Impact of Intraoperative Ergonomic Microbreaks on Surgeons' Well-Being and Performance: A Systematic Review

Surgeons face a considerable risk of work-related musculoskeletal disorders (WMSDs). Repetitive movements and poor ergonomic conditions can cause pain, particularly in the back, neck, arms, and shoulders. WMSDs not only impact surgeons' quality of life but may also affect surgical performance, absenteeism, and healthcare costs. To reduce WMSDs, intraoperative microbreaks (MBs) with active stretching exercises have been proposed. The aim of this review was to study ergonomic intraoperative MB interventions and their effect on surgeons' symptoms, well-being and performance and to define the features of efficacious interventions.

A systematic review of clinical trials evaluating physical or psychological impact of intraoperative microbreaks on surgeons was conducted in MEDLINE, Embase and Google Scholar until October 2024. Outcomes of interest included pain, discomfort, fatigue, dexterity, mental focus, stress as well as objective measures.

Ten clinical trials (284 study subjects) were retained for final analysis (8 crossover trials and 2 randomized controlled trials). Methodology and assessed outcomes varied considerably between studies. Similarly, interventions were heterogenous in terms of duration, interval, or set of exercises. 6 out of the 10 trials showed at least one improved outcome after the implementation of MBs. The most frequently assessed outcomes were pain and discomfort (improved in 5/8 studies), mental focus (improved in 3/3 studies), and accuracy (improved in 1/3 studies). Five studies evaluated operative duration, all showing no prolonged operating time associated with MBs.

Microbreaks might have a positive impact on surgeons' well-being and performance. There is a clear need though for standardization of interventions and outcome measures. The long-term effects of microbreaks and the most efficacious intervention need yet to be defined.