In 2019, NASA had planned the first all-female spacewalk from the International Space Station. While this event was not meant to be a symbol of gender equity, the occasion was celebrated with anticipation. The week before the walk, the agency realized there was only one available suit optimized for a spacewalk that fit the female astronauts. NASA chose to swap out one of their female astronauts for a male and the all-female spacewalk milestone was delayed.1 The design limitation of space suits directly impacted the assignments for which astronauts of “atypical” shapes and sizes are eligible.2
Meghal Shah, MD
The field of surgery is facing similar challenges. As the surgical workforce makes strides towards greater gender and minority representation, the instruments we use, and our built environment are not evolving at the same pace to match our diversifying needs. Most surgical instruments were designed in early and in the mid-20th century when the physician workforce was predominantly tall, white, and male. Many of today’s surgeons must now grapple with tools that were built for surgeons of yore who do not look like them, often requiring more physical effort and work-arounds.
The most obvious of these challenges is in hand size. The mismatch between large instrument handles and small hand sizes creates a challenge for many, especially with laparoscopic surgery. One frequently cited culprit is the laparoscopic stapler, which is meant to be held and deployed with one hand, though it is categorically impossible to do so with a small hand size. These challenges create musculoskeletal strain and injury when left unaddressed.
The nature of surgical training and practice compels us to develop ergonomic workarounds and take the blame when we fumble. We need to acknowledge that our built environment is not an unchangeable fact of nature but rather a fallible product of human design. As such, it can be changed. The time for those designing our tools and workspace to witness how all surgeons use what they have built is overdue.
Here are some suggestions on how to make the operating room more accessible:
- Advocate for equity in instrument design. In 2018, a meta-analysis found that 12% of surgeons were forced to take a leave of absence, reduce/modify hours, or even retire early due to work-related musculoskeletal injuries.3 Before signing supplier contracts, leadership can request a plan to improve instrument accessibility. It is in the hospital’s benefit to invest in and advocate for surgeon wellness as operating rooms generate significant revenue. Health systems need to advocate for equity in instrument and OR design.
- Ensure that all individuals are equally represented in leadership roles, especially those from underrepresented or marginalized backgrounds, to ensure that products are equitable and accessible. Women comprise 25% of biomedical engineers and 23% of medtech CEOs.4,5 Among the 118 chairs of academic general surgery departments in the U.S., 14.7% are women and 4.3% are Black.6 Diversity in these roles will ensure that valuable insights are incorporated into product and system design. This will only serve to make device companies more competitive and hospitals more attractive to surgeons and patients of all backgrounds.
- Democratize the design process. We need to actively seek opportunities for the designers of surgical instruments and equipment to collaborate with surgeons and trainees. The people who build our tools and environment should be invited into the operating room to see how our tools are used and how they can be improved.
References:
- Fortin, J. & Zraick, K. First All-Female Spacewalk Canceled Because NASA Doesn’t Have Two Suits That Fit. The New York Times (2019).
- Koren, M. The Original Sin of NASA Space Suits. https://www.theatlantic.com/science/archive/2019/03/nasa-spacesuit-women-spacewalk/585805/ The Atlantic (2019).
- Epstein, S. et al. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 153, e174947 (2018).
- Biomedical Engineer Demographics and Statistics [2023]: Number of Biomedical Engineers in the US. https://www.zippia.com/biomedical-engineer-jobs/demographics/ (2022).
- Kirsh, D. Diversity in medtech: 2022 markedly the best for women in medtech. Medical Design and Outsourcing https://www.medicaldesignandoutsourcing.com/diversity-in-medtech-2022-markedly-the-best-for-women-in-medtech/ (2022).
- Kassam, A.-F., Taylor, M., Cortez, A. R., Winer, L. K. & Quillin, R. C., 3rd. Gender and ethnic diversity in academic general surgery department leadership. Am. J. Surg. 221, 363–368 (2021).