title: Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery.
abstract: OBJECTIVE
  There is limited data regarding physical strain and minimally invasive gynecologic surgery (MIS). We sought to evaluate ergonomic strain among gynecologic oncologists.
  
  
  METHODS
  An online survey was sent to all physician members of the Society of Gynecologic Oncology in North America in 2010. The survey contained 42 questions and data was analyzed using univariate and bivariate analyses with summary statistics, t-tests, and chi-squared test.
  
  
  RESULTS
  There were 260 respondents (31.2%) to the survey. Case mix was 26% benign and 64% oncologic surgery. Over 52% of respondents had been in practice for greater than 11 years and 52% practice in an academic setting. Physical discomfort related to MIS was reported in 88% (216/244) of surgeons with 52% reporting persistent pain. Increased pain symptoms were associated with surgeon's height, glove size, age and female gender. Patient body mass index (BMI) was associated with pain symptoms in surgeons performing conventional laparoscopic surgery, but not robotic surgery. To decrease pain, surgeons changed positions (78%), limited the number of cases per day (14%), spread cases throughout the week (6%), or limited the total number of cases (3%). Only 29% had received treatment at any time for pain symptoms. Treatment included physical therapy (59%), medical management (28%), surgery (13%), and time off (1%). Only 16% of those with pain symptoms had received formal ergonomic training.
  
  
  CONCLUSIONS
  Physical strain rates of 88% are far greater than previously reported. Such prevalent occupational strain presents a growing problem in the face of increasing demand for MIS.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599–7570, USA. jfranasi@unch.unc.edu
authors.forename: Jason
authors.initials: J
authors.lastname: Franasiak
authors.forename: Emily M
authors.initials: EM
authors.lastname: Ko
authors.forename: Juli
authors.initials: J
authors.lastname: Kidd
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Maria
authors.initials: M
authors.lastname: Bell
authors.forename: John F
authors.initials: JF
authors.lastname: Boggess
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001827:Body Height; D015992:Body Mass Index; D016009:Chi-Square Distribution; D006804:Ergonomics; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006176:Gynecology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008328:Man-Machine Systems; D008495:Medical Oncology; D008875:Middle Aged; D015999:Multivariate Analysis; D059352:Musculoskeletal Pain / Q000209:etiology* / Q000628:therapy; D009784:Occupational Diseases / Q000209:etiology*; D026741:Physical Therapy Modalities; D011187:Posture; D012371:Robotics; D012737:Sex Factors; D011795:Surveys and Questionnaires