Ergonomics

Recently, a very important paper for all surgeons was published in JAMA Surgery online ahead of print.[1] It is a brief but focused and very helpful summary of everything you can do to harm your own body during an operation, and how to avoid it.

It is generally accepted that sticking a knife into someone without consent is legally equal to severe bodily harm with potentially fatal consequences, because surgery means trauma for the patient. This is the main reason why it is so unpopular, and allegedly minimally invasive approaches have become all the rage. Among the bustle about how to minimize scars, holes, tissue loss, etc. it should not be forgotten that everything comes at a price, and that the surgeon has to pay a fair share of it.

When I was a resident I could not wait to get my own loupes fitted because this symbolized the entry ticket to becoming a real cardiac surgeon. Specialization into pediatric cardiac surgery also necessitated a headlight, and thus the weight on my head increased even further. Standing in water-/bloodproof but otherwise nondescript plastic shoes for hours on end increased the pressure on my feet which, inherited from my mother, already had an inclination to transform into the flat, skewed, and splayed variant. Looking into holes at various unphysiological angles twisted my spine. All this went on for decades until one day an acute cervical spinal blockade stopped me in my tracks at full speed.

An understanding orthopedic surgeon and a sympathetic and excellent physiotherapist set to work on me conservatively when the effects of high-dose cortisone treatment had made this possible. In a combined effort and with continuous training a much dreaded operation could be avoided to this very day. For this I am immensely grateful.

The downside of that story is that nobody, no colleague, no mentor, no chief, had told me that in order to go into cardiac surgery you better embark on a physical training program similar to that of Formula One racing drivers. Their helmet and headgear tear at the cervical spine with accelerating forces of 5 g, five times that of the gravitation of the earth (9.81 m/s²). For the neck of an unathletic person this is murder.

Ever since the assault I have wandered the world in a literally self-conscious and more upright posture and, together with regular and targeted exercise guided by the physiotherapist, this continues to work for me. My trapezius muscle certainly looks at least a little bit more like Sebastian Vettel's now.

In summary, wide distribution of the mentioned paper and adherence to the rather simple principles described therein can only be recommended.[1] Mankind is clearly still adapting to the evolutionary development of walking on two rather than four extremities. Meanwhile, the spinal column and its muscular framework deserve all the attention they can get.

Publikationsverlauf

Artikel online veröffentlicht:
12. September 2022

• Reference

• 1 Hemmati P, Nguyen TC, Dearani JA. Ergonomics for Surgeons by Surgeons - Posture, Loupes, and Exercise. 2022 DOI: 10.1001/jamasurg.2022.0676 , last accessed August 17, 2022