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Ok. OK. All right. Good afternoon to tho good evening. Rather to those who have joined, we'll just wait a minute or so. Um To let uh anyone else that's about to log on, log on and then we can make a start within the next minute or so. Ok. All right. So I think we'll make a start. So, um good evening everyone. Thank you so much for joining us uh for our webinar this evening, which um is part of our women Wednesdays initiative by the morning um academy, which is the trainee wing of the Association of Surgeons of Great Britain Island. Um We've got two really, really great speakers for you this evening discussing surgical ergonomics. Um So we'll have our first speaker who will speak first, followed by a second speaker. Um And then we can do some questions at the end if that suits. Um everybody uh feel free to put question in the chart and then we can ask our speakers towards the and, or you can type them up towards the end as well. Um So I'm gonna um ask my colleague, Mike to introduce our first speaker. Um I'll just introduce myself before we move on. I'm G, I'm the education lead, um, and a general surgery ST six trainee in east of England. Thanks Groomer and the, um, Mike. I'm, er, er, ST for general surgical training from London and a phd student at Cambridge. Um, we are, er, really pleased to have Professor Halbe with us today. Uh, we can see the credentials that have appeared on the, the screen. So it's fantastic to have her speak er, today, but just as a summary, er, Professor H is a engineer and surgical researcher from the Mayo Clinic and emeritus professor at the University of Nebraska. She's previous president of the Human Factors and Ergonomics Society and the immediate past president for er Society of Surgical Ergonomics. So it's er fantastic to have her and er over to you, Professor er Halbe. Thanks Mike. So the title of my talk, my talk tonight is Surgical Ergonomics surgery is a pain in the neck. I'm gonna give you why I think that when I go into an or what I see is something different than what you see. You see all the technology that's happened in the past 100 years. I see the neck posture of one of the original founding fathers of Mayo clinic trials. Male, I see the neck posture at, during one of the first open heart surgeries. And I see today's neck postures in an even more technologically advanced or these surgical postures create a stressful environment for you to work in. It's really hard on your bodies. There's a lot of data out there that talk about the prevalence of work related musculoskeletal disorders. And they range from 6 to 8 out of 10 people self reporting musculoskeletal disorders. So you're not alone. If you have pain and discomfort from your job, these things can interrupt your work, your leisure, your sleep and can impact even patient safety. Overall, there's a lack of er ergonomic guidelines that we're trying to overcome right now in places like the Society of Surgical Ergonomics. So I'm gonna start out by talking a little bit about what I do on, on my daily job. I use two different types of methods, subjective and objective. I'm gonna put this down. So I don't distract you moving around. Um The subjective measures are things like the surgical task load index or NASA task load index. Um No, a questionnaire for body part discomfort and then survey instruments that were developed at clinic for things like burnout. I'm also lucky to be able to have gone into the motion analysis lab like you see in the upper right hand s picture there and use wearable sensors called imus inertial movement units. And we can look at the surgeon's interoperative posture, neck posture, torso posture, and arm posture. And then we can use that to approximate risk because we have a short time. I'm gonna talk about 22 studies that we were looking at um for surveys um for the subjective measures. One is a sort of a, an overview of some professional societies and the other one is within mayo clinic walls. So I've, I've been part of and may have been part of a number of different surveys for, for ea S members from uh the lead author is MS Antonio Wells. We, we looked at the general surgeons there. We've looked at reconstructive mic micros surgeons, male abdominal pelvic surgeons, vascular surgeons, and then Uro Gyne surgeons and everyone has pain as their number one spot. Those people that have either um a lot of bending forward also have lower back issues. But this is the one, this is the slide that really takes it home to me is that I asked on all of my surveys, if you fear that your work related physical discomfort will reduce your ability to perform future surgeries. What you see here is that half of the surgeons are concerned about their career longevity. You don't find that in other uh professional um roles. I don't fear that for example, this pain and if this is actionable pain, when you talk to your patients and they have a four out of 10 on their pain scale, you know, that's actionable. When we looked at those people who had pain uh four or higher and then correlated that with burn out, we had a statistically significant correlation for all of the groups that we asked that question of, we just did AAA internal survey across Mayo Clinic. And what we found was that different modalities have different physical and mental demands as well as rates of neuromuscular disorders that are self um reported at different rates of burnout. And it, the open surgery is the most high rates for all of these things statistically, significantly higher than physical demand for laparoscopic surgery and mental demand for that. And then robotic surgery is the least demanding except for mental demand and has fewer musculoskeletal disorders and lower spurn out. If we pivot now to objective measures, let's go back to those inertial movement units. I put them on 53 surgeons in, in the Mayo Clinic, Arizona campus. I'm in Minnesota and we looked at 100 and 16 surgeries across 10 different specialties. What we found was that the important thing here is to look at those orange and red categories. It goes basically no risk. It's hard to say no risk, minor risk, moderate risk and high risk. So if you look at those two wedges that are orange and red, those are the ones we wanna look at. So 65% of surgical duration across these 100 and 16 surgeries was in that high risk category. And then 31% of the torso flex forward was in that category and 11% of shoulder abduction was in that category. So what happens with that laparoscopic is statistically significantly more head upright than open and the drivers for that are loops and headlights. We also noticed as the surgical duration increased, your posture got worse. Again, these are all things that you probably know, but haven't really paid attention to it because you're, you're correctly tunnel visioned into the patient. So my role here is to tell you what can be done. Unfortunately, I don't have everything outside of Mao's, but I do have a number of things. If you have your camera or your camera on your phone ready, I'm gonna have a lot of QR Codes. Everything can be gotten to with this one QR code. So we've got some ergonomic education and that er ergo education is about the or set up. We have something called or stretch that we created and then within the firewall unfortunately, is the exoskeleton work. And that will, I'm gonna try to get that outside soon and that will then be linked again to the, um, the Q QR code here. So let's start out with the educational module with the Society of Surgical Ergonomics. We created something called a score module and that's for the American Board of Surgeries, um score modules that are for general surgery. And then we thought, well, nobody's really gonna go there for an optional module. Let's put something together. And Mayo Clinic allowed us to, if you use that QR code, get to create a five five-minute modules that, that teach you how to look at ergonomics in there, we had some postures. So the overall posture for surgery, no matter what you're doing is to be standing upright as much as you can have your shoulders relaxed. I know that when you're in something in your shoulders go up around your ears, you wanna keep your arms by your.