title: Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review.
abstract: The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery.
  
  
  
  Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic surgery imposes greater ergonomic constraints on surgeons. Recent reports indicate a 73% to 88% prevalence of physical complaints among laparoscopic surgeons, which is greater than in the general working population, supporting the need to address the surgeons' physical health.
  
  
  
  To summarize the prevalence of MSDs among surgeons performing laparoscopic surgery, we performed a systematic review of studies addressing physical ergonomics as a determinant, and reporting MSD prevalence. On April 15 2016, we searched Pubmed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and PsychINFO. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method.
  
  
  
  We identified 35 articles, including 7112 respondents. The weighted average prevalence of complaints was 74% [95% confidence interval (95% CI) 65-83]. We found high inconsistency across study results (I = 98.3%) and the overall response rate was low. If all nonresponders were without complaints, the prevalence would be 22% (95% CI 16-30).
  
  
  
  From the available literature, we found a 74% prevalence of physical complaints among laparoscopic surgeons. However, the low response rates and the high inconsistency across studies leave some uncertainty, suggesting an actual prevalence of between 22% and 74%. Fatigue and MSDs impact psychomotor performance; therefore, these results warrant further investigation. Continuous changes are enacted to increase patient safety and surgical care quality, and should also include efforts to improve surgeons' well-being.
authors.affiliation: *Radboud University Medical Center, Department of Obstetrics & Gynaecology, Nijmegen, The Netherlands †Leiden University Medical Center, Department of Gynaecology, Leiden, The Netherlands ‡Delft University of Technology, Department of Biomechanical Engineering, Delft, The Netherlands.
authors.forename: Chantal C J
authors.initials: CCJ
authors.lastname: Alleblas
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: de Man
authors.forename: Lukas
authors.initials: L
authors.lastname: van den Haak
authors.forename: Mark E
authors.initials: ME
authors.lastname: Vierhout
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
authors.forename: Theodoor E
authors.initials: TE
authors.lastname: Nieboer
mesh_terms: D006804:Ergonomics; D006801:Humans; D010535:Laparoscopy; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D009784:Occupational Diseases / Q000453:epidemiology*; D015995:Prevalence; D066231:Surgeons