Can RAS Drive Ergonomic Improvements for Surgeons?

Erik Wilson, MD, Medical Director of Bariatric Surgery, Memorial Hermann-Texas Medical Center, Associate Professor in the Department of Surgery, University of Texas Medical School at Houston, Director, Minimally Invasive Surgeons of Texas (MIST), Co-founder and President of the Texas Association for Bariatric Surgery

Dr. Erik Wilson recently shared insight from his experience in performing over 4,000 cases of robotic general surgery since 2002 and the longest series of robotic gastric bypasses in the world.

He sees robotic-assisted surgery as a driving force in the future of surgical excellence and being integral to addressing how ergonomics plays a factor in the length and quality of a surgeon’s career.

It’s no surprise that surgeons experience their share of ergonomic challenges in such a physically demanding profession. Injury from poor ergonomics is rarely recognized until the injury occurs, ultimately impacting productivity, job satisfaction, and career longevity. Improvements in ergonomics can help good surgeons stay at the top of their game longer and may even help address the predicted surgeon shortages in coming years.

By avoiding physical damage from poor ergonomics, a surgeon could potentially add years to their career. “Surgeon comfort is becoming more top of mind,” Dr. Wilson shares, “Surgeons are expensive to train and it may take years after training to become an expert. From there, you can expect a 20-to-25-year run. If we can add 10 to 20 years to that through better ergonomics, then there would be fewer stress injuries forcing surgeons to quit.”

There are many reasons that surgeons have to stop operating, but if repetitive stress injuries can be eliminated, then surgeons could be able to operate at that advanced level of experience for a longer period of time.

"Surgeons are expensive to train and it may take years after training to become an expert. From there, you can expect a 20- to 25-year run. If we can add 10 to 20 years to that through better ergonomics, then there would be fewer stress injuries forcing surgeons to quit.”

–Dr. Erik Wilson

Why adopt robotic-assisted surgery (RAS)?

RAS provides a highly stable platform that enables the surgeon to perform the surgery without an assistant and reduces external variables. Because of the configuration of camera and arms, surgeons can use both hands for some steps and complete more advanced maneuvers. Robotics eliminates a few of those external variables, so surgeons can have a consistent expectation at every step of the operation — the way it should look, how it should function and how everything should be designed when you're in there either dissecting or reconstructing.

The same ergonomic factors affect multiple surgery types

Survey data shows two-thirds of bariatric surgeons experience some musculoskeletal issue related to performing laparoscopic surgery on morbidly obese patients.1 Repetitive and stress trauma occurs when they have to fight the abdominal walls, especially on obese patients. Trocars can cause it as well. Many surgeons have bent instruments to accomplish a case in their careers, using significant force on their bodies while performing lap surgery. Good port placement and positioning may help, but there are situations that often occur within every case.

According to Dr. Wilson, “I have seen surgeons who have physical issues coming out of laparoscopy, with ergonomic problems usually from the shoulder down to the hands, that can even result in them stopping their career. I know many open surgeons who found that once they started robotic surgery, that they could extend their careers by years.”2

Surgeons can't always predict where they're going to be working within the abdomen. RAS alleviates much of that. It doesn't eliminate it completely, but once the surgeon learns good port placement, the arm, shoulders, and wrists are not as uncomfortable. Surgeons avoid repetitive stress injuries because they can move within the console to different positions, and shift to get in a more appropriate position where they’re not hunched over and more aligned with the arms. As surgeons become more adept at RAS, they will learn how to adjust the console and move within the console to make it the most beneficial.

RAS comes with its own set of challenges

When surgeons use a RAS system with a closed console, they are still forced to look down. Survey data shows that neck pain, tension headaches and forehead discomfort from pushing your head into the console, come from looking down into a closed console.3 An open console allows surgeons to look straight ahead with the neck, spine, arms, wrist, shoulders and fingers more aligned — a far more ergonomic approach. “If this type of design had been available 10 years ago, these ergonomic challenges would have been addressed already,” explains Wilson.

The power of partnership

Today, surgeon ergonomics and good data measurement are critical factors to the evolution and advancement of surgical technologies. To drive the future of surgery, the industry will lead the charge. “I am happy and proud to participate in fellowship and education events over the last many years because Medtronic sees robotics as critical and the pivot point for minimally invasive surgery (MIS). All other advanced MIS techniques will develop with a long-term focus of being driven by robotics,” shares Dr. Wilson.

For example, Medtronic worked side-by-side with surgeons all over the world to develop a RAS solution that takes surgeon ergonomics to the next level. Now that RAS is gaining momentum, it’s getting a lot of attention to every aspect of it, including the ergonomics element. People are talking, ideas are flowing, and there is more engagement around robotics, ergonomics, and surgeons. It’s an important stepping stone to a more widespread use of robotics across all surgical specialties.

1. AlSabah S, Al Haddad E, Khwaja H. The prevalence of musculoskeletal injuries in bariatric surgeons. Surg Endosc. 2019 Jun;33(6):1818-1827. doi: 10.1007/s00464-018-6460-1. Epub 2018 Sep 24. PMID: 30251136.
2. Schlussel AT, Maykel JA. Ergonomics and Musculoskeletal Health of the Surgeon. Clin Colon Rectal Surg. 2019;32(6):424-434. doi:10.1055/s-0039-1693026.
3. Giberti C, Gallo F, Francini L, Signori A, Testa M. Musculoskeletal disorders among robotic surgeons: A questionnaire analysis. Archivio Italiano di Urologia e Andrologia. 2014;86(2):95. doi:10.4081/aiua.2014.2.95.

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The Medtronic Hugo™ RAS system is commercially available in certain geographies. Regulatory requirements of individual countries and regions will determine approval, clearance, or market availability. In the EU, the Hugo™ RAS system is CE marked. In the U.S., the Hugo™ system is an investigational device not for sale. Touch Surgery™ Ecosystem is not intended to direct surgery, or aid in diagnosis or treatment of a disease or condition.