Intraoperative Neck Angles in Endoscopic and Microscopic Otologic Surgeries

Abstract

Objective To quantitatively compare the ergonomic risk of otologic surgeries performed with endoscopes and microscopes. Study Design Observational cross‐sectional study. Setting Operating room of a tertiary academic medical center. Methods Intraoperative neck angles of otolaryngology attendings, fellows, and residents were assessed during 17 otologic surgeries using inertial measurement unit sensors. Sensors were attached midline between the shoulder blades and on the posterior scalp of participants and were calibrated just prior to beginning each case. Quaternion data were used to calculate neck angles during periods of active surgery. Results Endoscopic and microscopic cases included similar percentages of time in high‐risk neck positions, 75% and 73%, respectively, according to a validated ergonomic risk assessment tool, the Rapid Upper Limb Assessment. However, microscopic cases included a higher percentage of time spent in extension (25%) compared to endoscopic cases (12%) (p < .001). When examining the magnitude of average flexion and extension angles, endoscopic and microscopic cases were not significantly different. Conclusion Utilizing intraoperative sensor data, we found that both endoscopic and microscopic approaches in otologic surgery were associated with high‐risk neck angles, which can result in sustained neck strain. These results suggest that optimal ergonomics may be better achieved by the consistent application of basic ergonomic principles than by changing the technology in the operating room.

Use of Soft Cervical Collar Improves Surgeon Ergonomics During Simulated Otologic Surgery

“…Increasing popularity of endoscopic ear surgery has led some to hypothesize about the potential ergonomic benefits associated with the use of the endoscope. Accumulating data suggest some benefit of a “heads-up” approach, though, like the present study, others suggest that high-risk postures are adopted in both simulated endoscopic and microscopic surgery (28). Although more research in otologic applications is necessary, research in other specialties has not shown a universal benefit of endoscopic surgery over open approaches.…”

Ergonomics of Various Modalities for Ear Surgery

“…Another study by Joo et al found no significant differences in neck flexion and extension angles or time spent in high‐risk neck positions between endoscopic and microscopic surgery. 16 This study found significant differences in all extremity and trunk angles between microscopic and endoscopic surgery. Specifically, microscopic surgery reported significantly higher angles in all categories compared to endoscopic surgery except for in elbow score.…”

“… 18 Whereas previous studies have focused on specific key body angles when assessing musculoskeletal disease risk, doing so without considering a plethora of other factors may paint an incomplete and less nuanced picture of bodily positioning during middle ear surgery. 5 , 16 As such, although endoscopic surgery may result in certain improvements in body angle and positioning relative to microscopic surgery, its ergonomic benefits may be incomprehensive and suggest a continued need for ergonomic innovation within otology. 19 …”

Comparison of Neck Angle and Musculoskeletal Discomfort of Surgeon in Cataract Surgery between Three-Dimensional Heads-Up Display System and Conventional Microscope

“…Additionally, the assessment of the surgeon's position and musculoskeletal discomfort relied on relatively simple methods. Other methods used in ergonomic studies to measure muscular burden or assess movements, if extended to elds other than ophthalmology, include myotonometer, electromyography, inertial measurement unit sensors, and Rapid Entire Body Assessment 43,[47][48][49][50] . Other tools, such as the NASA Task Load Index and the Borg scale, are also reported for assessing the perceived exertion of surgeons 30,48 .…”