eP635 - Colorectal Surgery Ergonomic Experience and Relationship to Surgical Platform: All Pain and No Gain?

ePoster Presenter(s)

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  Teena Nerwal, MD

  Colorectal fellow
  Baylor
  Baylor
  Dallas, TX, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• WB

  Whitnee Broyles, D.O.

  Resident
  Baylor University Medical Center - Dallas, TX
  Baylor University Medical Center
  Dallas, TX, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Fernando Lambreton, MD

  Colorectal Surgery Fellow
  Baylor University Medical Center
  Dallas, TX, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Brandon Smith, MD

  Fellow - Colon and Rectal Surgery
  Baylor University Medical Center
  Springfield, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• WL

  Warren Lichliter, MD FACS FACRS

  Program Director C&R Surgery
  Baylor University Medical Center Dallas Texas
  Da, Texas, United States

  Disclosure information not submitted.
• SS

  Sarah Stringfield, MD (she/her/hers)

  Colorectal Surgeon
  Baylor University Medical Center, Dallas, TX

  Disclosure information not submitted.
• 

  Alessandro Fichera, MD (he/him/his)

  Division Chief Colorectal Surgery
  Baylor University Medical Center
  Texas A&M
  Dallas, TX, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  James W. Fleshman, MD, FACS, FASCRS

  Department Chair of Surgery
  Baylor University Medical Center
  Texas A&M College of Medicine
  Plano, TX, United States

  Disclosure information not submitted.

Senior Author(s)

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  Katerina O.K. Wells, MD MPH

  Colorectal Surgeon
  Baylor University Medical Center, Dallas
  Dallas, Texas, United States

  Disclosure information not submitted.

Purpose/Background: Patient outcomes and wellness are well established metrics in surgical research. Little focus has been given to surgeon wellness and the physical impact of performing surgery. Occupational pain can be due to multiple reasons including poor posture and poor ergonomics. We hypothesized that surgeons would feel less pain and discomfort with the robotic platform, compared to open and laparoscopic, due to the better ergonomics that the platform provides.Methods/Interventions: This qualitative study was conducted by surveying a group of colorectal surgeons within a large medical system in Dallas, Texas. Baseline demographics were gathered from each surgeon. Following each case performed, perioperative data was gathered, and the surgeon reported information on specific body pains. Pictures of the surgeons’ posture during surgery were obtained and a rapid upper limb assessment (RULA, score < 2 acceptable posture) scoring system was calculated as a more objective measure of posture during surgery.Results/Outcomes: A total of twelve colorectal surgeons participated in this one-month study, with data on 81 operations collected. The average age of the surgeons was 57.6, and average BMI of 24.4 with all surgeons being right hand dominant. Of the 81 cases, 15 (18.5%) were open, 17 cases (21.0%) were laparoscopic, and 49 (60.5%) were robotic using the DaVinci Xi model. Patient demographics between the different platforms were similar, with slightly higher average BMI in robotic cases with BMI of 28.1, compared to BMI of 26.4 in open and 27.2 in laparoscopic cases. Case duration was similar between all three platforms, averaging between 183 minutes in open surgery, 210 minutes in laparoscopic surgery, and 188 minutes in robotic surgery. For open cases there was an increase in post operative neck, upper back, lower back, wrist and shoulder pain reported. In laparoscopic surgery there was an increase in neck, lower back, wrist and shoulder pain reported. In robotic surgery there was an increase in neck, upper back, wrist and shoulder pain reported. Results are shown in Figure 1. Average RULA scores were higher in open surgery with a score of 5.3, compared to 4.9 in laparoscopic surgery and 3.4 in robotic surgery.Conclusion/

Discussion: The majority of surgeon respondents report increase in pain after major abdominal and pelvic procedures. The regional distribution of pain varies by operative technique. Average RULA scores indicate poor posture and ergonomics across all techniques but our findings suggest that robotic surgery may offer relatively better ergonomics, as seen with lower RULA scores. Further study is underway to evaluate other metrics available on the robotic platform including guided ergonomic setup and intraoperative economy of motion metrics to better understand the physical impact of operative technique on physician pain.Pre and post procedure assessment of pain after surgeryRepresentative images (left) and pre/ post procedure assessment of pain in surgeons after open, laparoscopic and robotic surgery (right)