Canadian portrait of ergonomics in bariatric surgery

Proper ergonomics is crucial for surgeons in the operating room to reduce the risk of musculoskeletal injuries (MSI). Surgery performed on patients with high body mass indexes (BMI) is associated with an increase in non-neutral postures and a higher risk of developing MSIs in laparoscopic models (Sers et al., in Appl Ergon 97:103501). The aim of this study is to establish the prevalence and identify the risk factors of MSIs among bariatric surgeons in Canada.

This cross-sectional study is based on a researcher-administered questionnaire conducted using a videoconference platform with bariatric surgeons across Canada. A comprehensive questionnaire was created following a systematic search of the current literature on ergonomics in bariatric and minimally invasive surgery (Hilt et al., J Surg Res 295:864-873; AlSabah et al., Surg Endosc 33(6):1818-1827; Hess et al., Am J Occup Ther 78(5):7805205090; van Det et al., Surg Endosc 23(6):1279-1285; Monfared et al., Surg Endosc 36(11):8397-8402) and through focus groups. A combination of quantitative and qualitative data was collected. The majority (117) of surgeons with a dedicated bariatric practice in Canada were initially contacted through email. A logistic regression analysis was performed to assess the influence of multiple quantitative variables on the presence or absence of MSI. Inductive thematic analysis was used to analyze the qualitative data, which was then described in proportions to illustrate their relative importance.

A total of 33 bariatric surgeons were interviewed. 60.6% of participants reported experiencing chronic musculoskeletal pain. Of those, 75% sought treatment for their injuries. The three most common complaints were lumbar spine, cervical spine and shoulder injuries. More than one quarter of the participants experienced chronic lower back pain. Qualitative data analysis revealed the importance of teaching proper ergonomics to residents and fellows, which was the most discussed theme, by 43% of participants. 85% of surgeons mentioned they did not have proper ergonomics education or knowledge. 88% of responders perceived a lack of institutional support toward ergonomics.

MSIs are very prevalent among bariatric surgeons in Canada, affecting 60.6%. The results of this study may encourage bariatric surgeons and surgical trainees to pursue additional education in ergonomics and assistive technology. Future research should focus on the benefit of allocating more resources toward ergonomics and the impact of the robotic platform in bariatric surgery.