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Ergonomics & Longevity

Ergonomic gear reduces the physical load of long cases such as perineal urethroplasty and complex reconstruction, which routinely run 4 to 8 hours. Comfortable equipment helps, but preventing occupational strain also requires a suitable operating setup, breaks and assessment when symptoms develop. See Surgical Ergonomics for the broader workflow.

Footwear and Standing Surfaces​

Choose well-fitting, supportive shoes with grip appropriate to the floor and protection and cleanability that meet local theatre requirements. Features to prioritize are arch support, shock absorption, slip resistance (fluid and blood on operating room floors is routine), toe protection and a washable upper. Clogs with a rigid sole, lightweight easy-clean clogs, cushioned athletic shoes and athletic shoes with aftermarket insoles are all used. Rigid clogs give arch support and run hot, lightweight clogs give little arch support without insoles, and maximally cushioned shoes feel unstable to some surgeons during standing surgery. Trial them during standing and pedal use; excessive softness or instability may be uncomfortable even when walking feels good.[1] Insoles and anti-fatigue mats can help some workers who stand for long periods.[1]

Use theatre-approved mats that can be cleaned and positioned without obstructing pedals, equipment or the walking route. Replace footwear according to wear, grip, fit and symptoms. Cushioning can break down before the upper looks worn, and there is no universal replacement interval for surgeons.

Seating and Console Setup​

Choose a stable, adjustable seat that allows comfortable reach to the work and pedals. Set the table, viewer, armrests and seat together so the shoulders can relax and the hands remain near elbow level. Change sustained postures and plan short pauses when the operative stage permits. The ACS 2025 recommendations provide illustrated setups for open, laparoscopic and robotic work; specific gear should fit the operator and task.[2]

A saddle or active stool may suit an individual; neither is universally preferable. Saddle stools change hip angle, and active stools permit small movements. A four-surgeon crossover study of vaginal operations found no detected difference in measured postural load across four chair types, including a saddle chair.[5] Seated work occurs at the robotic console, in some perineal urethroplasty setups and in pediatric cases. The console seat is manufacturer-supplied. Trial the actual seat-console combination before buying.

Posture​

  • Keep the cervical spine neutral by setting loupe declination correctly (see Optical Aids).
  • Keep the shoulders relaxed and down, so the lead apron does not ride on the trapezius.
  • Keep the elbows at about 90° and adjust bed height case by case.
  • Keep both feet planted; placing one slightly forward is a common resting position.
  • Take short breaks, such as shoulder rolls and neck extensions, during long cases when the operative stage permits.

Compression Hosiery​

Graduated compression may help selected people with venous symptoms, but the pressure, length and fit should match the clinical indication. Hosiery of about 15–20 mmHg is commonly worn in practice to reduce ankle swelling and end-of-day fatigue, and higher pressures are used for known venous insufficiency or varicosities. Mid-calf length is the usual practical choice, since thigh-high stockings are harder to wear all day. Therapeutic hosiery and hospital anti-embolism stockings serve different settings. Suspected significant arterial disease requires assessment before compression.[3]

For prescribed hosiery, avoid folds and constricting rolls, follow its care instructions and arrange review when fit or symptoms change.[4]

See Also​

References​

1. OSHA. Ergonomic solutions for prolonged standing and lower-extremity tasks. General occupational guidance, not comparative trials of surgical shoe brands.

2. American College of Surgeons. Surgical Ergonomics Recommendations. 2025. Official recommendations and illustrated guide.

3. NHS Highland. Compression hosiery formulary: assessment and contraindications.

4. Guy's and St Thomas' NHS Foundation Trust. Compression stockings. Reviewed January 2025.

5. Singh R, Carranza Leon DA, Morrow MM, et al. "Effect of chair types on work-related musculoskeletal discomfort during vaginal surgery." Am J Obstet Gynecol. 2016;215(5):648.e1-648.e9. doi:10.1016/j.ajog.2016.06.016