Ergonomics considerations of radical prostatectomy: Physician perspective of open, laparoscopic, and robot-assisted techniques

Purpose: To analyze and compare physician perspectives of musculoskeletal ergonomic parameters associated with open, pure laparoscopic, and robot-assisted prostatectomy. Materials and Methods: Survey questions were designed to evaluate physician musculoskeletal discomfort during open and minimally invasive radical prostatectomy. The survey instrument was distributed to physician members of the Endourological Society (ES) and Society of Urologic Oncology (SUO) after approval from the respective organizations. We queried about the presence of chronic neck and/or back pain, relationship of musculoskeletal pain to operating, and pain characteristics associated with open, laparoscopic, and robot-assisted prostatectomies. Physicians were also asked to rank the three operative approaches with respect to associated pain and discomfort and to comment if practice patterns were impacted by these ergonomic variables. Results: There were 106 urologists who completed the survey. Chronic neck and/or back pain was present in 43% of urologists who responded to this survey. Of those surgeons with baseline neck/back pain, 50% indicated that operating caused or exacerbated this musculoskeletal pain. Furthermore, 25% of respondents indicated that musculoskeletal pain considerations impacted their choice of operative approach. Neck and/or back pain was experienced in 50%, 56%, and 23% of surgeons after open, laparoscopic, and robot-assisted prostatectomy, respectively. When ranking operative approach in order of decreasing amounts of associated pain, 32% indicated open>laparoscopic>robot-assisted, 28% responded that none caused pain, and 25% selected laparoscopic>open>robot- assisted. Three percent selected permutations, with robot-assisted causing the most discomfort. Conclusion: Urologists who responded to our study indicate that open and laparoscopic prostatectomy cause more musculoskeletal discomfort than a robot-assisted approach. Of urologists performing robot-assisted prostatectomies, however, 23% suggested that this approach also was associated with physical pain. Furthermore, physicians do take into account ergonomic considerations when determining an operative approach. Studies with actual physician monitoring and electromyography are requisite to more thoroughly delineate the ergonomics of performing a radical prostatectomy.