Its clear prevention is key. The concept and practice of ergonomics has gained significant awareness in recent years, but it continues to remain poorly understood and underutilized by health care workers, including practicing urologists and trainees.

Throughout their training, surgical residents and fellows spend most of their time focusing on learning anatomy, disease processes, and how to perform and get through cases in the operating room, while proper posture and technique take a back seat. Maintaining awkward positions or ergonomic stressors in the operating room for extended periods of time can lead to a variety of injuries known as work-related musculoskeletal disorders (WRMDs).¹ If left unchecked, these stressors can progress into debilitating neck, shoulder, and back pains that can result in career-ending injuries. In fact, a recent meta-analysis, which included over 5,000 surgeons, found that 2 in 3 surgeons reported experiencing a WRMD during their lifetime, with 30% of individuals surveyed reporting seeking medical care for their symptoms.²

Unfortunately, urologists are far from immune to WRMDs. Nearly 90% of practicing urologists surveyed by Urology Times reported having experienced pain in the last year attributed to their work, with 1 in 3 urologists reporting that they experienced pain more than once per week. Additionally, nearly 70% of urologists reported having used nonsteroidal anti-inflammatory drugs to cope with musculoskeletal pain while operating.³ Trainees seem to experience similar rates of injuries, albeit much earlier in the careers. In a recent study by Childs et al, two-thirds of urology residents surveyed experienced work-related pain or injuries during their training.⁴

So what can we do? There are many evidence-based ergonomic recommendations for the various surgical approaches that urologists use involving open, robotic-assisted, laparoscopic, and endoscopic procedures. Making simple adjustments to equipment (ie, monitor height, C-arm, pedal placement, light and energy sources contralateral to monitors) and body positioning (ie, optimal wrist, neck, elbow angles, seated vs standing posture), obtaining fitted loupes, taking microbreaks, and stretching during or between cases have been shown to reduce the risk of work-related discomfort and pain while improving operative performance and career longevity.^1,5 The earlier these principles can be adopted, the less likely potentially career-threatening injuries develop.

Any chance at reducing WRMDs among surgeons needs to start with early surgical ergonomics education. Park et al found that 59% of laparoscopy-practicing general surgeons surveyed reported slight to no awareness of surgical ergonomic recommendations.⁶ This comes as no surprise, as few residency programs have incorporated education on surgical ergonomics. In fact, a study by Epstein et al found that only 1.5% of general surgery residency program directors reported having some type of formal surgical ergonomics education as a part of their curriculum.⁷ These rates are likely similar in our field, further highlighting the need for surgical subspecialities to assess the feasibility and impact of implementing ergonomics education into their training programs.

Coupled with this nescience is a culture that prizes resilience under stressful situations, often conditioning trainees and practicing surgeons to “work through the pain,” prioritizing the health and safety of patients while neglecting their own comfort and well-being. And it’s often this mentality that backfires when untreated injuries lead to major health problems later on in a surgeon’s career. A new focus on improving health with ergonomic interventions needs to start at the trainee level. Residency is an opportune time to do this and can help reduce rates of workplace injuries and improve career longevity and overall well-being.

Since 2002, the AUA Residents and Fellows Committee has represented the voice of trainee members. The Committee’s mission is to address the educational and professional needs of urology residents and fellows and promote engagement with the AUA. The Committee welcomes your input and feedback! To contact us or inquire about ways to be involved, please email rescommittee@AUAnet.org.