In this post, I will share some ideas about how to set up the physical space in surgery.
I want to start by encouraging you to take photos or video in order to evaluate your surgical ergonomics and body posture. It’s hard to pay attention to your body posture while you’re in the middle of surgery. Even if you are trying to pay attention to postures and positions, you may not be able to know or evaluate your posture without a view from the outside. By taking video, you can later watch yourself and find problems that you can then make a special point of changing during your next surgery. The technology is so accessible now– a smartphone or digital camera is all you need. You can prop a phone on a box of gloves; tape it to an IV pole, tape it to a surgical light, or use a tripod.
In the picture here, I had set up video of myself from above and behind because I was having shoulder and upper back pain after surgery days, and this helped me figure out when I was tensing up so I could work on that.
The physical environment includes things like the height of your surgery table and how you position the patient and objects in your space. These factors influence the way you use your body– and changing them doesn’t have to be difficult or expensive.
In this first example, the surgery table is too high, so the surgeon has to raise her shoulders and abduct or raise her elbows in order to reach the patient. This puts strain on the upper body, especially the neck and shoulders.
In the second picture, the surgery table is too low, so the surgeon has to lean forward in order to reach the patient. This could place strain on the neck, upper back, and lower back, and perhaps also the shoulders.
When the surgery table is adjusted comfortably, the surgeon can stand with a relaxed upper body and arm posture.
In general, the easiest table height for a relaxed posture is one in which the hands fall about 5-10 centimeters – or 2-4 inches– below the elbows. This means that the table height will need to be adjusted between large, deep-bodied dogs and small patients, in order to keep the surgeon’s upper body in this relaxed position.
Not everyone has access to tables that adjust adequately, but this doesn’t have to mean that you are condemned to upper body strain. Low tech solutions like step stools or platforms, bed risers, blocks, and other boosters can help get you and your patient to a comfortable height.
Another positioning issue that comes up sometimes is that a tiny patient is placed in the middle of a surgery table, so that the surgeon has to reach a long way to the patient, or bend forward. A lot of reaching and bending can put strain on the upper and lower back and shoulders.
If you have a surgery table that you can lean your body against as you work, you may find that it’s comfortable to work with a patient in this position. However, if your table moves when you lean on it, then you may be straining yourself to reach like this. If you do find yourself bending and reaching forward to reach a patient in the middle of the surgery table, consider just positioning the patient closer to you.
When we talk about positioning, also remember to look at other objects in the surgery space. Are there objects that the surgeon has to work to avoid, or has to work to reach?
The surgeon in this picture is having to lift her arm and elbow way up to avoid the instrument tray. It’s great having the instruments nearby and in easy reach, but this tray would work a lot better if it was lower or further away, or even if the instruments were on the table between the patients back legs.
Most spay and neuter vets stand for surgery. Its what we were taught in school, and many of us don’t think about sitting unless we have to because of injury or for comfort during pregnancy.
But research with human surgeons showed that they were less fatigued if they either sat for surgery, or alternated between sitting and standing. So if you haven’t tried sitting during surgery, it may be something to consider at least some of the time to increase comfort during surgery.
Sitting for surgery is pretty straightforward when it comes to a small patient. It’s possible to use a standard stool or chair and get close enough to the patient to remain in a comfortable posture
However, it can be more challenging to stay in a comfortable position when doing surgery on a large, deep-bodied patient. A surgeon sitting on a standard stool or chair may have to raise her shoulders and elbows to clear the patient’s body. In this scenario, it’s not possible to lower the table or raise the surgeon’s height because the surgeon’s legs are already in contact with the underside of the table.
There is a solution–using alternatives like a saddle-shaped seat or a sit-stand stool can help by allowing the surgeon to remain close to the patient while achieving a better relative height
Finally, I want to mention some other aspects of the physical environment in surgery that can affect surgeon comfort and fatigue. Research shows that floor mats can decrease lower limb discomfort and fatigue. They sometimes get credit for helping relieve back pain, but that isn’t supported by the research.
The “perfect mat” will be one that’s not too hard and not too soft. The best mat will be a matter of personal preference. You want something that is cleanable and non-slip. Try out a variety of mats whenever you get the chance to see what feels best to you. Also, look online to ask for a (small) free sample mat from a supplier like Aspen or Smart Step, or a one month trial from other suppliers, so you can see what works for you.
As with floor mats, there is no perfect surgery shoe. But in general, wearing shoes with cushioned soles while in surgery will be the most comfortable, even if you are standing on a floor mat. Some studies of industrial workers found that people who wore different shoes on different days were less likely to have plantar fasciitis than those wearing the same shoes every day. Cushioned athletic shoes or rubber clogs can be good choices.
Next post, we’ll talk about ergonomics when it comes to surgical techniques.
Vet med is my second career gone into especially to be a spay/neuter vet. I wish I could have seen your articles 25 years ago. Although I am now retired due to broken , now removed, knee cap and broken right humeral neck, I believe the R shoulder and neck pain I continue to experience is due to bad posture and stress during doing surgery. I was always stressed I would do something wrong to the detriment of my patient. Hopefully your work here will benefit many practicing S/N vets. Thank you.
Thank you Isis– I too hope that s/n vets will find this information helpful, and that they may be able to have long, comfortable careers. So sorry to hear that you’re still experiencing pain even after you have retired from surgery.