Impact of minimally invasive surgery on Surgeon Health (ISSUE)
Research type
Research Study
Full title
Impact of minimally invasive surgery on Surgeon Health. A feasibility study
IRAS ID
300580
Contact name
Esther Moss
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
2 years, 0 months, 31 days
Research summary
Minimally invasive surgery (MIS) has a significantly better peri-operative morbidity/mortality compared to open surgery and is the preferred surgical route for the management of numerous conditions. However, the impact of this change on surgeons has been largely forgotten. Obesity is a major risk factor for work-related musculoskeletal symptoms (WMS) experienced by surgeons, an issue that has the potential to reduce the working life and productivity of surgeons due to high rates of pain, stiffness and fatigue. Optimising surgeons’ working conditions is vital for their own health and career longevity and also affects patients’ safety and outcomes impact on surgical performance.
ISSUE is a feasibility study that aims to develop and validate a multi-faceted assessment tool that can objectively capture the real-time physical and psychological impact performing surgery has on the surgeon. We have previously shown that surgeons require significantly greater muscle movement/activity to complete exercises with standard laparoscopy versus robotic-assisted, and this difference is magnified in case of high BMI patients. The assessment tool includes: pre/post procedure salivary cortisol; continuous heart rate monitoring and upper-arm motion sensor monitoring during the procedure; and pre/post procedure WMS and State Trait Anxiety Inventory (STAI) questionnaires. This study has the support of the NCRI EC group and BIARGS.
The outcome of ISSUE will be a validated tool that can be used in a prospective, multi-centre study of open/laparoscopic/robotic surgery, which will provide objective evidence not only of patient outcomes but the impact of the different surgical routes on the surgeon.
Lay summary of study results:
Overall, the study has demonstrated that surgeons are affected both physically and cognitively whilst performing surgery.Motion analysis data collected from the motion sensors has demonstrated that all anthropometric features (height, elbow height, arm span and hand size) have an effect on the physical impact a surgeon experiences whilst operating. Elbow height in particular can determine the level of physical stress experienced (i.e., shorter the elbow height, greater the physical stress).
There is significant variation in the level of physical stress a surgeon undergoes when comparing open surgery to minimally invasive surgery (laparoscopic / robotic assisted). There is significantly less movement undertaken by the surgeon when performing robotic procedure and therefore it is possible that less physical cumulative stress is experienced.
Heart rate has clearly stood out as a key biological marker of the cognitive and physical stress experienced by surgeons during operating. Our data has demonstrated that, regardless of case complexity or modality, surgeons with the greatest experience attain a state of eustress (equilibrium) and do not respond negatively to the ongoing stressful trigger but have developed coping strategies.
The anxiety levels were measured using validated questionnaires however they did not show any significant differences. This is likely due to this being influenced by outside / personal factors and do not directly correlate to the emotions experienced by the surgeon whilst performing the surgical procedure itself.
The musculoskeletal questionnaires were aimed to capture the immediate impact of surgery on the surgeon; however, no significance has been seen in this data as the reality is the injury is cumulative over the years a surgeon is practising.
The qualitative interviews have demonstrated the following themes during the initial analysis:
Surgeons are keen to incorporate surgeon ergonomic awareness into their practice; and are keen to learn and teach the next generation of surgeons.
Surgeons reported that since participating in the study they have changed their approach to their posture in theatre and feel there are many benefits to modifying theatre setup to aid the surgeon in preserving their physical health and avoid injury.
All participants felt that the study did not affect their provision of service and data collection is safe in a live surgical setting, and thereby feasible to be repeated to gather larger volumes of data thereby building on the findings of this study.This study clearly demonstrates the need to understand and design interventions to improve surgeon ergonomics to help reduce work-related burnout and musculoskeletal injury. It has provided a foundation to understanding the key measurable markers that will allow us to monitor the impact of surgery on surgeon health.
REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
21/EM/0174
Date of REC Opinion
6 Sep 2021
REC opinion
Further Information Favourable Opinion