Surgical Ergonomics for Urologists

Dear All,

Surgical Ergonomics to be practiced by Urologists are given not much importance during our practice and could be not given any consideration during training. Poor knowledge in Ergonomics results in many problems which could shorten the overall performance of the Urologists. Understanding Ergonomics desired to be followed for each variety of surgery will definitely help the Urologist from various musculoskeletal injuries, Rampant but not given attention it is due, so commonly associated with operative procedures we perform.

In the past, most of us who were performing Lower Tract Endourology predominantly were afflicted with Neck Pain and Backaches and instead of giving attention to them; we considered it as part of our profession.  With the availability of Endocamera during procedures, this mitigated to some extent but many still had to deal with them. With Open Urological procedures being replaced by Endourological Procedures with lap and Robotics assuming more space, the problems of associated with it have surfaced due t lack of understanding regarding the Ergonomics we have to follow. Today in addition to the injuries mentioned earlier, many have Shoulder problems as well.

The article provided should be understood by all of us and implementations of the recommendations offered should be followed as a routine.

Unfortunately many of the mentors who have take responsibility for training do not follow the needed ergonomics to be followed leaving the trainees at bay as they are not properly instructed.

For ensuring long life as a Urologist, we have to help not only us but our trainees by teaching them how to perform procedures with least strain.

C. Mallikarjuna, has given few talks on the need for us to understand Ergonomics of procedures we practice and hope we will have his commentary on this. There are several Urologists now proficient in Lap and Robotics and their experience in the field would be valuable for us.

With warm Regards,




  • Ravindra Sabnis
    Ravindra Sabnis
    31 Jan 2021 12:09:45 PM

    Ergonomics was very important in the era of open surgery - where - position of patient, where surgeon will stand, what incision to be taken & how to suture - was considered as of immense importance. We were taught to take back hand, forehand sutures, tie knot in particular way was all part of ergonomics. 

    Then came era of PCNL - standing for long time & in awkward position affected urologists. As mentioned by Venu Sir, endocamera took away greatest stress during TURP PCNL & URS. 
    Then came era of laparoscopy - where ergonomics became of great relevance. - what should be height of table, How shoulder pain can be avoided, how suturing can be done, where port to be placed. Every point ultimately affected ergonomics & thereby success of surgery. Laparoscopy however attractive it was, had sever limitations in reconstructive surgery due to ergonomics. Many people could not do it. Huge learning curve - all due to bad angles & poor ergonomics. 
    That generated invention of robotics. where ergonomics became of less relevance because robotic arm would move in any angle & direction & hence became easy for surgeon. Second benefit was surgeon was sitting on consol so not standing for long time, & no backache. 3 D vision further improved ergonomics. 
    Newer generation of robot - XI further progress to overcome ergonomics - as arms would not clash even if they are in same line 
    So whole robotic invention was to overcome ergonomincs, which automatically translated into the succcess. 
    However while imparting training to residents, it is important to teach importance of ergonomics. They must know what position of pt, surgeon, site of port placement, ....etc 
    I have seen many residents & consultants - victims of backache, frozen shoulder, finger pain...etc 
    I think this article is of great relevance stating about ergonomics. 

  • Dr G G Laxman Prabhu
    Dr G G Laxman Prabhu
    31 Jan 2021 06:57:36 PM

    Surgical ergonomics is a well known but not often discussed aspect of surgical practice. The article cited brings out the uniqueness of Urological surgery in the sense that perhaps it is the only specialty which has open, Lap, endo, robotic and microsurgical applications in its practice.

    The adage ' one who lives by the sword dies by the sword ' applies to us amply. In addition to needlestick injuries exposing the surgeon to hepatitis and HIV and the risk of radiation induced harm, poor ergonomics takes its own toll on the surgeon's body. Back takes the beating most, cervical spine being most vulnerable.
    I believe that the following precautions help in minimizing ergotrauma:

    1. Correct posture
    2. Stool with back support and arm rests for TURs 
    3. Using light weight armentarium( hand pick these, consult those who have larger experience)
    4. Videoscopy
    5.Organizing the cables, irrigation tubes etc to avoid entanglements, which adds to stretching for things
    6.Accesories of the correct length
    7.Avoiding makeshifts ( using a long ureteroscope for a pediatric case )
    8. Well trained staff who hand things without burdening the surgeon with stretching for instruments
    9.Not hurrying through a procedure
    10.Video record surgeon's movements ( not to be understood as recording the procedure) and reviewing it with an expert ( Ortho or spine surgeon) and applying corrective measures.

    Ergo-hygiene leads to ergo-comfort, which achieves ergo-efficiency.

    Having said this, I cannot recall any member of USI taking a premature retirement or changing the line due ergonomically caused injuries. I might be wrong. A survey monkey may shed light upon this under discussed yet vital topic!

    G G Laxman Prabhu
    KMC, Mangalore

  • Pankaj N Maheshwari
    Pankaj N Maheshwari
    09 Feb 2021 11:34:56 PM

    Surgical ergonomics is indeed very important in all endourological procedures. The importance is very high in procedures like RIRS. The problem is compounded by the fact that RIRS entails a heavy instrument to be held in hand for prolonged duration of time, occasionally standing. Apart from concentrating on proper patient and surgeon positioning, it is important to concentrate on shoulder and back strengthening exercises. Fitness for the Urologist is extremely important.   

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