Ergonomics in Endoscopic Transsphenoidal Surgery: A Survey of the North American Skull Base Society

Abstract

Objective Different surgical set-ups for endoscopic transsphenoidal surgery (ETS) have been described, but studies on their ergonomics are limited. The aim of this article is to describe present trends in the ergonomics of ETS. Design and Participants A 33-question, web-based survey was sent to North American Skull Base Society members in 2018 and 116 responded to it (16% of all members). Most respondents were from North America (76%), in academic practice (87%), and neurosurgeons (65%); they had more than 5 years of experience in ETS (73%), had received specific training (66%), and performed at least 5 procedures/mo (55%). Results Mean reported time for standard and complex procedures were 3.7 and 6.3 hours, respectively. The patient's body is usually positioned in a straight, supine position (84%); the head is in a neutral position (46%) or rotated to the side (38%). Most surgeons perform a binostril technique, work with a partner (95%), and operate standing (94%), holding suction (89%) and dissector (83%); sometimes the endoscope is held by the primary surgeon (22–24%). The second surgeon usually holds the endoscope (72%) and irrigation (42%). During tumor removal most surgeons stand on the same side (65–66%). Many respondents report strain at the dorsolumbar (50%) or cervical (26%) level. Almost one-third of surgeons incorporate a pause during surgery to stretch, and approximately half exercise to be fit for surgery; 16% had sought medical attention for ergonomic-related symptoms. Conclusion Most respondents value ergonomics in ETS. The variability in surgical set-ups and the relatively high report of complaints underline the need for further studies to optimize ergonomics in ETS.

Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery

“…2,3 Surgeons performing this type of surgery suffer from discomfort or injuries that are most common in the shoulder, back and neck, especially in the limb holding the endoscope. [2][3][4][5][6][7] In the medium term, this leads to increased fatigue, which can result in risk to the patient, and in the long term, chronic MSK injuries to the surgeon. 8,9 In the case of ESSBS, the surgeon often has to hold the endoscope permanently in the same position for hours without any support.…”

The Hitchhiker Position in Endoscopic Pituitary Surgery

“…1 In a survey of the North American Skull Base Society, 84% of respondents indicated that during these procedures, the patient is positioned in a straight, supine position, with the patient's head placed in a neutral position (46%) or rotated to the side (38%). 2 The operation is predominantly conducted by the primary surgeon standing (94%) using a binostril technique (95%); 80% of respondents believed that ergonomics play an important role in the surgical procedure. 2 Patients with acromegaly and with Cushing disease often undergo this surgical procedure; a common symptom of these conditions is obesity, which can make it difficult for surgeons to position themselves ergonomically while maintaining requisite operative capability.…”

“…2 The operation is predominantly conducted by the primary surgeon standing (94%) using a binostril technique (95%); 80% of respondents believed that ergonomics play an important role in the surgical procedure. 2 Patients with acromegaly and with Cushing disease often undergo this surgical procedure; a common symptom of these conditions is obesity, which can make it difficult for surgeons to position themselves ergonomically while maintaining requisite operative capability. Conventional positioning involves securing the patient's arm to the torso with taping and tucking of the sheet around it.…”

“…1 In a survey of the North American Skull Base Society, 84% of respondents indicated that during these procedures, the patient is positioned in a straight, supine position, with the patient's head placed in a neutral position (46%) or rotated to the side (38%). 2 The operation is predominantly conducted by the primary surgeon standing (94%) using a binostril technique (95%); 80% of respondents believed that ergonomics play an important role in the surgical procedure. 2…”

“…2 The operation is predominantly conducted by the primary surgeon standing (94%) using a binostril technique (95%); 80% of respondents believed that ergonomics play an important role in the surgical procedure. 2…”