The operating room (OR) is often imagined as a highly choreographed space – every step deliberate, every movement precise, and every member essential. Yet, beneath this seamless surface lies a persistent under-addressed risk to those who make it all happen: the ever-growing ergonomic hazards faced by OR teams. Our group recently reported about live observations by ergonomic experts in the OR, in “Under Pressure: Live Observation of Ergonomic Challenges in the Operating Room” published in the BJS, to shine a spotlight on some of these challenges and adds to a growing call for change.1

We observed OR teams across multiple specialties and procedures to identify common ergonomic challenges to target for improvement in future educational interventions. The findings were both revealing and concerning: surgeons leaning awkwardly to see monitors, anesthesiologists contorted around ill-placed equipment, scrub nurses reaching and twisting repeatedly to manage instruments. These were not rare occurrences, they were routine. In a single two-hour procedure, 37 near-miss tripping incidents were recorded due to poor cord management. It is not just a matter of individual minor discomforts, but systemic risks that accumulate over time, leading to musculoskeletal injuries, burnout, and ultimately threats to patient safety and the sustainability of surgical care systems.

Historically, the conversation around ergonomics in surgery has been largely focused on surgeons. Whilst important, this lens is incomplete. Poor ergonomics affects everyone in the OR: nurses, anesthesiologists, technicians, and trainees. A scrub nurse standing for hours with no anti-fatigue mat is as vulnerable as the surgeon operating with prolonged neck flexion. An anesthesiologist forced into a hunched position for intubation is as likely to suffer long-term strain as any other member of the team. Moreover, poor ergonomics doesn’t just result in discomfort. It affects communication, reaction time, and decision-making, all which affect patient safety. Increasingly, we recognize that surgical safety is not only about checklists and technique; it is also about ensuring that the people delivering care are supported, protected, and able to perform at their best.

Afroza Sharmin presents her BJS Prize session lecture “Exploring effective strategies in promoting diversity, equity and inclusivity (DEI) in surgery - a scoping review” from the 2025 Association of Surgeons of Great Britain and Ireland (ASGBI) International Surgical Congress, which placed 3rd in the prize session.

Welcome back to Dr Paul McCoubrie’s a 'view from the dark side' — a series looking at the world of surgery through the lens of a radiologist.

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“I’m absolutely bloody exhausted”

Correspondence to: Yuquan Chen (email: yuquan.chen@monash.edu)

School of Public Health and Preventive Medicine

Faculty of Medicine

How often do surgical patients experience pain, anxiety, stress, and sleep disturbance during their hospital stay? And how severe are these symptoms? In collaboration with numerous Dutch hospitals, we set out to answer these questions, using an uncommon and innovative, but for our goals perfectly fitting method: a flash mob study.

A flash mob study is a novel research design in which data is collected on a single day, simultaneously in multiple centres. It’s an efficient way to address clinically relevant questions on a large scale – in our case the point prevalence of surgical patient pain, anxiety, stress, and sleep disturbance. But this approach also requires meticulous planning: there’s only one shot to get it right.

The preparation for the project took a year. We started by developing the methodology and drafting the study protocol, followed by compiling all necessary documents for submission to the Medical Ethics Review Committee (MERC). While awaiting approval, we reached out to all hospitals across the Netherlands. Through secretaries and outpatient clinics, we found surgeons and residents in 29 Dutch hospitals who were eager to participate and helped forming a local research team and arranging institutional approval from the hospital board.

Now, hear directly from two of the paper’s authors, David N Burling and John T Jenkins.