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Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review

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Abstract

Background

Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons. In this review, we aimed to systematically evaluate the existing literature comparing the two surgical modalities.

Methods

A systematic literature search was employed in PubMed, Embase and Cochrane Library in spring 2015. Inclusion criteria were as follows: English language, full text available, original data, and comparative data on surgeons’ physical workload with robotic-assisted laparoscopy and conventional laparoscopy. Studies only describing a single surgical modality were excluded. We applied the checklist, STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), to assess the quality of reporting of the included studies. Semi-quantitative comparisons were made.

Results

In total, 2685 records were screened and 15 articles were included in the analysis. All studies were observational with sample sizes ranging from one single surgeon to 250 questionnaire responses. None of the studies fully fulfilled the criteria of STROBE, with an average score of 13 (range 10–16) out of 18.

Discussion

Results, mainly self-reported measures, suggest that robotic-assisted laparoscopy is less strenuous compared with conventional laparoscopy. However, results are limited by the large methodological heterogeneity and a high risk of bias. We advocate for further high-quality exposure studies to assess the potential ergonomic deficits related to different minimally invasive surgical techniques. In addition, future intervention studies should evaluate possible means to alleviate and prevent musculoskeletal pain among surgeons.

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Author contribution

TD, KS, OM and PTJ designed the study concept. TD and KTB have extracted data from the systematic literature search. TD, KS, OM and PTJ have made substantial contribution to the interpretation of data. All authors have been involved in drafting the manuscript and revising it critically for important intellectual content and have given final approval for the version to be published.

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Authors and Affiliations

  1. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark

    Tina Dalager, Karen Søgaard & Katrine Tholstrup Bech

  2. Clinical Institute, University of Southern Denmark, Odense, Denmark

    Ole Mogensen & Pernille Tine Jensen

  3. Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark

    Pernille Tine Jensen

  4. Department of Gynaecology and Obstetrics, Karolinska University Hospital, Stockholm, Sweden

    Ole Mogensen

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  1. Tina Dalager
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Correspondence to Tina Dalager.

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Disclosures

Tina Dalager, Karen Søgaard, Katrine Tholstrup Bech, Ole Mogensen and Pernille Tine Jensen have no conflicts of interest or financial ties to disclose.

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Dalager, T., Søgaard, K., Bech, K.T. et al. Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review. Surg Endosc 31, 516–526 (2017). https://doi.org/10.1007/s00464-016-5020-9

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  • DOI: https://doi.org/10.1007/s00464-016-5020-9

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