VANCOUVER, B.C. – Attention to ergonomics may reduce risks for a wide range of musculoskeletal problems and headaches that afflict Mohs surgeons, Dr. Mariusz Sapijaszko said at the annual meeting of the Pacific Dermatologic Association.
The demands of performing Mohs surgery were first detailed in a study of 17 Mohs surgeons at the Mayo Clinic. Nearly two-thirds (59%) had chronic neck pain, half had shoulder pain (53%), and nearly half had lower back pain (41%). About a third experienced eye fatigue and one-fourth had headaches (Dermatol. Surg. 2007;33:1304-13).
Dr. Mariusz Sapijaszko
Since then, a survey of American College of Mohs Surgery members found that 90% reported some type of musculoskeletal symptoms or injuries (Dermatol. Surg. 2012;38:240-8).
Dr. Sapijaszko of the Western Canada Dermatology Institute, Edmonton, Alberta, offered the following ergonomic tips based on his own clinical practice as well as recommendations offered by researchers who conducted the 2007 Mayo Clinic study and those focused on optimizing the operating theater environment (ANZ J. Surg. 2010;80:917-24).
To reduce neck-related symptoms:
• Keep your gaze angle between 15 and 30 degrees below horizontal.
• Position the patient close to you.
• Take short surgery breaks to stretch and adjust your posture.
• Use a stool with sternal support or a sit/stand stool.
To avoid lower back pain:
• Change positions frequently.
• Use a foot rest or foot rail.
• Use a stool with sternal support.
To prevent eye fatigue:
• Decrease the intensity of surgical lighting with a dimmer switch.
• Use goggles or glasses that contain antiglare film.
• Use brushed steel instead of polished steel instruments.
To minimize peripheral edema:
• Wear compression stockings.
• Use a foot rest or foot rail.
• Use gel insoles, or antifatigue floor mats.
To reduce headaches:
• Keep ambient noise below 56 dB.
• Select music based on the preference of the surgeon, patient, and other OR staff.
To optimize your comfort, optimize patient comfort:
• Select a procedure table that has adjustable positions for knee, hip, and neck angles as well as good lower back and lumbar support and a comfortable pillow type and position.
"You need to lie down on your own table and find out how good or bad it feels," Dr. Sapijaszko advised. He favors fully adjustable tables such as those used in the massage industry, and recommends a 12-degree tilt for the patient’s head.
On Twitter @dougbrunk