Ergonomic Considerations in Endoscopic Sinus Surgery: Lessons Learned from Laparoscopic Surgeons

Abstract

Increasing surgeon awareness will allow for many basic ergonomic principles to be applied to endoscopic sinus and skull base surgery. Although many simple changes can be immediately made, there is a clear need for further study and abundant room for innovation.

Estimation of surgeons’ ergonomic dynamics with a structured light system during endoscopic surgery

“…In addition, multiple endoscopic sinus surgery variables were recorded, including: Trendelenburg tilt of the operating table; angle of the endoscope to the horizontal plane; angle of the head of the operating table to the horizontal plane; height of the operating table with respect to the floor; distance from the handle of the endoscope to the surgeon's anterior superior iliac spine; height of the monitor relative to the surgeon's eyes; and the visual angle. Together these conformed to what was considered subjectively to be the most comfortable position for each surgeon to operate in (although approximately within ergonomic recommended values) . If the surgeon used a surgical chair, this could be adjusted for height and backrest but without supports for the arms or the forearms.…”

“…It is crucial to follow the recommendations proposed by Ayad et al and Ramakrishnan and Montero for endoscopic sinus and skull base surgery. Their indications cover aspects of appropriate monitor placement, proper instrument maintenance, adjustable operating tables, correct use of pedals, and correct upper body position, among others . Nevertheless, these ergonomic considerations may not be enough, because, as we have shown, basic and advanced endoscopic surgery requires maintaining non‐neutral positions of the neck, arms, trunk, and legs that expose the surgeon to musculoskeletal complications.…”

“…The skills required during the procedures impose strong physical and psychological demands on the surgeon. The tasks can be very complicated, require a high level of attention, and are intellectually and emotionally demanding . Rapid Upper Limb Assessment (RULA) is a validated survey method to assess posture risk in ergonomic investigations in occupational settings.…”

Ergonomic analysis of the surgical position in functional endoscopic sinus surgery

“…This surgeon typically stands during sinus surgery, but has experience in sinus surgery in the seated position, and surgical ergonomic principles were reviewed prior to initiation of each procedure. The order of surgeries was randomized, and surgical ergonomic principles were followed according to literature recommendations . Surgical procedures were performed at the end of a standard work day, after at least 1 hour of physical rest.…”

The Swansea Floating Endoscopic Assistant: A Surgical Handling Aid

“…Lessons learned from laparoscopic surgery to ESS include adjusting the table to keep hands in line with elbow +/−10 cm, keeping the arms slightly abducted and internally rotated, limiting wrist flexion, deviation and rotation to <15 degrees and gently resting the shaft of the endoscope at superior nasal vestibule when able [12]. Our described technique is setup to keep the elbows in line with the hands, and given the nature of the straps, the natural resting position is one of slight abduction in the arms and internal rotation which limits wrist flexion while the straps take the weight.…”