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Ergonomics is more than “ease of use” and the consequences of bad ergonomics in healthcare

The fast-paced nature of medical and surgical innovation means that research and development teams are as highly specialized as surgical practitioners, each by necessity in their separate spheres. Increased specialism means that technical developers and the end users of new technology have never been so diametrically separate.

New technology in surgical practice is revolutionizing healthcare with minimally invasive techniques, robot-assisted surgery, telemedicine and ever-more exciting innovations. The focus is always on the procedure, and the drive to improve practice has always centered directly on the patient experience. Audited improvement is measured in surgical success rates, and rightly so; but such simplistic metrics may be missing an important factor which contributes both to patient outcomes and the wellbeing of the surgical team.

The ergonomic aspects of new technology almost always take second place – medics of a certain age may recall the increase in people presenting with repetitive strain injuries when desktop computers were rapidly adopted in the workplaceᶦᶦ . It is absolutely clear that poor ergonomics in the workplace leads to poor health among staff and poor, ineffective and inefficient practice. To put it in more positive terms, good ergonomics and inbuilt ease-of-use mean better results for practitioners and patients alike.

Work-related injuries are common among surgeons, and can have serious – even catastrophic effects both on themselves and the people who make up their caseloads. A culture where essential work has to continue no matter the circumstances or danger to the worker contributes to under-reporting of concerns and means practices are slow to changeᶦᶦᶦ.

Increasingly minimally invasive techniques mean that surgeons are working with incredibly delicate tools in smaller, tighter spaces, contributing even further to physical fatigue and strainᶦᵛ.

Nurse crawls on pathogen-rich O.R. floor to reposition the right pedal.
Nurse crawls on pathogen-rich O.R. floor to reposition the right pedal.

Scratching the surface of bad ergonomics in the operating theatre reveals shocking inadequacies. Some improvements – adjustable working heights, better lighting, appropriate seating – have helped to shape the modern ergonomic environment in an operating theatre; it can be done.

The use of diathermy cautery in the operating room comes with its own particular set of challenges; until recently, the only way to operate diathermy was by using a foot pedal. This means operating an unseen foot plate – feeling around with one foot, perhaps glancing under the table, all while holding delicate instruments in critical positions as a patient lies incised and bleeding. When that pedal can slide around on the floor and fall off footstools, the risk can be tragic. Foot-operated instruments bring significant trip hazards and often even require a staff member to crawl on the floor to move the foot plate as the surgeon moves around the patient. Attempts have been made to improve the ergonomics of the foot controlᶦᵛ, but for complete freedom of movement and safety, a hand operated system is set to become the gold standard.

The BiPAD® diathermy control device is hand operated and designed with a simple goal: to eradicate the risks of foot-controlled devices. Hand controlled diathermy can bring an end to nurses crawling under the operating table to move equipment, to surgeons peering into the dark recesses of the OR to find the foot control as their patient bleeds. An end to performing surgery while almost standing on one foot. Truly ergonomic design for everyone’s safety; a better user experience and better patient outcomes. Our goal is ZERO: zero risk diathermy.


[1]Voss, R. K., Chiang, Y. J., Cromwell, K. D., Urbauer, D. L., Lee, J. E., Cormier, J. N., & Stucky, C. C. H. (2017). Do no harm, except to ourselves? A survey of symptoms and injuries in oncologic surgeons and pilot study of an intraoperative ergonomic intervention. Journal of the American College of Surgeons, 224(1), 16-25.

[1] Kiesler, S., & Finholt, T. (1988). The mystery of RSI. American Psychologist, 43(12), 1004–1015.

[1] Wohl, D. & Hubbard, T. (2019) Physician safety is patient safety: Good surgical ergonomics to optimize patient care. American Academy of Otolaryngology Bulletin.

[1] Catanzarite, T., Tan-Kim, J., Whitcomb, E. L., & Menefee, S. (2018). Ergonomics in Surgery: A Review. Female pelvic medicine & reconstructive surgery, 24(1), 1–12.

[1] Van Veelen, M. A., Snijders, C. J., Van Leeuwen, E., Goossens, R. H. M., & Kazemier, G. (2003). Improvement of foot pedals used during surgery based on new ergonomic guidelines. Surgical Endoscopy And Other Interventional Techniques, 17(7), 1086-1091.


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