Abstract
BackgroundBreast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures.MethodsFrom May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed.ResultsProcedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p < 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02).ConclusionNipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons’ left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.
Highlights
Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity
The goal of the current study was to focus on breast surgery procedures and evaluate mental and physical demand across procedures, as well as compare the ergonomics for the surgeon between skin-sparing and nipple-sparing mastectomy using both subjective and objective measures
Patients were predominantly middle-aged and were categorized as American Society of Anesthesiologists (ASA) Class II or III (Table 1). Both patient breast size and body mass index (BMI) were significantly different across procedure types (p \ 0.001; p = 0.02, respectively)
Summary
Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. Mastectomy options have changed from total mastectomy to skin-sparing mastectomy and, most recently, to increasing use of nipplesparing mastectomy These advances improve the cosmetic outcome for patients, yet require additional operative time and increased technical complexity to preserve greater amounts of the breast envelope, potentially through hidden incisions. As a result, such technical advancements in surgery can affect surgeons’ mental and physical demand—and workload—during the procedure. Our work documented varying workload across ten surgical specialties.[8]
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