Mohs Surgery is a pain in the Neck
Abstract
Ergonomics in Office-Based Surgery: A Survey-Guided Observational Study
· ADAM C. ESSER, MD**Department of Dermatology, Mayo Clinic, Jacksonville, Florida; and ,
· JAMES G. KOSHY, PHD Ergonomics & Human Factors Unit, Mayo Clinic, Rochester, Minnesota, AND
· HENRY W. RANDLE, MD, PHD**Department of Dermatology, Mayo Clinic, Jacksonville, Florida; and
· *Department of Dermatology, Mayo Clinic, Jacksonville, Florida; and Ergonomics & Human Factors Unit, Mayo Clinic, Rochester, Minnesota
Address correspondence and reprint requests to: Henry W. Randle, MD, Department of Dermatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, or e-mail: randle.henry@mayo.edu
Adam C. Esser, MD, James G. Koshy, PhD, and Henry W. Randle, MD, PhD, have indicated no significant interest with commercial supporters.
Abstract
BACKGROUND The practice of office-based surgery is increasing in many specialties.
OBJECTIVE Using Mohs surgery as a model, we investigated the role of ergonomics in office-based surgery to limit work-related musculoskeletal disorders.
METHODS All Mayo Clinic surgeons currently performing Mohs surgery and Mohs surgeons trained at Mayo Clinic between 1990 and 2004 received a questionnaire survey between May 2003 and September 2004. A sample of respondents were videotaped during surgery. The main outcome measures were survey responses and an ergonomist's identification of potential causes of musculoskeletal disorders.
RESULTS All 17 surgeons surveyed responded. Those surveyed spend a mean of 24 hours per week in surgery. Sixteen said they had symptoms caused by or made worse by performing surgery. Symptom onset occurred on average at age 35.4 years. The most common complaints were pain and stiffness in the neck, shoulders, and lower back and headaches. Videotapes of 6 surgeons revealed problems with operating room setup, awkward posture, forceful exertion, poor positioning, lighting, and duration of procedures.
CONCLUSION Symptoms of musculoskeletal injuries are common and may begin early in a physician's career. Modifying footwear, flooring, table height, operating position, lighting, and surgical instruments may improve the ergonomics of office-based surgery.
Solution for Selected Mohs Cases: by Dr. Richard J. DeAngelis
Operating with head straight up, but how?
Answer: Doing surgery under operating microscope as below
Further details are discussed below along with photos taken through the Accu-Scope
Basal Cell Carcinoma
Photo taken through Accu-Scope of this Basal Cell Carcinoma
Elliptical Excision with 15c blade while working through scope
Day 5 Post Op – Suture Removal
This scope allows one to sit upright in an ergonomically correct position, and dramatically improves one’s visualization and therefore accuracy of excision while sparing the pain in the neck. I have done about a dozen or so cases while working through the scope to date within the last month, and I am definitely a believer. This is the best thing that has come my way and changed my way of practice since the dermatoscope, which I can’t practice 5 seconds without.
Richard J. DeAngelis, M. D.
Slides and Histo. Of Debulking Biopsies – Vertical Sections
Can you find a Basal Cell Carcinoma on this forehead?
Dermatoscope helps to distinguish AK’s from Early BCC
These are just a few examples of how the dermatoscope can be used as a visual aid to better delineate the extent or presence of tumor that can not always be appreciated with either naked eye or visualization with 2.5x loops which I routinely use. I am also becoming more and more attached to this new Accu-Scope affordable operating microscope. This is particularly helpful for eyelid tumors where working around the lacrimal collecting system. A few photos of a case sparing the lacrimal duct in the medial canthal area is below.
It is also helpful if working around very vital structures deep in the mastoid neck below the Sternocleidomastoid Muscle where none of us has any business being. A picture showing residual tumor through and below the SCM Muscle is below, taken through the Accu-Scope.
