The Impact of the Alexander Technique in Improving Surgical Ergonomics and the Surgeon's Posture During Minimally Invasive Surgery

Saturday, October 2, 2010: 3:56 PM
Yerba Buena Salon 9 (San Francisco Marriott Marquis)
Pramod P. Reddy, MD1, Trisha Reddy1, Jennifer Roig-Francoli, M.AmSAT1, Lois Cone, M.AmSAT2, Bezalel Sivan, MD1, W. Robert DeFoor, MD1, Krishnanath Gaitonde, MD3 and Paul Noh, MD1, (1)Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Shriners Hospital, Cincinnati, OH, (3)Urology, University of Cincinnati College of Medicine, Cincinnati, OH

Purpose: One of the main ergonomic challenges during surgical procedures is the surgeon's posture.  This issue is further compounded by the surgical equipment used in Laparoscopic/Minimally invasive procedures (MIS).  The Alexander Technique (AT) is a process of psychophysical education of the musculo-skeletal system in order to improve posture and coordination.  The purpose of this study is two fold; (1) to assess the impact of AT in improving surgical ergonomics during MIS and (2) to assess the impact of AT in improving the surgeons posture during the performance of MIS.

Methods: We performed a prospective cohort study in which each subject served as their own control. Seven surgeons from the urology program were recruited after obtaining IRB approval.  All subjects underwent AT instruction by certified AmSAT teachers.  The subjects had a Pre-AT and Post-AT assessment of laparoscopic skills, co-ordination, manual dexterity and posture.  The data was tabulated and descriptive statistical analysis performed using the paired 't' test.

Results: All subjects unanimously reported a subjective improvement in their overall posture, The postural assessment scores of the spine, neck, hand and fingers all showed statistically significant improvements (Post-AT ‘p’ values ranged from 0.0198 – 0.0229).  They had an improvement in the time load test (postural endurance P value=0.0178).  The subjects also demonstrated improved Post-AT ergonomics and improved scores on the Post-AT assessment, with enhanced ability to complete the laparoscopic skill sets (suturing – p value = 0.0178 and ring transfer – p value = 0.02).  There was in improvement in the Post-AT assessment of intentional tremor (Rt hand P value=0.006 & left hand P value=0.0138). 

Conclusion: The AT training program resulted in a statistically significant improvement in posture, trunk and shoulder endurance and surgical ergonomics, accompanied by reduction in perceived discomfort when performing MIS maneuvers.  Overall there was significant improvement in the subjects posture both at rest and during MIS maneuvers documented by both subjective and objective assessments.  Improved endurance and posture reduces the occurrence of surgical fatigue during MIS.  AT training of surgeons has the potential to reduce surgical fatigue related surgical errors and additionally it may also reduce the repetitive stress injuries that MIS surgeons are prone to developing.  Future studies investigating the impact of AT training on surgeons as they perform MIS or open surgery is recommended as this will aid our understanding of the benefits afforded by AT and allow its implementation into other aspects of surgical training.