Abstract
Traditionally, the aim of the vast majority of the scientific medical publications is related with different kinds of researches but having the patient as the center of the study. Comparatively, the research published about care providers is much less. The safety of the patients has become a global initiative since May 2002, by World Health Organization with the resolution WHA55.1, 1 “Quality of care: patient safety” in its Fifty-Fifth World Health Assembly, urging the Member States to “pay the closest possible attention to the problem of patient safety.” It has been recognized that not following this policy of “Patient Safety” has significant increased risk of injuries, higher health cost, and other losses. This redirection focused in the patient's safety, triggered too the research of scenarios that the patients deal, including environment in operating room, as radiation exposure, noise pollution, surgical infections, and ergonomics of the patients and care providers among other issues.
Studies about ergonomics in urology are not new, but following this trend toward worldwide patient's safety policy, there are recent efforts to study the surgical team safety, workplace risks for health providers, and also ergonomics problems in several medical or surgical specialties. This time, Dr. Lloyd and coworkers 2 conducted an interesting anonymous web-based multinational survey among urologists focusing as a primary outcome the presence of back or neck pain and tried to determine if their surgical practice pattern, demographics, and physical activity might be correlated with those pains and to determine a potential cause of them as ergonomic issue.
Despite authors got a response rate for completed surveys in ∼30.9%, it represents an interesting approximation in the issue of ergonomics of the surgery maker in operating room, but this time among urologists involved and their self-perception. In general, with 701 urologist responders (142 women [20.25%]), the authors reported that back and/or neck pain were present in 313/701 (45%) of the cases, seeking noninvasive pain treatment and invasive treatment in 137 (43.7%) and 72 (23%) of the cases, respectively. It seems that even with pain, 104 (33.2%) of the cases did not seek for pain treatment; interestingly, it suggests that responders do not have preventing actions to avoid it and development of potential injury might worsen to temporary or permanent disability. Respondents reported significant pain that they blame on their work in 21% of the cases.
Dr. Lloyd and colleagues found that exercise (≥4 times/week), weight (≤82.52 ± 13.60 kg), and body mass index (≤26.31 ± 3.62) appear protective associated with from the less development of back pain, and women who have pain seek intervention less than men (p < 0.05 in all cases). They find no damaging effects on the spine from the act of performing surgery, regardless of duration, intensity, surgical modality, setting, or region of practice, and stated that despite studies reporting discomfort at the end of the surgical workday, there appears to be no relationship to long-term pain or the likelihood of undergoing surgery/intervention of the spine. This might be read with caution as the nature of a survey in part is based on personal perceptions and opinion of the respondents, and this instrument does not have the scientific power to correlate cause-effect of the events studied. It is neither a case–control study nor a long-term follow-up trial.
For example, Catanzarite et al. 3 did a review article based on PubMed and University library about ergonomics in surgery in terms of work-related musculoskeletal disorders (WMSDs) among surgeons. They found reports of studies, including surgeons suffering from WMSDs with prevalent rates ranging from 66% to 94% for open surgery, 73% to 100% for conventional laparoscopy, 54% to 87% for vaginal surgery, and 23% to 80% for robot-assisted surgery. In contrast, Wells and coworkers, 4 in a survey study, reported about one half of the respondents (49%) felt their physical discomfort would influence the ability to perform or assist with surgical procedures in the future.
Recently, in Urology Times 5 newspaper, a survey was conducted for urologists who experienced work-related pain. It included 165 respondents. They have experienced work-related pain in the past 12 months more than once per week in 32% of the cases. The main sites of pain reported were neck, back, shoulders, wrists/hands, and elbows in 70%, 66%, 48%, 39%, and 10% of the cases, respectively. They denied to have received training in ergonomics in 83% of the cases, considering their knowledge of surgical ergonomics “adequate” in 44%, and 70% would like to receive training in ergonomics. The effect of pain/discomfort on their work doing surgery affected 5% of them and led to early retirement/ended career in 2% of cases.
I thank Dr. Lloyd for his article, to be published in the Journal of Endourology, which gives us an opportunity to think about the importance of self-care of urologists and endourologists in terms of ergonomics. As evolving urology surgeons exposed to new surgical instruments, devices, and energy resources in the Operating Room, it is necessary to keep in mind the ergonomic issue not only in terms of the safety of our patients, but also the surgical team for avoiding temporary or permanent disabilities. It is also necessary to include the study, design, and applied ergonomic protocols per each surgical procedure on a regular basis. It is important to start now. Surgeons' self-care is just as important as patient care.