163 Laparoscopic Surgery: Good for the Patient, Bad for the Surgeon. A Systematic Narrative Review

Background Musculoskeletal (MSK) injuries are very common among laparoscopic surgeons. These injuries can result in physician burnout, early retirement, and medical/surgical treatment. The aims of this study are to identify the causes of MSK injuries in laparoscopic surgeons, the most common injuries, and strategies to prevent them. Method Following the PRISMA guidelines, Medline, Embase and PubMed databases were systematically searched for relevant articles using the predefined inclusion/exclusion criteria. Data was extracted by two independent reviewers. Results A total of 321 papers were found, after screening 41 papers were selected for inclusion. Many study designs involved the use of biomechanical methods, surveys, and quality of life questionnaires. Studies varied drastically in their sample sizes. Results show that long periods of static postures held in non-ergonomic positions are a significant contributing factor to MSK injuries. This is more likely in laparoscopic surgery, as surgeons hold more fixed positions with more physical demand when compared with open surgery. Studies show that the most common sites for injury are the neck, back and shoulder. Conclusions MSK injuries are an ongoing problem which is often underestimated and poorly reported. There was clear evidence in the literature that microbreaks and strength training is beneficial, and that ergonomic training should be a standard element of surgical training.