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Minimally invasive surgery great for patients, not so hot for surgeons

February 2, 2010 | 11:17 am

Minimally invasive surgery, known formally as laparoscopic surgery, has proved a boon for patients over the last 20 years, minimizing hospital stays, speeding recovery and reducing the cosmetic consequences of operations. But new evidence suggests the surgeons who perform the procedures are developing a new group of aches, pains and medical complications from them, according to Dr. Adrian E. Park of the University of Maryland School of Medicine.

Surgeons performing laparoscopic surgery -- in which long, narrow instruments are inserted through tiny holes in the skin and progress is viewed on a television monitor -- face constraints they don't encounter in conventional operations, Park said. "In laparoscopic surgery, we are very limited in our degrees of movement, but in open surgery we have a big incision, we put our hands in, we're directly connected with the target anatomy," he said in a statement. "With laparoscopic surgery, we operate by looking at a video screen, often keeping our neck and posture in an awkward position for hours. Also, we're standing for extended periods of time with our shoulders up and our arms out, holding and maneuvering long instruments through tiny fixed ports."

To explore problems associated with the surgery, Park sent out a 23-question survey to 2,000 board-certified gastrointestinal and endoscopic surgeons in North America and abroad. Of the 317 surgeons who returned the survey, 272 said they suffered physical discomfort or symptoms they attributed to the surgery, he reported in the Journal of the American College of Surgeons. The problems ranged from eye strain and neck, back and leg pain to headaches, finger calluses, disc problems, shoulder muscle spasm and carpal tunnel syndrome. The number of surgeries performed each year was a key predictor of risk, with caseloads higher than 150 to 200 presenting the most problems.  "However, if the surgeon did long, complex cases, they only needed half that number to increase the risk," Park said.

To minimize problems, 84% said they had changed their position while operating, while 30% said they changed instruments or took a break. But 40% said they just ignored any problems.

Park said the instrument industry needs to integrate technology and improve instruments to minimize problems. "If injuries among surgeons are not addressed significantly, we're going to face a problem in the near future of a shortage of surgeons as well as shortened career longevity among surgeons who enter, or are already in, the field."

-- Thomas H. Maugh II

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Comments (3)

Though a glamorized profession, it looks like it can be as uncomfortable as "blue collar" work in construction, welding and certain physically intensive visual arts. Welcome to the real world of temporary discomfort and feeling the effects of a physically tolling job . Hopefully, surgeons' and doctors' voices can be heard on this problem in which certain jobs require healing services, like physical therapy or chiropractor visits. Can't we include such help in the health care reform bill?

I have COPD, and so much more that I will constrain my 80-year-old self from detailing them. Recently, I added a gall bladder that was producing stones like gum-balls from ubiquitous machines that drop gum balls from all the change a boy can drop into the slot, coins purloined from his Mom's purse. The operating surgeon said he would also tuck in an abdominal (belly button) hernia during the process. All he asked of me was to breathe for them after the operation. I did, urinated to prove everything necessary was working and, much to the surprise of the nurses, opted to go home, which I did. I write this to say that all you report about the patient is true in my case; but I do hope more can be done to help great surgeons, as mine was and is. I would add that many people do not know that very dedicated surgeons are called into hospitals in the middle of a night's sleep to apply their skills that a body may go on living. They, too, are first responders. Many thanks to good reportage about the cutting edge of life saving surgery.

i cant agree with you...minimal invasive surgery is reducing the workload of the surgeon...remember , stress and strain is there in every field...



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