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Int J Surg. 2015 Jun;18:83-7. doi: 10.1016/j.ijsu.2015.04.047. Epub 2015 Apr 20.

Surgical ergonomics. Analysis of technical skills, simulation models and assessment methods.

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Golden Jubilee National Hospital, Cardiothoracic Department, Agamemnon Street, Clydebank, Glasgow G81 4DY, United Kingdom. Electronic address:
Royal Infirmary of Edinburgh, Cardiothoracic Department, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom. Electronic address:
Leeds General Infirmary, Cardiothoracic Department, Great George Street, Leeds LS1 3EX, United Kingdom. Electronic address:



Over the past two centuries the surgical profession has undergone a profound evolution in terms of efficiency and outcomes. Societal concerns in relation to quality assurance, patient safety and cost reduction have highlighted the issue of training expert surgeons. The core elements of a training model build on the basic foundations of gross and fine motor skills. In this paper we provide an analysis of the ergonomic principles involved and propose relevant training techniques. We have endeavored to provide both the trainer and trainee perspectives.


This paper is structured into four sections: 1) Pre-operative preparation issues, 2) technical skills and instrument handling, 3) low fidelity simulation models and 4) discussion of current concepts in crew resource management, deliberate practice and assessment.


Rehearsal, warm-up and motivation-enhancing techniques aid concentration and focus. Appropriate posture, comprehension of ergonomic principles in relation to surgical instruments and utilisation of the non-dominant hand are essential skills to master. Low fidelity models can be used to achieve significant progress through the early stages of the learning curve. Deliberate practice and innate ability are complementary to each other and may be considered useful adjuncts to surgical skills development.


Safe medical care requires that complex patient interventions be performed by highly skilled operators supported by reliable teams. Surgical ergonomics lie at the heart of any training model that aims to produce professionals able to function as leaders of a patient safety oriented culture.


Assessment; Deliberate practice; Motor skills; Simulation; Surgical ergonomics; Training

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