Colorectal Surgery Ergonomic Experience and Relationship to Surgical Platform: All Pain and No Gain?

Abstract Background: Patient outcomes and wellness are well-established metrics in surgical research. However, little attention has been given to surgeon wellness and the physical impact of performing surgery. We hypothesized that surgeons would experience less pain and discomfort with the robotic platform compared to open and laparoscopic approaches due to the platform’s superior ergonomics. Objectives: To evaluate ergonomic posture during open, laparoscopic, and robotic surgery and assess its impact on the body. Design: Three-month survey study. Patient and Methods: This study was conducted by surveying a group of colorectal surgeons in Dallas, Texas. Baseline demographic data were gathered from each surgeon. Following each procedure, perioperative data were recorded, and surgeons reported specific body pains. Pictures of surgeons’ posture during surgery were obtained, and a rapid upper limb assessment (RULA, score <2 indicates acceptable posture) was performed. Main Outcome Measures: RULA score, baseline pain, and postprocedural pain. Sample Size: 182 cases. Results: Fourteen colorectal surgeons participated in this study. Of the 182 cases, 38 (20.9%) were open, 42 (23.1%) were laparoscopic, and 102 (56.0%) were robotic. Patient demographics and case duration were similar across all groups. Open cases were associated with more than twice the increase in postoperative neck, upper and lower back, shoulder, and leg pain. In laparoscopic and robotic surgery, increased neck, upper back, wrist, shoulder, and leg pain were reported. The average RULA scores were higher in open and laparoscopic surgery (5.1 and 5.0, respectively) compared to robotic surgery (3.3). The difference in RULA scores between open and robotic cases, as well as between laparoscopic and robotic cases, was statistically significant ( P < 0.01). However, no significant difference was noted between RULA scores and factors such as the location of surgery, case duration, BMI, or comparisons between open and laparoscopic surgery. Conclusion: The majority of surgeon respondents reported increased pain after major abdominal and pelvic procedures. Our findings suggest that robotic surgery may provide better ergonomics, as indicated by lower RULA scores. Further studies are underway to evaluate additional robotic platform metrics, including guided ergonomic setup and intraoperative economy of motion, to better understand the physical impact of surgical techniques on physician pain. Limitations: This was a single-institution study involving residents and fellows. More than half of the cases analyzed were robotic, compared to open and laparoscopic cases. Additionally, the surgeons polled varied in age and years of experience, which may introduce some inherent bias. Conflict of interest: None.