Background
Minimally invasive and laparoscopic surgical techniques for gynaecological surgery are increasingly utilised across a range of procedures and are an important core skill. Unfortunately injuries to surgeons and theatre staff as a result of these techniques are also increasingly common. Different surgical techniques, operative room setups and specialised equipment can be used to optimise ergonomics during minimally invasive surgery; with an aim to improve efficiency, prevent fatigue and reduce the chance of injury. Despite this knowledge injuries as a result of suboptimal ergonomics still occur.
Aim
This study aims to identify perceived barriers to optimising laparoscopic ergonomics during minimally invasive gynaecology surgery at King Edward Memorial Hospital and develop solutions to address them. It also aims to examine the current level of understanding of equipment and techniques that can be employed to optimise ergonomics and the importance staff place on these strategies.
Methods
This qualitative study involves medical and nursing staff who regularly work in theatre at King Edward Memorial Hospital. An education package was presented to small focus groups alongside a de-identified pre and post education questionnaire. This questionnaire collected information regarding: participant demographics, the degree of importance placed on optimising ergonomics and which factors were barriers to this. It was administered pre and post the education session in order to detect any changes in attitudes or perceptions that occurred as a result of education. Information was also collected regarding injuries and treatment thought to have resulted from suboptimal ergonomics.
Results
Modifiable barriers to optimising laparoscopic ergonomics identified in our health care setting included lack of education and training in appropriate setup, lack of time and lack of support when requesting changes. Less modifiable barriers identified were availability of specialised equipment, case length and patient body habitus.
Discussion
Whilst some barriers to optimising ergonomics such as patient habitus are difficult to change, other barriers such as lack of education are modifiable. Benefits of the education package reported by staff included increased confidence in requesting set up changes and supporting requested changes. Staff showed an increased willingness to support changes to practice that optimise ergonomics and discussed providing an environment in theatre that supports this. Discussing theatre set up as part of the team time out prior to commencing operative lists has also been adopted. The provision of more ergonomically appropriate instruments, height adjustable beds and step stools, have also occurred as a result of this project.