Healthcare care professionals, particularly surgeons, are at significant risk of acquiring work-related musculoskeletal disorders that can lead to prolonged pain and diminish productivity. This study aimed to identify the prevalence, associated risk factors, and coping strategies for work-related musculoskeletal disorders among general and laparoscopic surgeons in Pakistan.

A cross-sectional survey was conducted to collect data from general and laparoscopic surgeons working in selected tertiary care hospitals located in Sialkot, Pakistan. The self-structured questionnaire consisted of four sections, including demographic information, musculoskeletal risk factors, work posture assessment and coping strategies. Logistic regression was used to determine associations between musculoskeletal disorders and personal and working factors, including postural demands during general and laparoscopic surgery using SPSS software 25.

Out of 171, 76% of the general surgeons and 86% of the laparoscopic surgeons reported suffering from WRMSDs within 1 year, and the 7-day prevalence was 24.5%. A total of 47.4% of the participants were also found to be at high risk or above, according to REBA scoring. Age, lifestyle, working hours, and number of surgeries performed per week were found to be significant (p value < 0.05) risk factors for WRMSDs. Assortment of coping strategies was employed, with changes in table/plinth height reported by 91.2% of the participants.

The current study revealed that surgeons have a high prevalence of developing WRMSDs. Personal factors as well as work-related risk factors were found to be significant in the development of WRMSDs. General and laparoscopic surgeons exhibited different incidences of pain among body regions. Varying degrees of coping strategies were employed, with changing table/plinth height being the most common.

Background/Objectives: Patient safety is directly linked with health and wellbeing of healthcare workers. In the UK, COVID-19 severely disrupted healthcare, with surgeons tackling prolonged waiting lists and working longer hours under high stress. This study explored the biomechanical and psychosocial demands on hospital surgeons, as well as their experience of pain and work-life balance post-pandemic. Methods: A questionnaire was developed combining validated tools assessing physical demands; modified job demand, control, and support; the WHO-5 wellbeing index; work-life balance from the Copenhagen Psychosocial Questionnaire; musculoskeletal pain; job satisfaction and retirement intentions. An online survey was developed using the Qualtrics© (Provo, UT, USA) platform and circulated through surgical networks using snowball sampling. Poisson regression modelling with robust confidence intervals was used to explore relationships between work-related factors and musculoskeletal pain, and associations with retirement intentions. Results: In total, 242 replies were received. Surgeons frequently reported strenuous occupational activities and work-life imbalance, and one in six reported job dissatisfaction. Only 17% reported no pain; the one-month prevalence of pain ranged from 46% at the lower back to 12% at the ankle, and pain was frequently disruptive. Better work-life balance had a protective effect for pain (PRR = 0.92, 95% CI = 0.85-0.99), while risk of pain increased with increasingly physically demanding activities at work (PRR = 1.04, 95% CI = 1.01-1.07) in the age- and sex-adjusted models. Job dissatisfaction was associated with intention to retire early (PRR = 1.83, 95% CI = 1.02-3.27). Conclusions: This study demonstrated high physical and mental demands among surgeons and poor work-life balance. Physical and emotional links to pain were identified. Fit surgeons ensure safe patient care. Our findings suggest that surgeons were facing health issues and work-life conflict post-pandemic, potentially limiting their job satisfaction and career span. A follow-up study is recommended.

Surgeons, like other healthcare providers, are susceptible to work-related musculoskeletal complaints (WMSCs). This study aimed to assess the prevalence of WMSCs including musculoskeletal injuries among surgeons in Saudi Arabia and identify predisposing factors contributing to these complaints.

An anonymous online cross-sectional survey was conducted and descriptive statistics, Pearson's χ2 test, Fisher's exact test, ϕ coefficient and Cramér's V test were used to analyze the data.

A total of 316 surgeons participated, of whom 63% were aged between 21 and 40 years, 40.2% were female, 61.7% were not married and 82.3% were in full-time practice. Of the surveyed surgeons, 65.5% complained of musculoskeletal symptoms including 15.2% who reported having musculoskeletal injuries. Position, years of experience and duration of daily practice were significantly associated with musculoskeletal injuries. There was no significant difference between male and female surgeons in developing musculoskeletal injuries; however, a higher proportion of females, compared to males, were thinking of retirement because of these symptoms.

A considerable proportion of surgeons reported experiencing WMSCs and injuries that negatively affected their work performance. This may lead some to consider early retirement. Based on the results, suggestions to minimize WMSCs among surgeons are presented.

This study aimed to quantitatively assess trunk and cervical non-neutral postures assumed by surgeons during the performance of routine open procedures. Indeed, musculoskeletal disorders are frequently reported by surgeons, especially at the head and neck level, due to the prolonged time spent in ergonomically challenging postures. Therefore, the posture of fourteen surgeons was monitored using wearable inertial sensors (and processed according to the ISO 11226 standard) by considering the effect of different surgical specialties (thyroid vs. breast) and roles (primary vs. assistants). Overall, surgeons spent most of their time in a standing posture, remaining within the acceptable limits of trunk flexion. More concerning results were observed analyzing the time spent in static head flexion and lateral bending (~72% and 48% of the time, respectively). Assistants, compared with primary surgeons, spent more than twice as much time in extreme neck flexion, although this was only when performing thyroid surgeries. The opposite was observed during breast surgeries. By spending most of their time in a standing posture with extreme forward neck flexion, surgeons are exposed to a high ergonomic risk, especially when frequently performing thyroid surgeries. The assumed role appeared to influence postural loading, with an effect that varies according to the surgical specialty.

The operating room (OR) infrastructure and equipment such as gloves, were historically designed at a time when most surgeons were male. Today, there are increasing numbers of females in the OR and we should ensure that there is not a disproportionate risk of ergonomic stress and risk of work-related injuries. This review provides a perspective on the representation of female cardiac surgeons globally and examines the unique ergonomic challenges they may face.

Female cardiac surgeons represent approximately 17% of practitioners in our sample of cardiac surgery centers, underscoring significant underrepresentation. Female cardiac surgeons report higher incidences of work-related musculoskeletal injuries and ergonomic challenges compared to their male colleagues. This could negatively impact their physical health and performance. Studies further highlight the inadequacy of standardized surgical tools and workstations in accommodating sex-specific anthropometry, contributing to the disproportionate strain experienced by female surgeons.

To mitigate gender disparities in cardiac surgery, there is a need to optimize OR infrastructure and surgical instrumentation to accommodate sex-based anatomical differences. Implementing ergonomic solutions, such as adjustable workstations and gender-specific surgical tools, could reduce musculoskeletal injuries and improve overall surgeon performance. Addressing these disparities represents a critical step toward fostering an equitable and inclusive surgical workforce, enhancing both the health and career longevity of female cardiac surgeons.

This study aims to assess the cervical spine positioning of consultant and trainee hand surgeons during standardised hand surgeries, focusing on the prevalence of sustained end-range postures, particularly cervical spine flexion.

Surgeons often perform procedures that require maintenance of sustained postures for prolonged periods of time. Hand surgeons may be at increased risk of sustained end of range postures, particularly cervical spine flexion. This can lead to strain on the musculoskeletal structures of the neck. Recent evidence suggests a higher incidence of neck dysfunction in hand surgeons, leading to an associated morbidity.

We examined hand surgeons of all experience levels during 40 common hand surgery procedures. We used real-time dynamic goniometric measurements of neck flexion using the "UPRIGHT GO 2" device and accompanying smartphone app. Neck flexion exceeding 40° was used as the threshold for defining an acceptable neck position.

Analysis included 20 total subjects at various levels of medical training (SHO n ​= ​6, Registrar n ​= ​9, Consultant n ​= ​5) performing surgeries under different conditions. Maladaptive neck positions were prevalent, with junior surgeons exhibiting such postures for 71 ​% of procedure time compared to 60 ​% for consultants. This underscores the potential contribution of sustained end-range postures to cervical spine dysfunction in hand surgeons, highlighting an early intervention opportunity. Notably, participants reported varied experiences with neck pain and expressed unanimous interest in integrating biofeedback posture devices into surgical training, with a single consultant expressing reservations.

Surgical specialists experience significant musculoskeletal strain as a consequence of their profession, a domain within the healthcare system often recognized for the pronounced impact of such issues. The aim of this study is to calculate the risk of presenting musculoskeletal injuries in surgeons after surgical practice.

Cross-sectional study carried out using an online form (12/2021-03/2022) aimed at members of the Spanish Association of Surgeons. Demographic variables on physical and professional activity were recorded, as well as musculoskeletal pain (MSP) associated with surgical activity. Univariate and multivariate analysis were conducted to identify risk factors associated with the development of MSP based on personalized surgical activity. To achieve this, a risk algorithm was computed and an online machine learning calculator was created to predict them. Physiotherapeutic recommendations were generated to address and alleviate each MSP.

A total of 651 surgeons (112 trainees, 539 specialists). 90.6% reported MSP related to surgical practice, 60% needed any therapeutic measure and 11.7% required a medical leave. In the long term, MSP was most common in the cervical and lumbar regions (52.4, 58.5%, respectively). Statistically significant risk factors (OR CI 95%) were for trunk pain, long interventions without breaks (3.02, 1.65-5.54). Obesity, indicated by BMI, to lumbar pain (4.36, 1.84-12.1), while an inappropriate laparoscopic screen location was associated with cervical and trunk pain (1.95, 1.28-2.98 and 2.16, 1.37-3.44, respectively). A predictive model and an online calculator were developed to assess MSP risk. Furthermore, a need for enhanced ergonomics training was identified by 89.6% of surgeons.

The prevalence of MSP among surgeons is a prevalent but often overlooked health concern. Implementing a risk calculator could enable tailored prevention strategies, addressing modifiable factors like ergonomics.

The healthcare industry is one of the main industries with a high prevalence of musculoskeletal disorders (MSDs). Surgical practice mostly involves repetitive tasks with fine motor control, precise motions, high levels of mental concentration, and close visual focus. This cross-sectional study aimed to define the prevalence and risk factors of MSDs and visual problems among physicians. One hundred surgical physicians and one hundred medical physicians were involved in the study. Both groups underwent assessment of socio-demographic and occupational history, alongside evaluation for musculoskeletal and visual problems. The study revealed a significantly higher prevalence of MSDs, particularly neck and back pain, as well as blurred near vision and eye dryness, among surgical physicians compared to medical physicians. Risk factors for these conditions included long working hours (≥30 h/week) in clinics or operating rooms, as well as using endoscopes and microscopes/loupes during surgery. In conclusion, MSDs and visual problems were prevalent among physicians, particularly surgical physicians. Integrating ergonomic principles across all domains of healthcare and promoting healthcare worker awareness through training and intervention programs are crucial steps in addressing these issues.

The surgical profession is plagued with a high prevalence of work-related musculoskeletal disorders. While numerous interventions have been tested over the years, surgical ergonomics education is still uncommon.

The available literature on surgical ergonomics was reviewed, and with input from surgeons, recommendations from the review were used to create pictorial reminders for open, laparoscopic, and robot-assisted surgical modalities. These simple pictorial ergonomic recommendations were then assessed for practicality by residents and surgeons.

A review of the current literature on surgical ergonomics covered evidence-based ergonomic recommendations on equipment during open and laparoscopic surgery, as well as proper adjustment of the surgical robot for robot-assisted surgeries. Ergonomic operative postures for the three modalities were examined, illustrated, and assessed.

The resulting illustrations of ergonomic guidelines across surgical modalities may be employed in developing ergonomic education materials and improving the identification and mitigation of ergonomic risks in the operating room.

Understanding effective ergonomic interventions is crucial for enhancing occupational health and career longevity. There is a paucity of clear ergonomics guidelines in facial plastic and reconstructive surgery (FPRS), placing practitioners at high risk of work-related musculoskeletal disorders (WMSDs) and their consequences.

There is mounting evidence that FPRS specialists are at increased risk of WMSDs as compared with the public and other surgical specialties. Numerous studies have demonstrated that implementation of ergonomics principles in surgery decreases WMSDs. Furthermore, WMSDs are reported as early as the first year of surgical residency, marking the importance of early intervention.

Fatigue and physical injuries among surgeons occur more often than expected, particularly during complex, extended procedures that necessitate maintaining a constant posture. FPRS procedure often place surgeons into procrustean positions. Thus, integrating ergonomic practices into the practice of FPRS is essential for reducing WMSDs.

Worker and work-related musculoskeletal symptoms are prevalent among surgeons operating on human patients. Despite incidence rates for accidents among veterinarians and their staff being 2.9 times higher than that of general practitioners of human medicine, little is known about musculoskeletal symptoms among veterinary surgeons. In this study, 212 board-certified members of the American College of Veterinary Surgeons responded to a survey regarding various work-related activities and their experience with musculoskeletal symptoms in 10 different body regions. Across all body regions, reported pain increased from before to after a typical day of surgery (p <.01). Gender, weight, age, and years performing surgery were worker factors that were related to pain (p <.05), while number of procedures, practice focus, and proportion of minimally invasive surgery were work factors related to pain (p <.05). Our findings suggest that musculoskeletal symptoms are prevalent among veterinary surgeons and may help provide evidence for guidelines for minimising musculoskeletal injuries in veterinary surgery.Practitioner summary: Little is known about the risk factors for musculoskeletal symptoms (MSS) among veterinary surgeons. This cross-sectional survey of veterinary surgeons investigates worker and work factors related to MSS. We show that MSS are prevalent and identify key factors providing evidence that MSS are a concern in veterinary surgery.

Musculoskeletal pain is a common occupational health problem among surgeons that can affect work productivity and quality of life.

The aim of the study was to investigate the prevalence and causes of back pain among rhinoplasty surgeons, evaluate their routine practice, and identify unique risk factors. A further goal was to measure functional disabilities with the Total Disability Index (TDI) questionnaire.

A structured online questionnaire was distributed to plastic surgeons performing rhinoplasty internationally. The questionnaire comprised sections on biodata, routine practice posture, length of practice, surgical duration, and the history of surgery or hospitalization related to these issues. In the second part of the survey, participants were asked to complete the TDI questionnaire.

The prevalence of back pain was reported by 93.6% of surgeons, with low back pain being the most common (76.7%). The average pain intensity for low back pain was 44.8 ± 26.8. The mean TDI score was calculated as 31 ± 12.1, with 58.2% of surgeons experiencing mild to moderate disability. Significant associations were found between musculoskeletal pain severity and disability index and factors such as BMI, exercise, years of rhinoplasty practice, number of surgeries performed per week, and average procedure length. Interestingly, only 16.4% of rhinoplasty surgeons had previous ergonomic training or education.

Musculoskeletal issues related to the spine are prevalent among rhinoplasty surgeons. It is imperative to educate surgeons about this underestimated health problem, provide proper physical rehabilitation targeting ergonomic concerns, and make changes to current practices to address this issue effectively.

Work-related musculoskeletal disorders in surgeons have been well documented. Hand surgeons, however, represent a unique population of surgical subspecialists due to frequent use of operative magnification. Thus, we aim to examine the contributing factors, types, and frequencies of work-related musculoskeletal injuries experienced by hand surgeons.

A Research Electronic Data Capture survey including 12 demographic and 13 Nordic Musculoskeletal Injury Questionnaire questions was emailed twice to all active members of the American Association for Hand Surgery (AAHS). Data collection remained open for 30 days.

Ninety-six of 1228 AAHS members (8%) responded. Respondents were predominantly attendings (88, 91.7%), male (67, 69.8%), in academic practice (48, 50%), and in the age range of 35 to 44 years (34, 35.4%). Sixty-nine respondents (71.9%) attribute discomfort to their profession. Pain (56, 82.4%) and stiffness (46, 67.6%) were the most frequent symptoms, most common in the neck and wrist/hand regions. Fifty-nine (61.5%) respondents had acute (<1 week) discomfort, with onset most frequently reported after surgery (45, 48.9%). Thirty-two (34.8%) of the respondents state they worry these symptoms will hinder their ability to perform surgery in future. Sixteen (16.7%) respondents sustained a musculoskeletal injury directly related to work. Exercise was the most popular nonmedical therapy, while over-the-counter medications were the most popular medical therapy.

The unique ergonomics of hand surgery, including frequent use of loupes and microscopes, appear detrimental to the surgeons' health and career longevity. Further research will allow for the development of preventative measures, with the goal of facilitating longer, more productive careers for hand surgeons.

Surgical team members in perioperative environments experience high physical demands. Interventions such as exoskeletons, external wearable devices that support users, have the potential to reduce these work-related physical demands. However, barriers such as workplace environment and task compatibility may limit exoskeleton implementation. This study gathered the perspectives of 33 surgical team members: 12 surgeons, four surgical residents, seven operating room (OR) nurses, seven surgical technicians (STs), two central processing technicians (CPTs), and one infection control nurse to understand their workplace compatibility. Team members were introduced to passive exoskeletons via demonstrations, after which surgical staff (OR nurses, STs, and CPTs) were led through a simulated workflow walkthrough where they completed tasks representative of their workday. Five themes emerged from the interviews (workflow, user needs, hindrances, motivation for intervention, and acceptance) with unique subthemes for each population. Overall, exoskeletons were largely compatible with the duties and workflow of surgical team members.

Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact of pregnancy on surgeon posture and ergonomics. We piloted the use of a pregnancy simulation suit (Empathy Belly) to assess the risk of ergonomic compromise when performing open septorhinoplasty.

Surgical simulation.

Single session, training simulation lab at academic medical center.

Medical students and surgical residents performed the initial steps of a rhinoplasty procedure without and with a pregnancy simulation suit and were filmed with an artificial intelligence-based video analysis app from Kinetica Labs that calculates joint angles and categorizes the ergonomic risk factors. Still images from videos were taken and analyzed using validated posture-based analysis rubrics. Participants were asked to complete a qualitative questionnaire after the session.

Twelve medical students and surgical residents participated in the study. Posture-based analysis indicated increased ergonomics risk factors among trainees when performing a rhinoplasty while wearing the pregnancy suit. Video analysis indicated trends of worsening back angle and shoulder postures. Trainees reported experiencing pain in the neck, suprapubic area, and lower back. They acknowledged the importance of ergonomics in otolaryngology and desired further education about workplace injury risk mitigation.

Pregnancy impacts the ergonomics of performing septorhinoplasty and further investigation is required into interventions to reduce risk of WRMSDs.

The impact of surgery on the surgeon's well-being encompasses both physical and psychological aspects. Physically, surgeons are at risk of work-related musculoskeletal symptoms due to the nature of their work, and this risk can be impacted by theater environment, equipment design, and workload. Many symptoms will be self-limiting, but work related musculoskeletal symptoms can lead to the development of an injury, which can have far reaching effects, including the need for medical or surgical treatment, time away from work, or a change in clinical duties. Additionally, surgery can place a significant cognitive workload on the lead operator and this can be exacerbated, or alleviated, by the surgical environment, experience of the assistance, surgical modality, and case complexity. Measuring and quantifying the impact of surgery on the surgeon is a challenging undertaking. Tools such as motion capture, physiological markers, including heart rate variability and salivary cortisol, and questionnaires can provide insights into understanding the overall impact of surgery on the surgeon. A holistic approach that incorporates injury prevention strategies, communication, and support, is vital in assessing and mitigating risk factors. Injury prevention assessment tools and interventions that can be used within the busy surgical environment are needed, alongside increased ergonomic awareness. Addressing the impact of surgery on the surgeon is a multifaceted challenge, and long term positive changes can only be sustained with the support of the whole surgical team and healthcare organizations by developing and maintaining a supportive working environment.

Work-related musculoskeletal disorders (WMSDs), also referred to as work-related musculoskeletal injuries (MSKIs), cause surgeons pain and discomfort. Implementing ergonomics in the operating room has helped reduce such symptoms. However, there are still many issues that surgeons face when dealing with medical instruments, especially among female surgeons or surgeons with smaller hands.

The Cochrane methodology for performing a systematic review was utilized to search five databases for pertinent literature based on the study question "Do female surgeons or surgeons with smaller hand size, who use surgical instruments have an increased risk of musculoskeletal disorders and discomfort compared to male or larger handed surgeons?". The literature search strategy was designed around the three conceptual domains of surgeons/surgery, smaller hand size, and instrumentation. We searched PubMed, Embase.com, CINAHL Plus with Full Text (EBSCOhost), Scopus, and Web of Science Core Collection. This exploration identified 2165 research publications, and after specific inclusion and exclusion criteria, 19 studies were included in the systematic review. Risk of bias analysis was conducted to assess the quality of the included studies. After conducting a heterogeneity test, a meta-analysis was not performed due to high heterogeneity.

Using certain surgical instruments presents challenges in the form of MSKIs for female and smaller-handed surgeons. Studies showed that 77% of females and 73% of surgeons who wear < 6.5 glove size report musculoskeletal issues ranging from difficulty of use to pain. Difficulties using surgical instruments and reported injuries have a greater impact on surgical trainees which might deter interest in surgical fields for future proceduralists. Recommendations for improved ergonomic tool design are suggested by some of the included studies to help tackle the MSKIs that surgeons face when performing operations.

The number of female surgeons has increased substantially in the last decade. Hence, there exists an urgent need to address the major challenges they encounter by focusing on this specific aspect of workplace safety and health to mitigate injury. Doing so will yield a productive environment while simultaneously protecting the health and safety of both surgeons and patients.

The study protocol was registered on PROSPERO (ID: CRD42022283378).

Healthcare workers in particular frequently report Work-related musculoskeletal diseases (WRMSDs). The purpose of this study is to evaluate the prevalence and features of WRMSDs in residents from different specialties and trainee nurses from educational hospitals in Damascus, Syria.

A cross-sectional survey was undertaken aiming at the medical residents and the trainee nurses working in the public health sector in 11 hospitals. The sample size was found to be 2016. In this study, a modified version of the Standardized Nordic Questionnaire was employed.

After the inclusion and exclusion criteria was the number of the participants 1855. In general, musculoskeletal pain was in the past week (69%) and the past 12 months (85%). Musculoskeletal pain in medical care practitioners was found to be linked to higher mean age (p = 0.0053) and body mass index (BMI) (p = 0.0437) in the last year. Females had a higher prevalence of WRMSDs than males (p = 0.0036), and those who were married also had a higher prevalence (p = 0.0218). Working longer hours per week and per month were associated with musculoskeletal pain in the previous 7 days (p = 0.0043 and p = 0.0003, respectively).

WRMSD prevalence was 85% among our study participants in the previous year. The most common complaint was lower back pain. Aging, female gender, and increasing BMI have been associated with higher reporting of WRMSDs. Our results suggested that doctors were twice as susceptible to developing WRMSDs as nurses. These results highlight the increasing urgency for ergonomics training programs and effective interventions to reduce WRMSDs and enhance working conditions for healthcare professionals in Syria.

Anesthesiologists are vulnerable to work-related musculoskeletal disorders (WMSDs) due to sustained repetitive movements and awkward postures. This study aimed to assess the prevalence of WMSDs among anesthesiologists and to evaluate its association with ergonomic risk factors.

A convenience sample of 380 Egyptian anesthesiologists were invited to participate in this cross-sectional study through an electronic questionnaire. Data were collected from May to August 2022 and involved questions about participants' demographic, health, and work-related characteristics; the ergonomic risks and perceived hazards; and the musculoskeletal complaints during the past 12 months and 7 days - using Nordic Musculoskeletal Questionnaire (NMQ). Descriptive, bivariate, and multivariate statistical analyses were used to estimate the prevalence of MSD and identify its determinants in the studied sample.

A total of 215 anesthesiologists were included in this study, with a 56.8% response rate, 66% males with an average age of 38 (± 0.7) years. 21% were resident physicians, 47% were specialists, and 32% were consultants. The 12-month prevalence of MSD among anesthesiologists was 71.6% (95% CI: 65.6- 77.7%). Multivariate analysis showed that the main determinants of MSD among the studied sample were age of 45-years and older (OR: 3.22, 95% CI: 1.21-8.52, p = 0.018), regular physical exercise (OR: 0.25, 95% CI: 0.10-0.65, p = 0.005), insufficient rest time between procedures (OR: 2.25, 95% CI: 1.15-4.41, p = 0.018), and three or more awkward postures of the trunk (OR: 3.55, 95% CI: 1.43-8.82, p = 0.006).

The study highlights a high prevalence of WMSDs among Egyptian anesthesiologists, linked to advancing age, lack of regular exercise, insufficient rest between procedures, and frequent awkward postures. Addressing these ergonomic risk factors through targeted workplace interventions is crucial for promoting the overall well-being of anesthesiologists and ensuring the provision of safe anesthesia services.

Minimally invasive surgery, in particular endoscopic surgery, has revolutionized the benefits for patients, but poses greater challenges for surgeons in terms of ergonomics. Integrating ergonomic assessments and interventions into the multi-stage endoscopic procedure contributes to the surgeon's musculoskeletal health and the patient's intraoperative safety and postoperative recovery.

The purpose of this study was to overview the objective assessment techniques, tools and assessment settings involved in endoscopic procedures over the past decade and to identify the potential factors that induce differences in high workloads in endoscopic procedures and ultimately to design a framework for ergonomic assessment in endoscopic surgery.

Literature searches were systematically conducted in the OVID, pubmed and web of science database before October 2022, and studies evaluating ergonomics during the process of endoscopic procedures or simulated procedures were both recognized.

Our systematic review of 56 studies underscores ergonomic variations in endoscopic surgery. While endoscopic procedures, predominantly laparoscopy, typically incur less physical load than open surgery, extended surgical durations notably elevate ergonomic risks. Surgeon characteristics, such as experience level and gender, significantly influence these risks, with less experienced and female surgeons facing greater challenges. Key assessment tools employed include electromyography for muscle fatigue and motion analysis for postural evaluation.

This review aims to provide a comprehensive analysis and framework of objective ergonomic assessments in endoscopic surgery, and suggesting avenues for future research and intervention strategies. By improving the ergonomic conditions for surgeons, we can enhance their overall health, mitigate the risk of WMSDs, and ultimately improve patient outcomes.

Surgeons are exposed to high levels of physical stress while working in the operating room. In industry, so-called exoskeletons are used to support the back and shoulder area. The aim of this study was to investigate the feasibility and effects of an upper body exoskeleton on postoperative physical complaints of surgeons.

Surgeons from a university hospital in the fields of orthopedics, trauma, and visceral surgery performed 2 operations of the same type and planned length on 2 different days. The first operation was performed without an exoskeleton, the second with an exoskeleton. The participants completed questionnaires on shoulder pain (Shoulder Pain and Disability Index [SPADI]), neck pain (Visual Analogue Scale [VAS] and Neck Disability Index [NDI]), and back pain (VAS and Oswestry Disability Index [ODI]) before and after the procedure.

A total of 25 participants were included and performed 50 surgeries with a mean surgery duration of 144 minutes without and 138 minutes with the exoskeleton. Without the exoskeleton, the activity of the operation resulted in a significant increase of the VAS neck by 1.0 point (SD 1.2; P < .001), NDI by 4.8 (SD 8.6; P = .010), VAS back by 0.7 (SD 1.0; P = .002), and ODI by 2.7 (SD 4.1; P = .003). With the exoskeleton the participants reported significantly fewer complaints after the surgery (VAS neck: P = .001; NDI: P = .003; VAS back: P = .036; ODI: P = .036; SPADI: P = .016).

An upper body exoskeleton can significantly reduce the discomfort in the neck, shoulder, and back caused to surgeons by surgery.

In surgical staff, low-back pain (LBP) is prevalent and prolonged trunk inclination is hypothesized to be one of its potential causes. The aim of this study was to evaluate the magnitude and duration of trunk inclination in the sagittal plane of surgical assistants during surgical procedures. The three-dimensional trunk orientation was measured in 91 surgical assistants across four medical facilities during surgical procedures using an inertial measurement unit on the thorax. Per participant, Exposure Variation Analysis was used to evaluate the percentage of the total time of trunk inclination (< -10° (backward inclination); -10-10° (upright posture); 10-20° (light inclination); 20-30° (moderate inclination); >30° (strong inclination)) taking into account posture duration (< 10 s; 10-60 s; 60-300 s; > 300 s). Participants reported their LBP history and perceived low-back load during the procedure via a questionnaire. Participants were in an upright posture for 75% [63-84%] (median [interquartile range]) of the total surgery time (average surgery time: 174 min). Trunk inclination was beyond 20° and 30° for 4.3% [2.1-8.7%] and 1.5% [0.5-3.2%] of the surgery time, respectively. In most of the participants, the duration of trunk inclination beyond 20° or 30° was less than 60 s. Questionnaire response rate was 81%. Persistent or repeated LBP was reported by 49% of respondents, and was unrelated to the exposure to inclined trunk postures. It is concluded that other factors than prolonged trunk inclination, for instance handling of loads or prolonged standing may be causally related to the reported LBP in the investigated population.

We investigated the prevalence of work-related musculoskeletal symptoms (WMSs) among medical staff and evaluated the associations of different levels of adverse ergonomic factors with WMSs. A total of 6099 Chinese medical staff were asked to complete a self-reported questionnaire to assess the prevalence and risk factors of WMSs from June 2018 to December 2020. A prevalence rate of 57.5% was observed for WMSs among overall medical staffs, which mainly affected the neck (41.7%) and shoulder (33.5%). 'Keeping sitting for long hours very frequently' (OR = 1.26, 95% CI: 1.04, 1.53) was positively associated with WMSs in doctors, while 'keeping sitting for long hours occasionally' (OR = 0.91, 95% CI: 0.85, 0.97) was identified as a protective factor of WMSs in nurses. The associations of adverse ergonomic factors, organisational factors, and environmental factors with WMSs were different among medical staff in different positions.Practitioner summary: We conducted a multi-city study concerning the risk factors of WMSs by carrying out a face-to-face one-to-multiple questionnaire survey among medical staff in China. As a risk factor of WMSs in medical staff, adverse ergonomic factors should be paid more attention by the standard setting department and policy makers.Abbreviations: WMSDs: work-related musculoskeletal disorders; WMSs: work-related musculoskeletal symptoms; MSDs: musculoskeletal disorders; NMQ: Nordic Musculoskeletal Questionnaires; DMQ: Dutch Musculoskeletal Questionnaires; NIOSH: National Institute for Occupational Safety and Health; ORs: odds ratios.

Radical prostatectomy (RP) is a definitive surgical therapy for localized prostate cancer. Evidence suggests that the poor ergonomics of surgeons during RP may lead to work-related musculoskeletal disorders and loss of productivity. Since each surgery modality has its physical demands, we compared the ergonomic risk between laparoscopic (LRP) and robotic-assisted (RARP) radical prostatectomy.

The study assessed the posture of 10 urological surgeons during LRP and RARP surgeries with the Rapid Entire Body Assessment (REBA) scale.

We found that the RARP approach resulted in lower REBA scores over the LRP procedure.

Robotic surgery improves body posture for the urological surgeon like in other medical specialties. However, the surgeons display harmful postures in both surgeries.

As laparoscopic surgery is used more widely across the globe and within multiple surgical specialties the potential impact on surgeons is yet to be fully quantified. Maintenance of uncomfortable body positions may lead to work-related musculoskeletal disorders (WMSD) in surgeons, with potential knock-on effects.

An international open online survey of multispecialty laparoscopic surgeons was carried out, designed and reported in accordance with the CHERRIES checklist for internet e-survey research. There was no paid advertising and no incentives offered.

A total of 259 surgeons from 9 specialties and 32 countries answered the survey, with 90% reporting pain attributable to performing laparoscopic surgery. All training grades were represented. Longer average operative duration and a greater number of years in practice were both associated with a significantly higher prevalence of pain. Surgeons with a pre-existing injury were significantly more likely to report pain than those without. Twenty per cent of surgeons would consider early retirement owing to pain.

The impact on surgeons of performing laparoscopic surgery is significant, even given the limitations of an open survey. Innovations such as robotic surgery and improved ergonomic education may reduce the incidence of WMSD in surgeons, to mitigate both the personal effects on surgeons and the wider effect on the future surgical workforce.

Surgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents.

Surgery residents performed simulated laparoscopic tasks before and after a review of the SCORE ergonomics curriculum while filmed with a sensorless app from Kinetica Labs that calculates joint angles as a metric of ergonomics. A survey was completed before the session and a focus group was conducted after.

Thirteen surgical residents participated in the study. The brief intervention took little time and residents improved their ergonomic scores in neck and right shoulder angles. Residents expressed increased awareness of ergonomics based on the session content and AI information. All trainees desired more training in ergonomics.

Ergonomic assessment AI software can provide immediate feedback to surgical trainees to improve ergonomics. Additional studies using sensorless AI technology are needed.

This study aimed to determine the baseline knowledge and beliefs, along with the impact of incorporating surgical ergonomics lectures during a residency.

A cohort of 123 Indian surgical residents participated in this educational intervention, which consisted of two educational webinars on ergonomics. Both pre- and post-intervention surveys were electronically sent to the participants. These included questions related to their demographics, prevalence of musculoskeletal (MSK) symptoms, and factors affecting participant awareness of ergonomic recommendations.

Seventy-one residents responded to the pre-webinar survey. Eighty-five percent of respondents reported MSK symptoms, with the most common being pain (70%) and stiffness (40%), which the residents attributed to their surgical training. Forty-six residents completed the post-webinar survey. The majority of respondents strongly agreed or agreed that surgical ergonomic educational sessions improved their understanding of the fundamental causes of MSK symptoms and increased their awareness of options available for prevention MSK injuries.

The rate of MSK symptoms and/or injury was high among this cohort of surgical residents. These surveys and educational session demonstrated there is limited awareness of the comprehension of ergonomics related to surgical procedures. Our study shows that a simple surgical ergonomic educational intervention can lead to improved understanding of prevention and ergonomic changes.

Our prototype wireless full-HD Augmented Reality Head-Mounted Display (AR-HMD) aims to eliminate surgeon head turning and reduce theater clutter. Learning and performance versus TV Monitors (TVM) is evaluated in simulated knee arthroscopy.

19 surgeons and 19 novices were randomized into either the control group (A) or intervention group (B) and tasked to perform 5 simulated loose-body retrieval procedures on a bench-top knee arthroscopy simulator. A cross-over study design was adopted whereby subjects alternated between devices during trials 1-3, deemed the "Unfamiliar" phase, and then used the same device consecutively in trials 4-5, to assess performance in a more "Familiarized" state. Measured outcomes were time-to-completion and incidence of bead drops.

In the unfamiliar phase, HMD had 67% longer mean time-to-completion than TVM (194.7 ± 152.6s vs 116.7 ± 78.7s, P < .001). Once familiarized, HMD remained inferior to TVM, with 48% longer completion times (133.8 ± 123.3s vs 90.6 ± 55s, P = .052). Cox regression revealed device type (OR = 0.526, CI 0.391-0.709, P < .001) and number of procedure repetitions (OR = 1.186, CI 1.072-1.311, P = .001) are significantly and independently related to faster time-to-completion. However, experience is not a significant factor (OR = 1.301, CI 0.971-1.741, P = .078). Bead drops were similar between the groups in both unfamiliar (HMD: 27 vs TVM: 22, P = .65) and familiarized phases (HMD: 11 vs TVM: 17, P = .97).

Arthroscopic procedures continue to be better performed under conventional TVM. However, similar quality levels can be reached by HMD when given more time. Given the theoretical advantages, further research into improving HMD designs is advocated.

Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I² statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.

Introduction: Firefighters are often placed in situations that require high levels of physical exertion, leading to significant strain on firefighters' musculoskeletal system, predisposing them to musculoskeletal discomfort (MSD) and/or musculoskeletal injury (MSI). Physical fitness programs are often recommended and justified, in part, to prevent injuries. The aim of this study was to determine the association between physical fitness and musculoskeletal health (MSH) in firefighters. Methods: A total of 308 full-time firefighters took part in the study conducted in Cape Town, South Africa. Physical fitness tests encompassed a non-exercise estimation for cardiorespiratory fitness, grip and leg strength for upper and lower body strength, push-ups and sit-ups for muscular endurance, and sit-and-reach for flexibility. The Nordic Musculoskeletal Questionnaire and Cornell Musculoskeletal Discomfort Questionnaire were used to determine MSIs and MSD, respectively. A p-value <0.05 indicated statistical significance. Results: Every one-unit increase in AbVO2max, push-ups, sit-ups, and sit-and-reach decreased the odds of firefighters reporting MSIs by 5% (p = 0.005), 3% (p = 0.017), 3% (p = 0.006), and 3% (p = 0.034), respectively. Every one repetition increase in push-up capacity increased the odds of firefighters reporting neck, elbow and forearm, wrist and hand, and thigh discomfort by 3% (p = 0.039), 4% (p = 0.031), 5% (p = 0.002), and 5%` (p = 0.007), respectively. Every one repetition increase in sit-up capacity increased the odds of firefighters reporting upper back discomfort and thigh discomfort by 5% (p = 0.045) and 7% (p = 0.013), respectively. Conclusion: Maintenance of physical fitness is likely beneficial in reducing MSIs, which, however, may increase the feeling of MSD in firefighters. In addition, it may be noticed that there is an ideal level of physical fitness that is conducive to the reduction of MSIs and should be studied further.

Introduction Musculoskeletal disorders (MSDs) have a tremendous impact on working people and are becoming a serious problem in the modern society. The healthcare system is regarded as having one of the most physically demanding jobs, and the risk of musculoskeletal injuries is high. Irrespective of their age, healthcare workers (HCWs) worldwide frequently experience shoulder and neck pain. In our study, we sought to understand what initiates shoulder and neck pain, such as stress or environmental factors, and what causes shoulder and neck discomfort among Saudi Arabian healthcare professionals. Methods A descriptive, cross-sectional study was conducted from 2022 to 2023, assessing shoulder and neck pain among healthcare workers in the central region of Saudi Arabia. An online survey was used, with 409 participants aged 20 or older. The questionnaire included socio-demographic data, Shoulder Pain and Disability Index (SPADI) questionnaire to measure shoulder pain and disability, neck Bournemouth questionnaire (NBQ) to assess neck pain, and quadruple visual analogue scale (QVAS) to measure the intensity of pain. Results Of the 409 HCWs, 56% were males, and 56.5% belonged to the age group of 20-30 years. The prevalence of high-intensity pain based on QVAS criteria was 29.3%. The mean percentage of neck pain (32.3%) was slightly higher than shoulder pain (31.8%). There was a significant association between the level of pain intensity in terms of the total score of NBQ, SPADI score, and its dimensions. It is interesting to know that HCWs with associated chronic diseases had higher scores in all three questionnaires (NBQ, SPADI, and QVAS). Conclusion High-intensity musculoskeletal pain was relatively high among HCWs. It was found that neck pain affected HCWs more than shoulder pain. Furthermore, an increased pain intensity in the shoulder and neck was more frequently seen in HCWs with chronic diseases. More studies are needed to determine the causes and risk factors for neck and shoulder pain to help improve the healthcare system and patient care.

Ergonomic development and awareness are critical to the long-term health and well-being of surgeons. Work-related musculoskeletal disorders affect an overwhelming majority of surgeons, and various operative modalities (open, laparoscopic, and robotic surgery) differentially affect the musculoskeletal system. Previous reviews have addressed various aspects of surgical ergonomic history or methods of ergonomic assessment, but the purpose of this study is to synthesize ergonomic analysis by surgical modality while discussing future directions of the field based on current perioperative interventions.

pubmed was queried for "ergonomics," "work-related musculoskeletal disorders," and "surgery," which returned 124 results. From the 122 English-language papers, a further search was conducted via the articles' sources for relevant literature.

Ninety-nine sources were ultimately included. Work-related musculoskeletal disorders culminate in detrimental effects ranging from chronic pain and paresthesias to reduced operative time and consideration for early retirement. Underreporting symptoms and a lack of awareness of proper ergonomic principles substantially hinder the widespread utilization of ergonomic techniques in the operating room, reducing the quality of life and career longevity. Therapeutic interventions exist at some institutions but require further research and development for necessary widespread implementation.

Awareness of proper ergonomic principles and the detrimental effects of musculoskeletal disorders is the first step in protecting against this universal problem. Implementing ergonomic practices in the operating room is at a crossroads, and incorporating these principles into everyday life must be a priority for all surgeons.

Upwards of 79%-88% of practicing surgeons report musculoskeletal pain due to operating. However, little is known about when these issues begin to become clinically significant. This survey evaluates the prevalence and impact of musculoskeletal pain among surgical residents.

After IRB approval, an anonymous 19-question survey based on Cornell Musculoskeletal Discomfort Questionnaire was sent to current surgical residents measuring frequency and degree of pain at 5 sites (neck, shoulder, upper back, lower back, and elbow/wrist) as well as impact on activities both at work and outside of work. Chi square analysis was used to identify differences between groups.

Single academic medical center.

Trainees in all surgical-based specialties.

Fifty-three residents responded from 8 different specialties (38% response rate). Respondents were a representative balance of male (53%)/female (47%) with a mean age of 30 ± 2 years. Residents in all specialties and all years of clinical training responded, with the greatest number from general surgery (the largest program with 48% of respondents), second year of clinical training (30%) and an overwhelming 96% of residents reported experiencing pain they felt was due to operating. The most common sites of pain were the neck (92%) and lower back (77%). This pain was a frequent issue for most with 74% reporting multiple times per month and 26% reporting pain nearly every day. Nearly half of residents reported that pain slightly to substantially interfered with their ability to work (44%) and with activities outside of work (47%). Most residents (75%) sought no treatment. No residents missed work despite reporting pain.

Musculoskeletal pain begins during training, occurs regularly, and affects function. Neck pain is the most frequent, severe, and disabling site. This provides a target for interventions to reduce the impact of chronic pain on patient care, surgeon wellness, and career longevity.

Improvement of visualization tools in neurosurgery such as the exoscope has raised the question of how this technology compares to the conventional microscope for surgeon ergonomics, discomfort, and patient outcomes. Exoscopes have the advantage of greater optical zoom, resolution, and illumination at a lower light intensity. Heads-up display for both the primary surgeon and other assistants permits neutral positioning of the surgeons while placing the camera in more angled positions. In a survey sample, this study assesses the surgeon experience utilizing 3D exoscope in general neurosurgery cases.

Data weere recorded by 8 surgeons at 5 separate hospitals utilizing a mobile phone application survey. Surgeons recorded information about case type, intraoperative clinical outcomes such as blood loss and extent of resection, whether fluorescence visualization was used, as well as surgeon pain when compared to matched cases using conventional tools.

A total of 155 neurosurgical cases were recorded in this multisite study, including 72% cranial cases and 28% spinal cases. Of the cranial cases, 76% were brain tumor resections (31% of which were brain metastases). Surgeons reported significantly less neck (P < 0.0001) and back (P < 0.0001) pain in cases when using the robotic exoscope compared with the conventional microscope or surgical loupes. Surgeons did not convert to a microscope in any case.

The exoscope provides excellent delineation of tissue with high resolution. Surgeon pain was markedly reduced with the robotic exoscope when compared with conventional technology, which may reduce work-related injury and fatigue, potentially leading to better patient outcomes.

Previous studies in robotic-assisted surgery (RAS) have studied cognitive workload by modulating surgical task difficulty, and many of these studies have relied on self-reported workload measurements. However, contributors to and their effects on cognitive workload are complex and may not be sufficiently summarized by changes in task difficulty alone. This study aims to understand how multi-task requirement contributes to the prediction of cognitive load in RAS under different task difficulties. Multimodal physiological signals (EEG, eye-tracking, HRV) were collected as university students performed simulated RAS tasks consisting of two types of surgical task difficulty under three different multi-task requirement levels. EEG spectral analysis was sensitive enough to distinguish the degree of cognitive workload under both surgical conditions (surgical task difficulty/multi-task requirement). In addition, eye-tracking measurements showed differences under both conditions, but significant differences of HRV were observed in only multi-task requirement conditions. Multimodal-based neural network models have achieved up to 79% accuracy for both surgical conditions.

A contemporary exercise and strength regimen can improve posture, minimize injury, and improve career longevity in surgeons. By targeting core stability, neck posture, and thoracoscapular strength, surgeons and operating room teams can minimize neck and lower back pain.

 The aim of this study was to determine the prevalence of work-related musculoskeletal symptoms (MSS) in veterinary surgeons using an online survey.

 An online survey was distributed to 1,031 diplomates of American College of Veterinary Surgeons. Responses were collected with data regarding surgical activities, experience with various types of MSS in 10 different body sites and attempts to reduce MSS.

 Two hundred and twelve respondents (21% response rate) completed the distributed survey in 2021. Ninety-three per cent of respondents had experienced MSS associated with surgery in at least one body part, with the neck, lower back and upper back frequently affected. Musculoskeletal discomfort and pain worsened with prolonged surgical hours. Forty-two per cent of them suffered from chronic pain persisting longer than 24 hours after surgeries. Musculoskeletal discomfort was common regardless of practice emphasis and procedure types. Forty-nine per cent of respondents with musculoskeletal pain had taken medication, 34% sought physical therapy for MSS and 38% ignored the symptoms. Over 85% of respondents showed more than some concern regarding career longevity due to musculoskeletal pain.

 Work-related MSS are common in veterinary surgeons, and the results of this study warrant longitudinal clinical studies to determine risk factors and attention to workplace ergonomics in veterinary surgery.

Standard laparoscopy (SL) is responsible for musculoskeletal disorders in surgeons because of poor ergonomic positions, which could be reduced by robot-assisted laparoscopy (RAL) owing to the surgeons' seated position. One of the aims of the ROBOGYN-1004 study (NCT01247779) was to evaluate surgeons' workloads during real-time procedures of gynecological oncological surgery.

Patients with gynecological cancer eligible for minimally invasive surgery were recruited from 13 French centers between December 2010 and December 2015. Physical workload was evaluated using the Borg scale every hour over the surgery duration and the perception of workload evaluated using NASA-TLX at the end of surgery.

A total of 369 patients were recruited, of whom 176 underwent RAL and 193 underwent SL (per-protocol analysis). Posture during SL was significantly more challenging for all body parts except the back. There was an increase in discomfort over time (up to 4 h) for the hands and arms, neck, and legs in SL compared with RAL. Perceived physical activity and abilities were rated higher in SL than in RAL (p < 0.01), whereas perceived personal performance was higher in SL (p < 0.01). Perceived physical effort during surgery was lower in RAL than in SL.

RAL improves the perception of physical workload. Compared with SL, the perceived effort is lower in RAL regardless of the complexity of the surgery.

Healthcare professionals perform daily activities that can lead to musculoskeletal disorders (MSDs). The objective of this review was to summarize these MSDs by body areas in relation to healthcare professions. The underlying question is, worldwide, whether there are areas that are more exposed depending on the occupation or whether there are common areas that are highly exposed to MSDs. This issue has been extended to risk factors and responses to reduce MSDs. The review was conducted according to the PRISMA guidelines between February and May 2022. Google scholar and Science Direct databases were scanned to identify relevant studies. Two authors independently reviewed, critically appraised, and extracted data from these studies. Overall and body area prevalence, risk factors, and responses to MSDs were synthetized by occupational activity. Among the 21,766 records identified, 36 covering six healthcare professions were included. The lower back, neck, shoulder and hand/wrist were the most exposed areas for all healthcare professionals. Surgeons and dentists presented the highest prevalence of lower back (>60%), shoulder and upper extremity (35-55%) MSDs. The highest prevalence of MSDs in the lower limbs was found for nurses (>25%). The main causes reported for all healthcare professionals were maintenance and repetition of awkward postures, and the main responses were to modify these postures. Trends by continent seem to emerge regarding the prevalence of MSDs by healthcare profession. Africa and Europe showed prevalence three times higher than Asia and America for lower back MSDs among physiotherapists. African and Asian nurses presented rates three times higher for elbow MSDs than Oceanians. It becomes necessary to objectively evaluate postures and their level of risk using ergonomic tools, as well as to adapt the work environment to reduce exposure to MSDs with regard to the specificities of each profession.

Oral and maxillofacial surgeons (OMS) are continually required to adjust position and posture to access the limited surgical field in and around the head and neck, oral cavity, and oropharynx. Very limited data exists that quantifies the burden of musculoskeletal disorders (MSD) among OMS.

This exploratory study seeks to address these literature gaps by assessing the prevalence of MSD among OMS.

A 12-question survey was designed to investigate the prevalence of MSD for OMS, including residents in training, actively practicing surgeons, and retired surgeons. Seventy-six surveys were distributed and completed in person by surgeons attending professional conferences from September 2018-September 2019. Survey questions included the Baker-Wong Faces pain scale, years in practice, number of hours worked per week, job tenure, pain attributable to work, and age. The Nordic scale identified and delineated anatomic site of musculoskeletal complaints, duration and treatment sought.

The most frequently cited sources and locations of pain attributable to occupation were shoulders, neck, and lower back. The risk of MSD symptoms was relatively two-fold [PR = 2.54, 95% CI = 0.90, 7.22] among OMS in practice for more than ten years compared to those in practice less than ten years. After adjusting for age and hours worked per week as potential confounders, the risk of MSD symptoms was higher among OMS in practice for more than ten years compared to those with less than ten years of experience, despite no statistically significant association.

OMS are impacted by a high prevalence of MSD. The neck, shoulder, and lower back are the most frequently affected with discomfort and pain. This study found that practicing oral and maxillofacial surgery for more than 10 years is a potential risk factor for experiencing MSD.

General surgeons are at high risk for work-related musculoskeletal disorders (WRMSDs), especially in their neck and back. The prevalence and risk factors for surgeons' WRMSDs in Japan have not been well surveyed.

A cross-sectional questionnaire survey on WRMSDs was conducted among general surgeons in Japan. Surgeons were asked about the presence and degree of neck, shoulder, and back disability in relation to open and laparoscopic surgery.

The questionnaire was sent to 174 general surgeons in 21 hospitals and 106 (60.9%) responded. The prevalence of WRMSDs in the last month was 65.1%, and the prevalence at least once in a lifetime was 79.2%. The rate of WRMSDs of the neck and back was higher after open surgery (44.3%, 42.5%) than after laparoscopic surgery (28.2%, 31.1%), but there was no marked difference in shoulder pain. Age was the strongest risk factor for WRMSDs, and the pain scores, prevalence of chronic pain, and rate of WRMSD-related absence from work tended to increase with age.

A questionnaire survey of surgeons in Japan showed that about 80% of surgeons suffer from WRMSDs. Countermeasures for WRMSDs among surgeons are urgently desired to ensure that limited numbers of surgeons work in the operating theatre throughout their career.

Registry name: a survey of surgeons' musculoskeletal pain associated with performing surgery. University of Tsukuba Institutional Review Board registration number: 1519.