Effects of prolonged microscopic work on neck and back strain amongst male ENT clinicians and the benefits of a prototype postural support chair

Vijendren, Ananth; Devereux, Gavin; Kenway, Bruno; Duffield, Katherine; Rompaey, Vincent Van; Heyning, Paul Van de; Yung, Matthew

doi:10.1080/10803548.2017.1386411

Cited by 14 publications

(28 citation statements)

References 18 publications

(34 reference statements)

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“…In fact, microscopic work-related neck and back pain has been prospectively studied and the time to fatigue shown to correlate with surgical experience. 16 Additionally, microscopic work-related fatigue may compound over time despite surgeon experience, and in low volume settings, the fatigue experienced may not lead to any noticeable decrease in efficiency or long-term musculoskeletal side effects; however, in high-volume centers, the effects of fatigue may become measurable. The high-intensity lighting may result in homogenization of colors and diminished ability for anatomic distinction.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

Raymond

Soriano

Belcher

et al. 2021

J Neurol Surg B Skull Base

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Objectives The three-dimensional (3D) exoscope has several advantages over the operative microscope (OM) but has not been extensively reported for its use in malignant temporal bone resections (TBR). We sought to demonstrate the feasibility of performing TBR, both lateral (LTBR) and subtotal (STBR), using the 3D exoscope for head and neck cancers. Design present study is a retrospective chart review from August 2016 until August 2019. Setting The study was conducted at a tertiary care center. Participants Patients were undergoing TBR with the Karl Storz VITOM 3D exoscope. Main Outcome Measures Demographics, tumor and surgical characteristics, patient outcomes were the primary measurements of this study. Results Fifty-five patients underwent 3D exoscopic TBR from 2016 through 2019 of which 18% (n = 10) underwent STBR. The 3D exoscope was used uninterruptedly in all procedures with no intraoperative complications. Most tumors were primarily T3 (42%, n = 23) or T4 (55%, n = 30) and of cutaneous (62%, n = 34) and parotid (27%, n = 15) origin. These TBR were often accompanied by infratemporal fossa resections (87%, n = 48), auriculectomies (47%, n = 26), mandibulectomies (53%, n = 29), and parotidectomies (96%, n = 53). On final pathology, 24% (n = 13) had microscopically positive margins. Over the study period, 20% (n = 11) of patients had recurrences with a median recurrence time of 5 months (range: 2–30 months). Conclusion In the largest case series of LTBR and STBR under exclusive 3D exoscopic visualization to date, we demonstrate the 3D exoscope is a feasible alternative to the operative microscope for LTBR and STBR. While oncologic outcomes remain to be clarified, it carries significant potential for use in complex oncologic procedures.

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Section: Discussionmentioning

confidence: 99%

Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

Raymond

Soriano

Belcher

et al. 2021

J Neurol Surg B Skull Base

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“…In contrast, without the availability of such visual displays, head and neck surgeries, a majority performed via an open approach, were associated with the longest duration of poor posture even when other ergonomic measures, such as tucking in patient arms, were taken. Despite finding overall better cervical‐thoracic spine posture in endoscopic, microsurgical, and robotic surgeries, it should be noted that prolonged static posture, eye strain, and awkward upper extremity maneuvers often associated with these procedures also contribute to poor ergonomics and potential risk of MSK injuries over time, 9 , 17 however, these variables were out of the scope of this study.…”

Section: Discussionmentioning

confidence: 85%

“…Even then, the currently published quantitative assessments have used intricate methods of measurement or observational methods. 8 , 9 , 12 Despite improved posture being shown to help with management of MSK pain symptoms when implemented with workplace interventions and an increase in general fitness, no studies to date have directly quantified surgeon posture. 13 Furthermore, for the surgeon seeking to improve their ergonomics in the operating room, there remains a need to clearly identify targets for improvement and have the tools available to properly meet these goals.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Within otolaryngology practicioners, the most commonly reported sites of pain are the cervical spine and neck followed by the back and shoulder regions. [7][8][9] These repetitive strain injuries commonly arise from engaging in awkward postural positions to work in narrow surgical fields inherent to the head and neck region. Other reported factors associated with work-related MSK symptoms in this group include standing while operating, using headlamps or surgical loupes, operating without a monitor in endoscopic sinus surgeries, and performing microlaryngeal surgeries for greater than 30 min or without arm support.…”

Section: Introductionmentioning

confidence: 99%

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Surgical ergonomics: Assessment of surgeon posture and impact of training device during otolaryngology procedures

Leung

Segal

Bernstein

et al. 2022

Laryngoscope Investig Oto

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Objective To identify factors associated with cervical‐thoracic spine posture in otolaryngology surgeries and evaluate the efficacy of a commercially available posture‐training device in enhancing surgeon ergonomics. Methods Over 3 months, neck and spine posture from individuals performing otolaryngology surgeries was recorded using UpRight Go 2™. Average baseline posture was first recorded and biofeedback was later introduced to attempt to correct posture. The proportion of time spent in upright/neutral cervical‐thoracic spine posture was correlated with surgeon and procedure characteristics and compared to proportion of upright posture time after biofeedback intervention. Results The proportion of upright operating time was significantly different between procedure subtypes and surgical approaches with best performance in rhinology procedures and worst performance in head and neck surgeries (90% vs. 62%; both p < .001). Female gender, shorter stature, and use of sitting stools were associated with greater proportion of surgery spent upright (all p < .05). Loupes use was associated with less time in upright posture ( p < .001). With biofeedback intervention, 8 of 10 subjects demonstrated an average of 5% improvement in operating upright, with most improvement found when performing laryngology procedures (7%) and least improvement in head and neck procedures (2%). Conclusions While surgeon posture varies across otolaryngology surgeries, sitting and minimizing the use of loupes may help promote a more ergonomic operating environment and improve surgeon posture. Although the efficacy of biofeedback intervention from a commercially available posture‐training device differs among otolaryngologists, exploration of alternative interventions and incorporation of an ergonomics curriculum is warranted to address postural issues experienced by many surgeons. Level of Evidence 3.

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“…(2017) investigated a modified chair with sternal support to maintain a neutral position of the cervical and thoracic spine along with a cushion to rest the forehead on to reduce the load on the cervical joints during clinic procedures. 32 Outcome measures were time to fatigue and pain in the neck and back as well as surface electromyography as a measure of muscular activity as a percentage of the resting value for each participant. The authors reported an increase in time to neck fatigue ( p < 0.05) and neck pain ( p < 0.05) when using the ergonomic chair compared with a standard operating chair but no statistically significant delay in back fatigue ( p = 0.11) or back pain ( p = 0.21).…”

Section: Equipment-based Interventionsmentioning

confidence: 99%

A systematic review of interventions to prevent work-related musculoskeletal disorders in ENT surgeons

et al. 2021

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Objective Work-related musculoskeletal disorders in ENT surgeons are common and detrimental, yet few are aware of preventative measures. We evaluate the evidence for interventions to prevent work-related musculoskeletal disorders in ENT surgeons. Method A systematic search of databases up to 8 June 2021 was performed using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and predetermined inclusion criteria. Results Seven prospective cohort studies and 2 case series were identified (51 participants). Interventions included novel equipment (n = 3), patient positioning (n = 2), clinician positioning (n = 3) and operative technique (n = 1). Five studies reported Rapid Upper Limb Assessment scores as outcome measures of strain. Strain decreased when adopting a favourable operating posture, using a supportive chair and keeping patients supine for clinic procedures. Conclusion A small number of low-quality studies were identified. Modifiable risk factors exist, and ergonomic education may help prevent work-related musculoskeletal disorders. Further studies with longer term follow up are required.

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Effects of prolonged microscopic work on neck and back strain amongst male ENT clinicians and the benefits of a prototype postural support chair

Cited by 14 publications

References 18 publications

Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

Surgical ergonomics: Assessment of surgeon posture and impact of training device during otolaryngology procedures

A systematic review of interventions to prevent work-related musculoskeletal disorders in ENT surgeons

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