International Institute of Biomechanics and Occupational Ergonomics, ErBio, Avenue du Dr Marcel Armanet, 83400 Hyères, France.
Université de Toulon, CS60584, CEDEX 9, 83041 Toulon, France.
Int J Environ Res Public Health. 2023 Jul 20;20(14):6419. doi: 10.3390/ijerph20146419.
Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired -test, < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.
外科医生高度暴露于与工作相关的肌肉骨骼疾病（WMSD）中。本综述的目的是总结有和没有辅助设备的情况下，按身体部位划分的 WMSD 患病率。根本问题是，无论外科医生的专业如何，在手术过程中使用辅助设备（机器人、视频或其他）是否会对外科医生的 WMSD 患病率产生影响。系统评价是按照 PRISMA 指南进行的。扫描了 Google Scholar、Pubmed/Medline 和 ScienceDirect 数据库以确定相关研究。由两名作者独立进行文章选择、审查、批判性评价和数据提取。在 34854 个独特的已识别记录中，有 77 项研究被纳入。它们分为两组：35 项侧重于机器人和视频辅助手术（RVAS），48 项涉及没有视频/机器人辅助的手术（WAS）（6 项研究评估了两组的患病率）。报告了 13 个身体部位的 WMSD 患病率：颈部、背部、上背部、中背部、下背部、肩部、肘部、手腕、手指、拇指、臀部、膝盖和脚踝。结果表明，在肩部（WAS：28.3%比 RVAS：41.9%）、手腕（WAS：20.9%比 RVAS：31.5%）和拇指（WAS：9.9%比 RVAS：21.8%），RVAS 的 WMSD 患病率显著更高（未配对检验，<0.05）。对 10 个身体部位进行了荟萃分析（其中 4 个部位包括超过 25 项研究）。中背部、拇指或臀部没有足够的数据。观察到高度的异质性（Cochran's Q 检验和 I 统计量）。随机效应模型显示，全球患病率最高的部位是颈部（WAS：41%和 RVAS：45.3%）、背部（WAS：37.7%和 RVAS：49.9%）、下背部（WAS：40.0%和 RVAS：37.8%）和肩部（WAS：27.3%和 RVAS：41.4%）。未来的工作可以集中在工作环境设计上，特别是设备的定位和调整，以及姿势分析，以减少 WMSD 的出现。为未来的综述和荟萃分析提出了建议。
