Новые технологии и эргономика помогут хирургам избежать профессиональных травм

Eye on Efficiency: Ergonomics Key takeaways: - Surgeons should not forget to take care of themselves. - New technology may mitigate ergonomic problems. Whether in the clinic or in the operating room, ophthalmologists go through a lot of repetitive movements. Over the course of a career, small inconsistencies in posture or support can compound and create problems for a surgeon. “Surgeons perform thousands of repetitive, highly precise movements in operating rooms, often in fixed postures,” Cynthia Matossian, MD, said. “Moreover, we see patients in repetitive manners in our clinics, day in and day out. The cumulative strain can lead to a musculoskeletal injury if we don't recognize the problem and intervene early.” In this episode of Eye on Efficiency, Matossian is joined by Eric D. Rosenberg, DO, and Shannon M. Wong, MD, to discuss how physicians can take care of their physical health and set themselves up for long careers. Poor ergonomics that lead to long-term pain can start early because some young surgeons lack awareness about their posture while they are working at the microscope or the slit lamp, according to Wong. “It’s just having proper posture, making sure, if your head is a bowling ball on top of a pole, you want that head above the pole and not leaning forward creating unnecessary strain on your neck,” he said.” You’re just so locked in. You’re thinking about accomplishing the task at hand, and you are unaware of the strain you’re putting on your body.” That tunnel vision can be difficult for some people to overcome because doctors are not taught to put themselves first, Rosenberg said. “It’s from the start, basically. When we first are entering the hospital setting, we are not focused on eating, drinking or even taking care of ourselves because we need to make sure that the people that are under our care are okay,” he said. “And that extends into the operating room. We are really worried about the person in front of us and doing good by them, and what happens is we put these things that are really instrumental and really important for us on the back burner, and frequently we dial into understanding why this is so important a little too late.” Matossian said it took her some time to incorporate something as basic as staying hydrated into her surgical routine. “On my long OR days, I realized I was barely drinking any water at all,” she said. “So, I developed a system to make sure that I stayed hydrated throughout the day. Between cases, once I broke my scrub and before re-scrubbing, I would make a point of taking a few sips of water. When you're in the OR for hours at a time, it’s easy to overlook something as basic as hydration. I didn't recognize its importance until much later in my career.” When a surgeon sits down at a microscope, Wong said the most important thing to do is to get comfortable and position their body so they are properly supported from their feet all the way up to their head. That means things like putting foot pedals in a place where their feet can reach them without stretching and positioning the microscope in a way that helps them maintain proper posture. “Just make sure that you put your body comfort optimal from the start, and that includes in the exam room. I often put my comfort in the exam room and the operating room ahead of the patients because I have to do this tens of thousands of times, and the patients only has to do it maybe a few times in their lifetime.” Wong also stressed the importance of keeping in shape and exercising. “Work on your upper body, your lower body, your core, stretching, cardio, all those things,” he said. “They help you throughout your life, and I think they make us all more durable as surgeons doing repetitive movements.” While there are things surgeons can do physically to deal with the stress of repetitive surgery, Rosenberg said the real solution might be technological. He said ophthalmologists are under more stress than most other surgical specialists because their bodies are fixated at three points: the feet at the pedals, the hands at the eye and the head at the microscope. One way to cut back on physical stress is to remove one of those fixation points by transitioning to a heads-up display. “Removing one of those fixation points is unbelievably valuable for ergonomics because now, it's just the difference between your hands and your feet,” he said. “It also allows you to do things that you were previously unable to do. And that includes operating on people who are confined to wheelchairs and can't ambulate. You're now not subjected to having to figure out this weird ergonomic posture to allow you to operate on those individuals.” The market for heads-up surgical displays has come a long way, Rosenberg said, and new devices could make ergonomic concerns a thing of the past. “While it's very important topic now, because this is what we use daily, I think, and hope, that ergonomics will be a less important topic in the future,” he said. “I challenge us to revisit this discussion 10 years from now and take a look and see how the world has changed and what it is that we're using in the OR, both for our patients and for our own benefit.” For more information: Cynthia Matossian, MD, FACS, can be reached at [email protected]. Eric D. Rosenberg, DO, can be reached [email protected]. Shannon M. Wong, MD, can be reached at [email protected].