Alleblas Chantal C J, de Man Anne Marie, van den Haak Lukas, Vierhout Mark E, Jansen Frank Willem, Nieboer Theodoor E
*Radboud University Medical Center, Department of Obstetrics & Gynaecology, Nijmegen, The Netherlands †Leiden University Medical Center, Department of Gynaecology, Leiden, The Netherlands ‡Delft University of Technology, Department of Biomechanical Engineering, Delft, The Netherlands.
Ann Surg. 2017 Dec;266(6):905-920. doi: 10.1097/SLA.0000000000002223.
The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery.
Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic surgery imposes greater ergonomic constraints on surgeons. Recent reports indicate a 73% to 88% prevalence of physical complaints among laparoscopic surgeons, which is greater than in the general working population, supporting the need to address the surgeons' physical health.
To summarize the prevalence of MSDs among surgeons performing laparoscopic surgery, we performed a systematic review of studies addressing physical ergonomics as a determinant, and reporting MSD prevalence. On April 15 2016, we searched Pubmed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and PsychINFO. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method.
We identified 35 articles, including 7112 respondents. The weighted average prevalence of complaints was 74% [95% confidence interval (95% CI) 65-83]. We found high inconsistency across study results (I = 98.3%) and the overall response rate was low. If all nonresponders were without complaints, the prevalence would be 22% (95% CI 16-30).
From the available literature, we found a 74% prevalence of physical complaints among laparoscopic surgeons. However, the low response rates and the high inconsistency across studies leave some uncertainty, suggesting an actual prevalence of between 22% and 74%. Fatigue and MSDs impact psychomotor performance; therefore, these results warrant further investigation. Continuous changes are enacted to increase patient safety and surgical care quality, and should also include efforts to improve surgeons' well-being.
本研究旨在回顾进行微创手术的外科医生中肌肉骨骼疾病（MSD）的患病率。
腹腔镜手术的进展主要集中在提高患者受益方面。然而，与开放手术相比，腹腔镜手术对外科医生施加了更大的人体工程学限制。最近的报告表明，腹腔镜外科医生中身体不适的患病率为73%至88%，高于一般工作人群，这支持了关注外科医生身体健康的必要性。
为总结进行腹腔镜手术的外科医生中MSD的患病率，我们对将身体人体工程学作为决定因素并报告MSD患病率的研究进行了系统综述。2016年4月15日，我们检索了PubMed、EMBASE、Cochrane图书馆、科学引文索引、护理学与健康领域数据库（CINAHL）和心理学文摘数据库（PsychINFO）。使用哈通-克纳普-西迪克-琼克曼方法进行荟萃分析。
我们确定了35篇文章，包括7112名受访者。投诉的加权平均患病率为74%[95%置信区间（95%CI）65 - 83]。我们发现研究结果之间存在高度不一致性（I = 98.3%），且总体回复率较低。如果所有未回复者均无投诉，患病率将为22%（95%CI 16 - 30）。
从现有文献中，我们发现腹腔镜外科医生中身体不适的患病率为74%。然而，低回复率和研究之间的高度不一致性留下了一些不确定性，表明实际患病率在22%至74%之间。疲劳和MSD会影响心理运动表现；因此，这些结果值得进一步研究。为提高患者安全性和手术护理质量不断进行变革，同时也应包括改善外科医生福祉方面的努力。
