Poster4-06: ERGONOMICS OF LAPAROSCOPIC SIMULATION TRAINING: A PILOT STUDY
Ian M Kratzke, MD, Prithima R Mosaly, PhD, MHA, Timothy M Farrell, MD, FACS, Jason Crowner, MD; UNC Chapel Hill

Background: Surgeon ergonomics during laparoscopy can affect both patient care and provider wellness. Unfortunately, instruction in ergonomics remains informal and underemphasized during surgical residency, with no standardized curriculum for proper ergonomic positioning and technique. Few studies have attempted to measure residents’ body positioning during laparoscopy or the incidence of physical symptoms that may be associated with laparoscopy-related strain. This study aims to investigate resident ergonomics during laparoscopy to identify areas needing improvement, in order to develop strategies for better education and teaching. 

Methods: Surgical residents at our institution across training years were asked to perform tasks from the Fundamentals of Laparoscopic Surgery (FLS), and were subsequently provided a survey on musculoskeletal complaints. Their body position was video recorded and graded using the Rapid Upper Limb Assessment (RULA) tool by two independent researchers and assigned scores for varying body regions. Any discrepancy between the scores were later discussed and consensus was reached. Scores were between 1 and 7, with lower scores indicating more acceptable posture. Surveys were graded based on extent and severity of musculoskeletal complaints. Means were compared using the t-test. 

Results: Ten residents (5 PGY-1, 5 PGY-2 or greater) participated in the study. All residents scored outside the level of acceptable posture, indicating a potential need for change in body position per RULA. PGY-1 residents scored worse than more senior residents on the RULA assessment, suggesting a more severe degree of malposition. Mean RULA score for PGY-1 residents was 6, while mean RULA score for senior residents was 5.4 (p=0.04). Scores for musculoskeletal complaints demonstrated no difference based on PGY level (p=0.5) and did not directly correlate to RULA scores.

Conclusions: The ergonomics of laparoscopic surgery are not specifically taught during general surgery training. Our study demonstrated residents having suboptimal ergonomics while performing FLS tasks, with interns having significantly worse body positioning. Interestingly, all residents surveyed had varying degrees of musculoskeletal complaints. As this preliminary study demonstrates ergonomics to be an area for improvement, further assessment and education is required to develop better ergonomic teaching strategies.