Minimally Invasive Surgery: Are We Doing It Right?

Ergonomics is essential in surgical practice and especially in minimally invasive surgery (MIS) due to concerns with dexterity, loss of 3D view, fulcrum effect and longer duration. This paper aims to audit the ergonomic practice amongst minimally invasive surgeons in Bangalore, India. In this audit, personal assessments of surgeons were done while they were performing surgery based on accepted ergonomic practice guidelines, after taking their consent. The assessment data included demographics, surgeon's posture and operating room configurations. Of the 51 surgeons who were assessed, 17 (33%) of them reported history of musculoskeletal problems. Majority (more than 75%) of surgeons followed proper ergonomics when keeping themselves in line with target organ and monitor, maintaining proper angles at the elbow joint and forearm. More than 80% of operating rooms had appropriately functioning tables and instruments. Less than 50% of surgeons maintained proper head and neck posture. Monitor height was more than the operating MIS surgeon's height in 43% of operating rooms. Although many surgeons showed good ergonomic practice overall, it was found that there were a few areas for improvement with respect to the ideal posture. Our recommendations include adjusting height of the monitor with respect to the surgeon's height by use of foot stools or by updating operating rooms with ceiling suspended monitors, height adjustments of the operating table to facilitate maintenance of pelvic girdle symmetry with equal weight distribution while standing. Surgeons must also be advised to be aware of the prolonged and extreme degrees of joint movements and correct them accordingly.