Assessing the Ergonomics of Gynecologic Surgeries

INTRODUCTION: The healthcare industry is known to have one of the highest work-related injuries. Despite evidence that musculoskeletal pain and injury can shorten the career of a surgeon and cause significant personal distress, there is limited data on the ergonomics of various surgical approaches and little discussion about prevention of musculoskeletal injury to increase career longevity and reduce burnout. More data on ergonomics in gynecologic surgery is needed to assist in the development of ergonomic devices and training that maintain the health of the surgeons. OBJECTIVE: The purpose of this study was to compare surgeon pain associated with different routes of four commonly performed gynecologic surgeries. METHODS: Gynecologic surgeons performing the following procedures: robotic sacrocolpopexy, laparoscopic sacrocolpopexy, vaginal native tissue apical suspension, vaginal natural orifice transluminal endoscopic surgery (VNOTES) uterosacral ligament suspension, and laparoscopic and robotic myomectomy or hysterectomy were surveyed between August 2023 and September 2024. A preoperative survey, including demographic data and baseline pain score, was completed before each case. A postoperative survey, including operative timing, surgeon positioning, and postoperative pain score by body location, was completed after each case. If both surveys were not completed, participant entries were removed from the data set. SPSS v18 was utilized for data analysis. RESULTS: There were 178 responses collected from a cohort of 30 surgeons. Majority of participants were female and right-handed (Table 1). Less than half (48.3%) reported use of pain management at a baseline. For all body regions except for the lower back, the Visual Analog Scale (VAS) score for both preoperative and postoperative were between 0 and 1. The lower back had a statistically significant increased standardized difference in pain change score, most notably among surgeons completing laparoscopic sacrocolpopexy, vaginal and VNOTES native tissue apical suspension procedures (Table 2). The average pain change score in the lower back was approximately 10 mm, which is below the established minimum clinically important difference. When adjusted for age, there was an average pain change score of 19.6 mm in the lower back after VNOTES procedures. When comparing average change score between routes of native tissue apical suspension procedures, there was a statistically significant increase in postoperative pain score of 0.49 in the right wrist after VNOTES versus vaginal approaches (p<0.001). CONCLUSIONS: Vaginal and VNOTES suspension may confer higher risk postoperative lower back pain compared to other routes of gynecologic surgery. Surgeons should be aware of this information and consider intraoperative adjustments and exercises targeted at the lower back to counteract undue strain on the region during surgery.