A Randomized Trial of Microbreaks and Intraoperative Exercises for Gynecologic Surgeons (MIGS Trial)

INTRODUCTION: Prior studies have shown intraoperative microbreaks decrease surgeon work-related discomfort, but there are no randomized trials evaluating the impact of intraoperative exercises on gynecologic surgeons. OBJECTIVE: To evaluate the effect of intraoperative microbreaks with exercises on gynecologic surgeon body discomfort. METHODS: Residents, fellows, and attendings performing gynecologic surgery were recruited. Surgeons operating on average at least 2 days per month over 12 months were eligible to participate. Surgeons were excluded if they were unable to perform the exercises. An eligible surgery day needed to include at least one surgery with total operative time of at least 2 hours. Each surgery day was randomized to microbreaks with exercises (intervention) or no microbreaks (control). Surgery days randomized to the intervention included 1.5- to 2-minute breaks during which surgeons performed five targeted exercises while remaining sterile. The primary outcome was Body Part Discomfort (BPD) scores reported by surgeons preoperatively and at the end of all surgical cases for the day. The mean differences in pre- to postsurgical BPD scores were calculated for all eligible surgery days. The daily mean differences were compared between microbreak with exercise days and no microbreak days at the group level. Adjusted mean outcomes were calculated using a 2-level mixed-effects regression model that included a random intercept for individual surgeon (level 2), and repeated measures of outcome (level 1), with adjustment for covariates (baseline BPD score). Data was analyzed using SAS 9.4. RESULTS: Randomization occurred on 386 surgical days of 21 individual surgeons. The median number of microbreaks with exercise and control days for participants was 12 and 13, respectively. Median surgeon age was 33 years. 47.6% of participants were attendings, 23.8% fellows, and 28.6% residents. Of the participants, 28.6% self-identified as general gynecologists, 33.3% as urogynecologists, 23.8% as minimally invasive gynecologic surgeons, and 14.3% as gynecologic oncologists (Table 1). For control days, the difference between mean pre-op and post-op BPD scores was significant for 7 of the 10 body parts (Table 2). For microbreak with exercise days, there was no significant difference between pre-op and post-op BPD scores for any body part. Upon comparison of microbreak with exercise and control days, the adjusted mean difference in BPD scores between the groups showed that no microbreak days had significantly higher mean differences for all body parts compared to microbreak with exercise days (Table 2). CONCLUSIONS: Work-related body part discomfort is significantly increased in the core, upper body, and neck at the end of surgical days in gynecologic surgeons. Body part discomfort is significantly lower on surgical days including microbreaks with exercises. This suggests that intraoperative microbreaks with exercises may mitigate surgeon body discomfort.