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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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