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Study Led by Temple’s Dr. Christina Jacovides Finds Female Surgeons Face Unique Ergonomic Challenges in the Operating Room

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Research highlights the impact of equipment design and working conditions on female surgeons and advocates for industry-wide ergonomic adjustments

Female surgeons face unique ergonomic stressors in the operating room, from the design of surgical instruments to pregnancy-related risks, according to new research by the Association of Women Surgeons published in the Journal of the American College of Surgeons (JACS).

“We need to get back to the drawing board with the medical equipment industry and get people involved who represent the range of surgeons to ensure that instruments and equipment are optimally sized for everyone,” said Christina Jacovides, MD, Assistant Professor of Surgery at the Lewis Katz School of Medicine at Temple University and joint first author of the study.

Ergonomic stress relating to smaller hand size or smaller height is not limited to one group but is felt disproportionately by female surgeons. These differences become even more pronounced in applications such as endoscopy. This difficulty is echoed in the standardized exam pass rates, with female surgeons experiencing lower first attempt pass rates on the Fundamentals of Endoscopic Surgery (FES) exam than their male counterparts. Female surgeons pass rate was 71% compared to 92% for male surgeons; even controlling for glove size and height did not eliminate gender differences in pass rates.*

“Endoscopy is particularly difficult for those with smaller hands. It is difficult to manipulate both dials, the buttons, and the scope simultaneously. There are workarounds for smaller hands, but it is definitely more challenging,” said Dr. Jacovides. 

The study also highlights the impact of operating table height, which can lead to discomfort and increase injury risk for female surgeons due to their generally shorter stature. The study points to a simulation that found that traditional operating room tables are too high for 95% of surgeons performing laparoscopic surgery.* 

Pregnant surgeons face additional ergonomic challenges, with research indicating an increased risk of pre-eclampsia and miscarriage among those whose duties require lifting heavy weights.*

The study underscores the ergonomic stressors many surgeons feel, regardless of sex. 

“The prevalence of degenerative spine disease and other musculoskeletal disorders among surgeons is alarming,” Dr. Jacovides said. 

With a surgeon-to-patient ratio of 7.6 per 100,000 in the United States, the authors highlight the importance of ergonomic improvements to prevent early retirement or disability due to work-related pain.*

Despite the evidence of ergonomic stressors and their impact on surgeons, the study reveals a significant gap in awareness and education. Less than a quarter of surgical residencies currently offer any form of education on ergonomics, with only 1% having a formal program.*

The research proposes several solutions to address these challenges, including:

  • Better-designed surgical instruments
  • Adjustable operating room equipment
  • Incorporating ergonomic principles into surgical training

“Attending surgeons should incorporate principles of ergonomics into their cases and teaching strategies. Occupational therapists and ergonomics specialists should be engaged to provide feedback and advice about poor ergonomics in the operating room,” Dr. Jacovides said.

The authors note that there are also cost-effective interventions that hospitals can implement, such as adequate operative lighting, sufficient assistance in the operating room, and education in proper lifting techniques, floor mats, and “microbreaks” to reduce strain.

Looking to the future, the authors envision operative equipment that may be custom-fit to individual surgeons, including laparoscopic and endoscopic equipment with adjustable or interchangeable handles designed for smaller hand sizes.

While ergonomic stressors are under-reported and under-studied, the authors argue there is an even larger gap in the literature on and lack of awareness of gender-related differences in ergonomics. Most studies do not separately analyze female and male subjects, and the true impact of poor ergonomics on female surgeons is unknown. The researchers call for a collective effort from the medical community, industry, and educational institutions to make surgery a more accessible and sustainable profession for all.

The ACS Division of Education and the Surgical Ergonomics Committee publishes resources for Surgical Ergonomics Recommendations.

Study coauthors are Camila R. Guetter, MD, MPH; Marie Crandall, MD, MPH, FACS; Kandace McGuire, MD; Eliza M. Slama, MD; Anastasia Plotkin, MD; Meghana V. Kashyap, MD, DIM&PH; Geeta Lal, MD; Marion C. Henry, MD, MPH, FACS

The study is published as an article in press on the JACS website. 

Citation: Jacovides C, Guetter CR, Crandall M. Overcoming Barriers: Gender Disparities in Surgeon Ergonomics. Journal of the American College of Surgeons, 2024. DOI: 10.1097/XCS.0000000000001043

*These data come from outside sources cited by the study authors in their meta-analysis. All of the data sources are included in the study.