Ergonomic considerations in open liver surgery

Work-related musculoskeletal disorders (MSDs) are highly prevalent among surgeons, negatively affect their performance and well-being, and may prematurely reduce or end their intended careers. The ergonomic demands of open liver surgical procedures are substantial but underappreciated because of the complexity and duration of these operations.

This was a narrative review of the literature on ergonomic challenges specific to open liver surgery and identified strategies to reduce the risk of MSDs among surgeons and surgical teams.

The factors that most substantially increase the ergonomic burden of OLS are prolonged postural strain, manual liver rotation and retraction, suboptimal placement, and use of equipment, including foot pedals, loupes, headlights, and self-retaining retractors. Strategies to enhance the ergonomic environment for OLS include (i) optimizing patient positioning and operating table height and tilt; (ii) maintaining a neutral body posture; (iii) optimizing equipment placement; (iv) using steps, foot mats, and compression stockings; (v) maximizing surgical exposure and use of retractors; (vi) minimizing passing of instruments; (vii) using adequate tie length; (viii) engaging in microbreaks and posture resets; (ix) maintaining a dynamic workflow; (x) pursuing ergonomics training; and (xi) exercising regularly.

Increasing awareness of the ergonomic hazards faced by surgeons and educating surgeons about the available interventions to address these hazards are the first steps to reducing work-related MSDs among surgeons performing OLS.