title: Physician pain and discomfort during minimally invasive gynecologic cancer surgery.
abstract: OBJECTIVE
  Despite increasing awareness of physical strain to surgeons associated with minimally invasive surgery (MIS), its use continues to expand. We sought to gather information from gynecologic oncologists regarding physical discomfort due to MIS.
  
  
  METHODS
  Anonymous surveys were e-mailed to 1279 Society of Gynecologic Oncology (SGO) members. Physical symptoms (numbness, pain, stiffness, and fatigue) and surgical and demographic factors were assessed. Univariate and multivariate analyses were performed to determine risk factors for physical symptoms.
  
  
  RESULTS
  We analyzed responses of 350 SGO members who completed the survey and currently performed >50% of procedures robotically (n=122), laparoscopically (n=67), or abdominally (n=61). Sixty-one percent of members reported physical symptoms related to MIS. The rate of symptoms was higher in the robotic group (72%) than the laparoscopic (57%) or abdominal groups (49%) (p=0.0052). Stiffness (p=0.0373) and fatigue (p=0.0125) were more common in the robotic group. Female sex (p<0.0001), higher caseload (p=0.0007), and academic practice (p=0.0186) were associated with increased symptoms. On multivariate analysis, robotic surgery (odds ratio [OR] 2.38, 95% CI 1.20-4.69) and female sex (OR 4.20, 95% CI 2.13-8.29) were significant predictors of symptoms. There was no correlation between seeking treatment and surgical modality (laparotomy 11%, robotic 20%, laparoscopy 25%, p=0.12).
  
  
  CONCLUSIONS
  Gynecologic oncologists report physical symptoms due to MIS at an alarming rate. Robotic surgery and female sex appear to be risk factors for physical discomfort. As we strive to improve patient outcomes and decrease patient morbidity with MIS, we must also work to improve the ergonomics of MIS for surgeons.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Iowa, Iowa City, IA, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: McDonald
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.affiliation: Department of Institutional Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Greer
authors.affiliation: Department of Obstetrics and Gynecology, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.affiliation: Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Wendel T
authors.initials: WT
authors.lastname: Naumann
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: mfrumovitz@mdanderson.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
mesh_terms: D000328:Adult; D000368:Aged; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery; D013509:Gynecologic Surgical Procedures; D006176:Gynecology; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology*; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009784:Occupational Diseases / Q000453:epidemiology*; D010146:Pain / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Discomfort; Fatigue; Laparo-endoscopic single-site surgery (LESS); Laparoscopy; Numbness; Pain; Robotic surgery