Female Surgeons, Musculoskeletal Problems and Surgical Equipment
I have noticed over the last three years that I have been getting more musculoskeletal problems after my days in an operating theatre. At that stage, I decided to change a few things regarding this problem, but more importantly, I decided to research this topic, and it's prevalence among surgeons.
So I did that research with a couple of my colleagues. We presented this study at the last annual meeting of the Royal Australasian College of Surgeons that happened at Bangkok in Thailand. We have found out that 47% of respondents developed musculoskeletal pain or problems during or after operating, and 17% of surgeons have considered discontinuing or cutting down operating because of the musculoskeletal issues. Interestingly 49% have sought treatment for their discomfort.
Surprisingly, we have also found that almost 20% of surgeons developed neck discomfort after prolonged use of computers, tablets and phones.
Few other studies that have been published in the last two years have shown similar results. Musculoskeletal problems occur in 66-94% of surgeons who perform open surgery, 73-100% for laparoscopic surgery (keyhole) and 23-80% for robotic-assisted surgery. These numbers are enormous.
What I have also found interesting reading a recent blog post by Dr Geeta Lal on the women surgeons website was that each forward bending of the neck of 15 degrees increases the load on our cervical spine by several kilograms. And this is huge, especially as we operate in these positions for hours at the time. This load onto our neck spine is even worse in surgeons who use headlights and surgical loupes (magnification glasses).
I have also noticed this in my practice. When I perform thyroid or breast operations, I also sometimes bend my head sidewise to point the light from the headlight into the area where I am operating. And I definitely develop more neck pain after performing more of these types of surgeries.
What I have always found was also when I performed lots of laparoscopic (keyhole) surgeries, I have always struggled with hand, shoulder and back pain. Problem with the hand pain was that the laparoscopic surgery equipment was sized for male surgeons and the handles are too big for my hands. A recent study by Dr Sutton and her colleagues has found out that female laparoscopic surgeons develop more hand pain than their male colleagues. Female surgeons with smaller hand sizes (glove sizes 5.5 - 6.5) developed more hand symptoms than those with larger hands. And female surgeons with smaller hands compared to male surgeons with smaller hands were also more likely to develop hand pain. Female surgeons with small hands are more likely to be shorter than the male surgeons with same hand size, and the hight of the operating table is probably contributing to this finding.
Few of my female colleagues and I have noticed that the operating bed cannot go as low as we would need it for laparoscopic surgery and we need to lift our elbows to the side to perform these procedures. And this will often cause us to develop shoulder and neck pain.
So what can we do about this:
Develop different size equipment that fit surgeons with smaller hands
Develop operating theatre tables that are better suited to all surgeons
Regular breaks
Develop awareness of body the position and avoid certain positions if possible
Develop exercises, stretches and routines that will prevent these problems
Use of brace or padded mat if it improves
Regular reviews of what works and what does not.
Have more training and research into the prevention of these problems
We have developed lots of research and awareness of injury prevention in athletes, especially elite athletes. They sleep more, eat food that will increase their performance and have developed training programmes to improve their abilities and prevent injuries.
As doctors, we should be starting to think more of ourselves as elite athletes and become more aware of what improves our performance and minimise injuries.