Keeping ‘Surgeon Athletes’ in the Game

Surgeons who use ergonomic equipment are well on their way to avoiding injury in the OR.

• Lightweight loupes. Surgeons should invest in a set that is comfortable and with an angle of declination that keeps their head as close to a neutral position as possible. They should pay attention to the angle of their head as they perform surgery to help vendors in properly fitting them with a new pair. New loupes are available with a mirror built into the magnification piece that allows surgeons to look straight ahead in an ergonomically comfortable position while working and still see the surgical field below.

• Comfortable headlights. The brighter the illumination, the better, and battery-operated models are preferable. Debilitating and potentially career-ending injuries can occur when a member of the surgical team accidentally steps or pulls on a cord that tethers the surgeon’s headlight to a power source. Battery packs for portable lights can be attached to the surgeon’s waistband or come integrated into the headset itself. I prefer having the battery pack on my waist because that makes the headset lighter. 

• Form-fitting aprons. For years, surgeons often used whichever apron was available to protect themselves from radiation exposure during cases involving intraoperative imaging. When I finally got a custom-fit one, it made a big difference in my comfort level during surgery. Aprons that fit properly ensure that most of the weight is supported by your hips, not your shoulders. Ill-fitting aprons are often too heavy, offer less protection and alter the range of motion in your arms — all of which can affect a surgeon’s ability to do their job comfortably and precisely.

• Ergonomic instruments. Surgeons have access to many different types of instruments to perform essentially the same surgical tasks. Being aware of how the tools work and feel in their hands, and realizing they have options in terms of tools designed with ergonomics in mind, can help them select instruments that will be more comfortable to use while they’re holding and manipulating them — especially during longer procedures. 

Although roughly 25% of current cardiothoracic trainees are female, practicing surgeons in this specialty currently make up only 7% of the workforce, and most surgical instruments are designed for larger, male hands. If I’m forced to use two hands to operate a larger instrument, I’m not embarrassed to do so because using one hand might cause undue muscle strain, which could ultimately result in a repetitive strain injury.

Ultimately, surgeons must always be on the lookout for instruments that rest comfortably in their hands, match their preferred operating style and are an overall ergonomic fit.

• Footing and stance. Standing during surgery for hours on end can be grueling, so surgeons must concern themselves with softening the strain on their feet, knees and hips. Fluid-collecting anti-fatigue mats add some cushion to hard OR floors and limit stress on the lower limbs. Wearing supportive and comfortable shoes is also an effective way for surgeons to reduce discomfort in their feet and limit lower back pain.

Surgeons can achieve neutral body positions while operating by avoiding rotating their neck and not tilting it more than 15 degrees; occasionally shifting their weight from one foot to the other; limiting their hand reach to a maximum of 16 to 18 inches; keeping their hands between the waist and the middle of the chest; and positioning the angle of their elbows between 90 and 120 degrees. Taking a few minutes to prep the OR setup can help them maintain these comfortable positions during surgery.

• Table height. Before the case begins, adjust the OR table to just below the surgeon’s elbows. This forces them to extend their arms slightly in order to operate and with their elbows in the targeted 90- to 120-degree range. Throughout surgery, the surgeon’s arms should be closer to a straight line than the more acutely bent “T-Rex” position. 

• Monitors. Screens that hang around the sterile field are usually placed too high and too far away from the surgeon. Ideally, monitors should be positioned 80cm to 120cm from the surgeon’s eyes and between their eye level and hand positioning. Taking 30 seconds to adjust the position of monitors at the outset of the procedure will likely save you more than that amount of time during the case because surgeons won’t be constantly stopping to twist and contort themselves to see what’s on the screens. 

• Step stools. You can’t always adjust the table to a height that’s perfect for everyone, so shorter surgeons shouldn’t be shy about using step stools to make sure their elbows are positioned in a way that promotes ergonomic comfort. Surgeons who need a stool — or two or three put together to create a larger platform for cases involving a wider surgical field — should take the time to position it correctly before the case starts to make sure they can access all areas of the patient easily and comfortably.