Bariatric Times

MAR 2018

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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18 Original Research Bariatric Times • March 2018 and robotic surgery. It was seen that the bariatric surgeries performed were mostly sleeve gastrecotmies (98.2%) and gastric bypasses (88%), with 65.7 percent performing the surgery in the French position (Table 4, Table 5). Sixty-six percent of participants reported that they have experienced some level of discomfort/pain attributed to surgical reasons, causing the case load to decrease in 27.2 percent of the surgeons (Table 6). It was seen that the back was the most affected area in those performing open surgery, while shoulders and back were equally as affected in those performing laparoscopic, and the neck for those performing robotic (Figure 2), with 29.4 percent of the surgeons reporting that this pain has affected their task accuracy/surgical performance. As demonstrated by Figure 3, the nature of the discomfort experienced was shown to be mostly pain from performing open and laparoscopic surgery, but of the fatigue nature for robotic surgery. Table 6 illustrates the difference between the sexes when it came to assessing the location of pain according to the type of surgery. A higher percentage of female surgeons than male surgeons reported pain in the neck, back, and shoulder areas when performing laparoscopic procedures. Supine positioning of patients evoked more discomfort in the wrists, while the French position caused more discomfort in the back region. An interesting observation was seen when correlating amount of physical exercise per week with pain/discomfort during surgery. It was seen that a higher percentage of surgeons that did not exercise experienced more issues in the neck and back region, while those that exercised more than three hours a week experienced issues in their shoulders and wrists in both open and laparoscopic approaches (Table 7). Only 36.9 percent of the respondents who had experienced pain/discomfort due to performing surgeries had some form of imaging done to diagnose the problem (Table 8) and 57.7 percent sought medical treatment for their MSK problem, of which 6.35 percent had to undergo surgery for their issue—55.6 percent of those felt that the treatment resolved their problem. DISCUSSION Work-related MSK injuries are one of the most important occupational health issues among healthcare workers, and with the high physical demands of surgeons' daily activities, high rates of MSK injuries have been reported, specifically between the orthopedic surgery group. 16–18 This has been hypothesized to be due to the necessity of maintaining a static posture for long periods of time while using precision hand and wrist movements during surgical procedures. 14 In a systemic review conducted, Alleblas et al 19 was able to show that the prevalence of MSK complaints was 74 percent among surgeons. This number is comparable to our percentage of bariatric surgeons that had reported the existence of some form of MSK problem that they would attribute to their work. However, there are currently no studies that look specifically into the prevalence and cause of MSK injuries and pain the bariatric surgery group. A possible angle to consider is that, while the prevalence of bariatric surgery is on the rise, 3 the shift toward the laparoscopic approach has become more prominent, with 68.5 percent of our study population having over 10 years of experience in laparoscopic bariatric surgery as of 2017. This has been hypothesized to be due to the preference for laparoscopic bariatric surgeries among patients, as well as this being the most recommended approach by guidelines, given the lower complication rates and improved aesthetics over the open approach. 20–22 However, this comes with its own consequences given a different form of physical demand and physical workload for the surgeon, taking little consideration of ergonomics. As shown by our study, 58.4 percent of bariatric surgeons complained of pain in their shoulders, as well as in the back region and 40.59 percent reported having pain in their wrists and fingers while performing laparoscopic bariatric surgeries. These numbers were shown to be notably higher than those for the open approach, with 15.2 percent and 20.7 percent reporting pain in their wrists and fingers, respectively. This observation is understandable given the equipment and surgical techniques employed in laparoscopic bariatric surgeries. One reported benefit from the introduction of robotic surgery in bariatrics is the superior ergonomics that it is known to offer. However, from our study population, it was shown that 69.2 percent of the surgeons complained of having had some form of pain or discomfort in the neck that they attributed to performing bariatric surgery using the robotic approach. This can be explained given the position in which robotic surgery is performed. This has also been shown to be the case in several studies, 4,23–25 but at a much lower average prevalence of 35 percent than in our study population. An interesting observation noted was the difference in results when comparing sexes. On average, female surgeons are known to have smaller hands and glove sizes, and therefore the "one size fits all" of the laparoscopic equipment handles might be a cause of discomfort. 4,9 FIGURE 2. Musculoskeletal pain according to the type of bariatric surgery approach FIGURE 3. Nature of discomfort experienced according to the bariatric surgery approach TABLE 8. MSK Injuries attributed to bariatric surgical procedures PERCENTAGE % Average number of hours that surgical procedure lasts <1 1–3 3–5 >5 20.4 73.9 4.9 0.9 Have you ever experienced any abnormal levels of discomfort/pain that you would attribute to surgical reasons Yes (Pain scale) 0 1–3 4–6 7–10 No 66.0 7.8 64.1 26.2 1.9 34.0 Continue working despite the pain/discomfort Yes No 27.2 72.8 Pain/discomfort caused a decrease in case-load Yes No 27.2 72.8 Length that each pain/discomfort episode last 1 hour 1 day 1 week 1 month 6 months 33.0 40.8 17.5 5.8 2.9 Imaging done to diagnose problem Yes (what was done) X-ray CT Scan MRI No 36.9 37.8 10.8 86.5 63.1 Did imaging help diagnose the problem Yes No 66.7 33.3 Medical treatment for this problem Yes (type) Pharmaceutical Physical therapy Surgical No 57.7 54.0 39.7 6.4 42.3 Did treatment resolve problem Yes No 55.6 44.4

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