Providing Recommendations and Preventative Measures (to Avoid MSKD) for Surgeons who Perform Laparoscopic Surgeries
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ķirurģijā ir vairākas iespējamības kā aizsargāt pacientus operāciju zālēs, kā arī nodrošinot labākās ārstēšanas pieejas. Tāda jauna minimāli invazīva metode kā laparaskopija ir viens no pamatlicēja metodēm, nodrošina pacientus ar labākiem ieguvumiem. [10, 11] Tomēr šai metodei ir lielākas izmaksas. Lielāka ķirurgu daļa, proti, 73-100%, kuri veic laparaskopiskas operācijas, cieš no muskuloskeletālām problēmām, kuras savukārt, ir saistītas ar arodu. [2-4, 12-16] Līdz ar laiku, šīs slimības akumulējas un tādējādi var ietekmēt ķirurgu karjeras ar ilgstošām darba nespējas epizodēm. [12] Izvērtējot darba apstākļus, ir iespējams risināt šo problēmu ar ergonomiskiem paņēmieniem, tādējādi potenciāli uzlabojot darbinieku apmierinātību, darba izpildi, līdz ar to samazinot ķirurgu prombūtni sāpju un darba nespējas prombūtni. [17]
Darba mērķis ir noteikt darba riska faktorus ķirurgiem, kuri veic operācijas ar laparaskopiskām metodēm, kuri ir saistīti ar aroda muskuloskeletālam problēmām; noteikt ergonomiskas aroda problēmas operāciju blokos; nodrošināt pilnvērtīgas rekomendācijas, kā arī preventīvus pasākumus ķirurgiem, kuri veic laparaskopiskas operācijas.
Darba metode ir sistēmiskā literatūras apskate. Pētījumā tika izmantoti 66 zinātniski raksti no Cochrane, PubMed, Google scholar aun AMA datu bāzēm.
Analizējot iegūtus rezultātus, tika noteikts, ka aroda etioloģijas muskuloskeletālās slimības ir biežāk sastopamas ķirurgiem veicot laparaskopiskas operācijas, salīdzinājumā ar laparatomijām no 45 līdz pat 100%. To iemesli ir dažādi, proti. Piespiedu darba poza, lokāls muskuļu sasprindzinājums, nepietiekoša pieredze un darba slodze. Darba gaitā tika atrastas vairākas rekomendācijas un vadlīnijas, tomēr tās netika pārbaudītas laikietilpīgos pētījumos.
Tika secināts, ka muskuloskeletālās slimības ir bieži sastopama problēma ķirurgiem, kuri veic operācijas ar laparaskopiskam metodēm. Viens no galvenajiem modificējamiem darba riska faktoriem ir ergonomija. Svarīgo lomu spēlē arī monitoru pareiza pozicionēšana, optimālā augstuma un regulejamības nodrošinājums operāciju galdam, ergonomisko pareizo operāciju instrumentu pielietojums, pareizas ķermeņa darba pozas noturēšana. Mūsdienās pastāv ergonomijas vadlīnijas, tomēr tikai neliela ķirurgu daļa to ievēro.
In surgery there are many advances in protecting patients in the operating room and giving them the best care possible. New minimally invasive techniques, such as laparoscopy have pioneered its way in the field, giving so many benefits to patients. [10, 11] However, it comes at a price. 73-100% of surgeons that perform laparoscopic techniques are affected by work related musculoskeletal problems. [2-4, 12-16] Over time these ailments build up and can influence surgeons taking longer time off due to injury, and ultimately affect their career. [12] By studying these problems we can find ergonomic solutions and potentially increase work satisfaction, improve performance and at the same time reduce pain and sick leave among surgeons.[17] Aim: The aim of this review is to (1) broadly identify work related musculoskeletal problems amongst surgeons performing laparoscopic techniques; (2) Identify ergonomic problems within the OR for LS surgeons. (3) Provide adequate recommendation and preventative measure for surgeons who perform surgeries involving laparoscopic techniques, using current research. Methods: A systematic literature review was conducted. 66 Articles were analysed and compared by searching Cochrane, PubMed, Google scholar and AMA databases with the help of medical subject headings (MeSH). Results: The results show that WMSD is more common in laparoscopic surgery than open surgery and the prevalence of MSKD among LS surgeons ranges from 45-100%. There are multiple reasons for this, including forced awkward positions and posture, the workload and lack of training. We found many experiments as well as reviews addressing this issue and providing recommendations and guidelines, however studies on the long-term effect of following those guidelines were not found. Conclusion: MSKD is a very common problem in surgeons that perform laparoscopic surgery. The most important modifiable factors to improve the ergonomics are (1). Proper positioning of monitors, (2) optimal height and adjustability of operation table, (3) specific designed ergonomic instruments. (4) Proper posturing and positioning of body parts. Current guidelines on ergonomics exist. However, few surgeons are aware of them and follow them.
In surgery there are many advances in protecting patients in the operating room and giving them the best care possible. New minimally invasive techniques, such as laparoscopy have pioneered its way in the field, giving so many benefits to patients. [10, 11] However, it comes at a price. 73-100% of surgeons that perform laparoscopic techniques are affected by work related musculoskeletal problems. [2-4, 12-16] Over time these ailments build up and can influence surgeons taking longer time off due to injury, and ultimately affect their career. [12] By studying these problems we can find ergonomic solutions and potentially increase work satisfaction, improve performance and at the same time reduce pain and sick leave among surgeons.[17] Aim: The aim of this review is to (1) broadly identify work related musculoskeletal problems amongst surgeons performing laparoscopic techniques; (2) Identify ergonomic problems within the OR for LS surgeons. (3) Provide adequate recommendation and preventative measure for surgeons who perform surgeries involving laparoscopic techniques, using current research. Methods: A systematic literature review was conducted. 66 Articles were analysed and compared by searching Cochrane, PubMed, Google scholar and AMA databases with the help of medical subject headings (MeSH). Results: The results show that WMSD is more common in laparoscopic surgery than open surgery and the prevalence of MSKD among LS surgeons ranges from 45-100%. There are multiple reasons for this, including forced awkward positions and posture, the workload and lack of training. We found many experiments as well as reviews addressing this issue and providing recommendations and guidelines, however studies on the long-term effect of following those guidelines were not found. Conclusion: MSKD is a very common problem in surgeons that perform laparoscopic surgery. The most important modifiable factors to improve the ergonomics are (1). Proper positioning of monitors, (2) optimal height and adjustability of operation table, (3) specific designed ergonomic instruments. (4) Proper posturing and positioning of body parts. Current guidelines on ergonomics exist. However, few surgeons are aware of them and follow them.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Atslēgas vārdi: aroda muskuloskeletālas slimības, laparaskopiskas operācijas, ķirurgi, ergonomika., Keywords: Work related musculoskeletal disorder, Laparoscopic surgery, surgeons, and ergonomics