Study: Surgical Ergonomics During Ureteroscopy Differs for Male and Female Urologists

Editor’s note: The article originally appeared on Cleveland Clinic Lerner Research News.

Female urologists experience higher muscle activation, greater physical workload and poorer ergonomics than their male counterparts during kidney stone surgery, according to a Cleveland Clinic study. The American Journal of Surgery publication provides data to address work-related injuries and prevent physician burnout.

More than 70% of United States surgeons experience work-related injury or pain over their careers. Nearly half report that their injuries impair their ability to work and care for patients and a significant portion of these individuals end up requiring surgery or physical therapy themselves. Despite growing attention to ergonomics, there's still not much information on gender differences, says Smita De, MD, PhD, HoLEP surgeon and endourologist at Cleveland Clinic.

"Even a minimally invasive procedure involves a lot of physical work and strain," says Dr. De. "There's a lot of movement involved in performing a surgery, but there's also a lot of heavy equipment that isn't really designed with shorter individuals or women in mind."

To address these problems, Dr. De, the study's lead author, teamed up with Kyle O'Laughlin, MS, a lead research technologist in Cleveland Clinic’s Department of Biomedical Engineering.

"Working with clinical professionals allowed me to gain knowledge of a different research field while providing them with my own expertise," he says. "Sharing our knowledge and expertise enhanced the quality and scope of this study, which will help it have a greater impact on urology surgical practice going forward."

Setting up a mock ureteroscopy

O'Laughlin helped the physicians set up protocols to collect and analyze data from 14 Cleveland Clinic urology residents, fellows and junior staff. The team divided the physicians by gender (eight men and six women) and attached electromyography (EMG) sensors to their arms. EMG sensors track muscle contraction through electrical activity. O'Laughlin and the team determined where to place the sensors so they would not obstruct the residents' movement while collecting useful, accurate data.

Physicians performed a mock ureteroscopy, a routine procedure to remove kidney stones. After, they reported how they perceived the workload through a NASA Task Load Index (NASA-TLX) form. The researchers tested in multiple conditions, including whether the physician was sitting or standing and whether they were using a reusable or single-use ureteroscope.

Data show women require greater muscle activation

For all positions and equipment types, women reported higher physical exertion NASA-TLX scores than their male counterparts. These reports were backed up by EMG measurements showing that female urologists required greater muscle activation in multiple muscle groups, especially in their forearms. Single-use ureteroscopes were less strenuous to use for both genders.

Research and preventing physician burnout

With physician shortages at an all-time high, it is important to understand and combat what contributes to burnout. Hospital leaders consider many factors when selecting equipment and navigating budget limitations while prioritizing the well-being of their staff.

Dr. De says the gender distinctions uncovered in her study provide Cleveland Clinic with a better understanding of employee needs. She hopes findings aid leadership in informed decision-making when ordering and implementing equipment.

On a larger scale, Dr. De hopes her findings will help convince industry leaders to consider more ergonomic designs for their products.

"Industries don't usually modify their products with alternative ergonomics in mind," says Dr. De. "Ureteroscopes and similar surgical equipment have stayed pretty much the same shape for the past 20 years because there wasn't any research-backed evidence that things need to change."

Dr. De is also working with Vijay Krishna, PhD, Biomedical Engineering, to develop laser-activated nanoparticles that may allow for treatment of kidney stones without the need for strenuous surgeries.