluated significant between group differences in body positions in all three planes of motion at the p<0.05 level. Compared to experts, naïve surgeons exhibited significantly greater variation in lateral neck (2SD=5.43±2.35° vs. 3.91±1.72°, p=0.029) and sagittal trunk motion (2SD=3.84±2.57° vs. 1.91±0.91°, p=0.018). Naïve surgeons also performed the task with their elbows significantly more flexed than the expert surgeons (Dominant Arm=96.9±9.2° vs. 82.9±2.1°, p=0.002; Non-Dominant Arm=94.7±8.9° vs. 86.2±8.4°, p=0.043). <h3>Conclusion</h3> Musculoskeletal injury risk factors among laparoscopic surgeons include awkward body posture, static muscle loading, and long operating times. This study demonstrates postural differences of the neck, trunk, and arms between expert and naïve surgeons. Incorporating ergonomic awareness and knowledge into surgical education may help to reduce surgeons' risk of developing cumulative musculoskeletal disorders and enhance surgeon career longevity.