**2. Epidemiology study**

The epidemiological study enables collection of data regarding the incidence of musculoskeletal pathologies in laparoscopic surgery and the risk factors, which favor their appearance [16].

The study was conducted on a sample of 52 surgeons (35–65 years), (7.31 ± 3.30 years of experience) in the techniques of laparoscopic surgery and (12.9 ± 6.7) hours per week dedicated to them.

The standardized Nordic Musculoskeletal Questionnaire (NMQ ) modified by the Health and Safety Executive (HSE) of the United Kingdom was used (**Figure 2**) [17, 18]. The epidemiological study also included the procedure of the National Institute of Health and Safety at Work of the USA [19], which allows to identify the musculoskeletal disorders, the conditions which cause them, as well as the perception of the workers.

According to results of the study, 58% of the survey respondents have suffered **neck** pain (43% in the last 12 months) and 66% attribute it to their activity at work. The frequency of pain in the neck area is high (**Figure 2**). Occasionally, pain is intense to very intense, though in most cases, it is of lower intensity (**Figure 3**).

Thirty-seven percent of the survey respondents have suffered from **shoulder** pain (33% in the last 12 months) and 75% associate it with their activity at work. The frequency of shoulder pain is high with approximately 50% of the subjects reporting intense to very intense pain and with the remaining subjects reporting pain of lower intensity (**Figure 4**).

As regards the **back**, 42% of subjects have suffered pain or discomfort in the upper part (21% in the upper part and 35% in the lower part in the last 12 months); 71% of the survey respondents attribute their back pain to activity at work and 19% have even missed work for this reason. Pathologies of the back occur with a considerably high frequency (**Figure 5**).

Thirty-seven percent of subjects have suffered from pain in the **wrists** and **hands** (31% in the last 12 months). Although the frequency is considerably low (**Figure 6**), 17% have suffered from pain in these areas at least once a month. Although they did not miss work, 6% of survey respondents have seen their work performance affected for at least 1 week due to pain in the wrists and hands.

It is important to highlight the relevance for surgeons of the position they adopt during minimally invasive surgical procedures. In personal interviews, surgeons have stated that the position adopted during surgery is substantial to better perform the intervention (96%), they consider training being necessary in association with the adoption of a comfortable posture during the intervention (88%), and they indicate that they are "forced" to operate by adopting an uncomfortable position according to their subjective perception (46%). The data suggest that the forward inclination of the body is performed unconsciously (67% of respondents). On the other hand, 61% surgeons think that the coordination of the posture


#### **Figure 2.**

*Anatomical parts of the body analyzed in the epidemiological study and percentage of musculoskeletal discomfort by anatomical regions adapted from [17].*

**13**

during the surgical procedure appears naturally while for the remaining 39%, it is learned. Furthermore, data suggest that the arrangement of the equipment in the operating room is the cause of the adoption of forced trunk postures (80% of the respondents). These forced postures are due to the distance to the operating table (15%) and due to its height (13%). The placement of the monitor also implies the adoption of an awkward posture (57%). Sixty-two percent of surgeons have problems due to the prolonged maintenance of the posture, 68% indicate the adoption of uncomfortable postures, and 70% indicate the adoption of forced postures. Finally, surgeons were asked about comfort in the use of surgical instruments and

*Advanced Ergonomics in Laparoscopic Surgery DOI: http://dx.doi.org/10.5772/intechopen.84233*

*Frequency of pain appearance and pain intensity in the neck area.*

*Frequency of appearance and intensity of shoulder pain.*

*Frequency of appearance and pain intensity in the back area.*

**Figure 3.**

**Figure 4.**

**Figure 5.**

*Advanced Ergonomics in Laparoscopic Surgery DOI: http://dx.doi.org/10.5772/intechopen.84233*

#### **Figure 3.**

*Recent Advances in Laparoscopic Surgery*

pain of lower intensity (**Figure 4**).

erably high frequency (**Figure 5**).

them, as well as the perception of the workers.

The standardized Nordic Musculoskeletal Questionnaire (NMQ ) modified by the Health and Safety Executive (HSE) of the United Kingdom was used (**Figure 2**) [17, 18]. The epidemiological study also included the procedure of the National Institute of Health and Safety at Work of the USA [19], which allows to identify the musculoskeletal disorders, the conditions which cause

According to results of the study, 58% of the survey respondents have suffered **neck** pain (43% in the last 12 months) and 66% attribute it to their activity at work. The frequency of pain in the neck area is high (**Figure 2**). Occasionally, pain is intense to very intense, though in most cases, it is of lower intensity (**Figure 3**). Thirty-seven percent of the survey respondents have suffered from **shoulder** pain (33% in the last 12 months) and 75% associate it with their activity at work. The frequency of shoulder pain is high with approximately 50% of the subjects reporting intense to very intense pain and with the remaining subjects reporting

As regards the **back**, 42% of subjects have suffered pain or discomfort in the upper part (21% in the upper part and 35% in the lower part in the last 12 months); 71% of the survey respondents attribute their back pain to activity at work and 19% have even missed work for this reason. Pathologies of the back occur with a consid-

Thirty-seven percent of subjects have suffered from pain in the **wrists** and **hands** (31% in the last 12 months). Although the frequency is considerably low (**Figure 6**), 17% have suffered from pain in these areas at least once a month. Although they did not miss work, 6% of survey respondents have seen their work performance affected for at least 1 week due to pain in the wrists and hands.

It is important to highlight the relevance for surgeons of the position they adopt during minimally invasive surgical procedures. In personal interviews, surgeons have stated that the position adopted during surgery is substantial to better

perform the intervention (96%), they consider training being necessary in association with the adoption of a comfortable posture during the intervention (88%), and they indicate that they are "forced" to operate by adopting an uncomfortable position according to their subjective perception (46%). The data suggest that the forward inclination of the body is performed unconsciously (67% of respondents).

On the other hand, 61% surgeons think that the coordination of the posture

*Anatomical parts of the body analyzed in the epidemiological study and percentage of musculoskeletal* 

**12**

**Figure 2.**

*discomfort by anatomical regions adapted from [17].*

*Frequency of pain appearance and pain intensity in the neck area.*

#### **Figure 4.**

*Frequency of appearance and intensity of shoulder pain.*

#### **Figure 5.**

*Frequency of appearance and pain intensity in the back area.*

during the surgical procedure appears naturally while for the remaining 39%, it is learned. Furthermore, data suggest that the arrangement of the equipment in the operating room is the cause of the adoption of forced trunk postures (80% of the respondents). These forced postures are due to the distance to the operating table (15%) and due to its height (13%). The placement of the monitor also implies the adoption of an awkward posture (57%). Sixty-two percent of surgeons have problems due to the prolonged maintenance of the posture, 68% indicate the adoption of uncomfortable postures, and 70% indicate the adoption of forced postures. Finally, surgeons were asked about comfort in the use of surgical instruments and

**Figure 6.**

*Frequency of appearance and pain intensity in the wrist-hand area.*

they reported having experienced difficulties with handling the needle holder (22%), handling the suction-irrigation equipment (15%), with the view of the monitor (8%), with scissors (6%), with diathermy equipment (6%), and with the dissector (4%).
