Talk on Optimizing Surgical Ergonomics & Mitigating Thermal Injuries: Insights by Dr. Premkumar Balachandran on 8th of February 2025 during World Congress of World Association of Laparoscopic Surgeons {WALS 2025}.
 
In the evolving landscape of minimally invasive surgery (MIS), optimizing surgical ergonomics and mitigating thermal injuries are critical for enhancing patient safety and improving surgeon performance. Dr. Premkumar Balachandran, a renowned expert in the field, emphasizes the importance of ergonomic principles in laparoscopic and robotic surgery, along with strategies to minimize thermal injuries from energy devices.
 
Understanding Surgical Ergonomics
 
Surgical ergonomics involves designing workspaces and techniques that reduce surgeon fatigue, prevent musculoskeletal disorders, and enhance precision. Poor ergonomics in MIS can lead to physical strain, reduced dexterity, and increased operative time. Dr. Balachandran highlights key ergonomic considerations, including:
 
Optimal Port Placement: Proper positioning of trocars minimizes instrument collisions and ensures better triangulation for instrument maneuverability.
 
Surgeon Posture: Maintaining a neutral spine, proper monitor alignment at eye level, and keeping arms close to the body reduces strain on the neck and shoulders.
 
Instrument Handling: Using lightweight, ergonomic instruments with appropriate shaft length and grip design enhances dexterity and control.
 
Team Coordination: Efficient operating room layout and synchronized team movement prevent unnecessary exertion and delays.
 
In robotic surgery, ergonomics are significantly improved due to the surgeon’s seated posture and wristed instrument movement, but Dr. Balachandran stresses the importance of adjusting the console, foot pedals, and camera settings to optimize workflow.
 
Mitigating Thermal Injuries in Minimally Invasive Surgery
 
Thermal injuries are a major concern in laparoscopic and robotic surgery due to the widespread use of energy devices, including electrosurgical instruments, ultrasonic scalpels, and bipolar diathermy. Unintended thermal damage can lead to serious complications such as delayed bowel perforation, nerve damage, or vessel injury.
 
Dr. Balachandran underscores key strategies to minimize thermal injuries:
 
Understanding Energy Device Mechanisms: Different devices have varied thermal spread properties. Surgeons should be well-versed in the safe use of monopolar, bipolar, ultrasonic, and advanced vessel-sealing systems.
 
Controlled Activation: Avoiding prolonged activation of energy sources near vital structures helps prevent collateral thermal damage.
 
Tissue Effects and Spread: Awareness of thermal spread and conducting real-time assessment of tissue response during energy application is crucial.
 
Intermittent Firing: Pulsing energy sources rather than continuous activation can minimize excessive heat buildup.
 
Proper Instrument Insulation: Damaged insulation in electrosurgical instruments can cause stray energy burns. Routine checks and the use of active electrode monitoring systems can help prevent these injuries.
 
Maintaining a Safe Distance: Keeping a safe margin from delicate structures like ureters, bowel, and nerves reduces the risk of unintended burns.
 
Integration of Technology for Enhanced Safety
 
Recent advancements in energy devices incorporate features such as real-time feedback systems, automatic tissue sensing, and temperature modulation to improve precision and reduce unintended thermal damage. Dr. Balachandran advocates for the adoption of modern technology, including advanced vessel sealers and robotics, which enhance control and safety.
 
Conclusion
 
Optimizing surgical ergonomics and mitigating thermal injuries are paramount for ensuring superior surgical outcomes in MIS. Dr. Premkumar Balachandran’s insights highlight the importance of proper ergonomic practices, mindful energy device usage, and technological advancements in preventing surgeon fatigue and patient complications. By implementing these principles, surgeons can achieve greater precision, reduce complications, and enhance both patient safety and professional longevity.