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Campbell RG, Zadro JR, Gamble AR, Chan CL, Mackey MG, Osie G, Png LH, Douglas RG, Pappas E. Work-Related Musculoskeletal Disorders in Endoscopic Sinus and Skull Base Surgery: A Systematic Review With Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38971976 DOI: 10.1002/ohn.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/06/2024] [Accepted: 06/22/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Endoscopic sinus and skull base surgery has led to significant improvements in patient outcomes, yet may have come at a cost to surgeons' musculoskeletal (MSK) health. We aimed to determine the prevalence and characteristics of work-related MSK disorders (WRMDs) in endoscopic sinus and skull base surgeons; to investigate contributing factors for WRMD in this population; and to evaluate the effectiveness of ergonomic interventions on the severity or prevalence of WRMD in this population. DATA SOURCES Medline, Embase, CINAHL, Web of Science, and Scopus from inception to April 2, 2024. A bibliographic examination was performed for further papers. REVIEW METHODS Inclusion criteria included original peer-reviewed papers with work-related MSK outcomes (prevalence, contributing factors, and interventions) relating to endoscopic sinus and/or skull base surgeons in any language. RESULTS Of 25,772 unique citations, 37 studies met the inclusion criteria. The pooled lifetime, point, and 12-month prevalences of WRMD were 75.9% (95% confidence interval; I2, 67.2%-83.6%, I2 95.6%), 80.8% (77.0%-84.3%, I2 98.0%), and 82.0% (71.8%-90.3%, I2 60.96%) respectively. The neck, lumbar spine, and thoracic spine were the most commonly involved areas. One of 9 studies on contributing factors investigated discomfort as an outcome. The remainder focussed on surrogate outcomes (eg, posture, hand dysfunction). Two of the 13 intervention studies investigated pain or fatigue as an outcome. The remainder targeted posture, muscle activity, or workload. CONCLUSION WRMDs are highly prevalent in endoscopic sinus and skull base surgeons. Further studies focusing on the direct outcomes of WRMD such as pain are needed.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Joshua R Zadro
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew R Gamble
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Cliffton L Chan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Martin G Mackey
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Gabriel Osie
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Lu Hui Png
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Richard G Douglas
- Faculty of Medical and Health Sciences, Surgery, University of Auckland, Auckland, New Zealand
| | - Evangelos Pappas
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Bessone V, Roppenecker DB, Adamsen S. Work-Related Musculoskeletal Injury Rates, Risk Factors, and Ergonomics in Different Endoscopic Specialties: A Review. Healthcare (Basel) 2024; 12:885. [PMID: 38727442 PMCID: PMC11083686 DOI: 10.3390/healthcare12090885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Endoscopy-related musculoskeletal injuries (ERIs) are frequent among gastrointestinal, pulmonary, nasal, and urologic endoscopists, impacting the healthcare system. The present review aims to compare the ERI rates, risk factors, and ergonomic recommendations in the different endoscopic fields. A review was conducted using PubMed and Cochrane Library for articles based on surveys and published until 10 January 2024. Demographic, work, and ERI data from 46 publications were included, covering 10,539 responders. The ERI incidence ranged between 14% and 97%, highlighting the need of intervention independent of the specialties. The neck, back, and shoulder were the most frequent ERI locations, while gender, age, years of experience, and procedure volume the most common risk factors. Ergonomic recommendations suggest concentrating on endoscope design changes, especially in gastrointestinal endoscopy, to increase the comfort, adaptability of the equipment in the operating room, and workflow/institutional policy changes. The inclusion of an ergonomic timeout guarantees the correct equipment positioning, the neutralisation of the endoscopist's posture, and an indirect break between procedures. Ergonomic training to increase awareness and best practice should be promoted, also using new technologies. Future research should concentrate on intervention and comparative studies to evaluate to which extent prevention measures and newly designed equipment could reduce ERI incidence.
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Affiliation(s)
- Veronica Bessone
- Ambu Innovation GmbH, Karl-Drais-Strasse 4B, DE-86159 Augsburg, Germany
| | | | - Sven Adamsen
- Ambu A/S, Baltorpbakken 13, DK-2750 Ballerup, Denmark
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
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Campbell RG, Douglas RG, Zadro J, Gamble A, Chan CL, Mackey MG, Pappas E. Don't Just Stand There. Rethinking the Ideal Body Posture for Otorhinolaryngologists. Ann Otol Rhinol Laryngol 2024; 133:355-362. [PMID: 38044532 DOI: 10.1177/00034894231214035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Surgeons have a high rate of work-related musculoskeletal injuries; an area that has received little attention. These injuries result in surgeons performing less efficiently, needing to take time off work, suffering higher rates of burnout, and may ultimately lead surgeons to retire earlier than planned. Otorhinolaryngologists are at particular risk for work-related musculoskeletal injuries. Beyond the clinician, sustaining such injuries can negatively impact patient safety. Ergonomic interventions have been used effectively to reduce work-related musculoskeletal injuries in other professions, yet not in surgery. With traditional teachings of ideal body postures to avoid injury and manual handling training being re-evaluated, it is important to explore evidence based interventions for reducing work-related musculoskeletal injuries in otorhinolaryngologists. New research encourages us to shift the focus away from the traditional one-size-fits-all approach to ergonomics and toward postural recommendations and education that promote a dynamic, individualized approach to avoiding sustained, static and awkward postures.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Richard G Douglas
- Faculty of Medical and Health Sciences, Surgery, University of Auckland, Auckland, New Zealand
| | - Joshua Zadro
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Andrew Gamble
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Cliffton L Chan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Martin G Mackey
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Evangelos Pappas
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Cheng SH, Lin YT, Lu HT, Tsuei YC, Chu W, Chu WC. The Evolution of Spinal Endoscopy: Design and Image Analysis of a Single-Use Digital Endoscope Versus Traditional Optic Endoscope. Bioengineering (Basel) 2024; 11:99. [PMID: 38275579 PMCID: PMC10813680 DOI: 10.3390/bioengineering11010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Spinal endoscopy has evolved significantly since its inception, offering minimally invasive solutions for various spinal pathologies. This study introduces a promising innovation in spinal endoscopy-a single-use digital endoscope designed to overcome the drawbacks of traditional optic endoscopes. Traditional endoscopes, despite their utility, present challenges such as fragility, complex disinfection processes, weight issues, and susceptibility to mechanical malfunctions. The digital endoscope, with its disposable nature, lighter weight, and improved image quality, aims to enhance surgical procedures and patient safety. The digital endoscope system comprises a 30-degree 1000 × 1000 pixel resolution camera sensor with a 4.3 mm working channel, and LED light sources replacing optical fibers. The all-in-one touch screen tablet serves as the host computer, providing portability and simplified operation. Image comparisons between the digital and optic endoscopes revealed advantages in the form of increased field of view, lesser distortion, greater close-range resolution, and enhanced luminance. The single-use digital endoscope demonstrates great potential for revolutionizing spine endoscopic surgeries, offering convenience, safety, and superior imaging capabilities compared to traditional optic endoscopes.
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Affiliation(s)
- Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Yen-Tsung Lin
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
| | - Hsin-Tzu Lu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - William Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
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Lobo D, Sancibrian R, Mesones A, Llata JR, Williams M, Viera-Artiles J. Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery. Laryngoscope 2024; 134:79-86. [PMID: 37255028 DOI: 10.1002/lary.30790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The main objective of this study was to develop and evaluate the feasibility and effectiveness of a novel exoskeleton system designed to provide ergonomic assistance to surgeons while preserving or improving the quality of endoscopic sinus and skull base surgical procedures. METHODS To evaluate the functionality and ergonomic characteristics of the device, five experiments were conducted in different and increasingly realistic scenarios: silicone model of the nasal cavity, freshly frozen cadavers and finally in a real surgery. Each volunteer's task was recorded and timed. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) rating scale was used to estimate the surgeons' workload while performing the tasks. RESULTS Twenty-five volunteers took part in the experiments. Volunteers perceived more comfort and less fatigue and pain when using the armrest than when not using the device (3.3, SD 1.75 vs. 5.9 SD 1.49; p = 0.02). Participants found the device intuitive, comfortable, and improving accuracy and stability with endoscope use. CONCLUSION A new system that provides ergonomic assistance to surgeons was tested in simulation surgery with acceptable usability. Initial results in terms of pain and fatigue reduction and efficiency were excellent, justifying further research into this technology. LEVEL OF EVIDENCE NA Laryngoscope, 134:79-86, 2024.
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Affiliation(s)
- David Lobo
- Otolaryngology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Valdecilla Biomedical Research Institute, Santander, Spain
| | - Ramon Sancibrian
- Department of Structural and Mechanical Engineering, Universidad de Cantabria, Santander, Spain
| | - Angela Mesones
- Department of Structural and Mechanical Engineering, Universidad de Cantabria, Santander, Spain
| | - José Ramón Llata
- Department of Electronic Technology, Systems Engineering and Automatic Control, Universidad de Cantabria, Santander, Spain
| | - Monica Williams
- Anaesthesiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jaime Viera-Artiles
- Otolaryngology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
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Gabrielson AT, Wei J. Assessment of musculoskeletal pain and surgical ergonomic parameters among members of the American Society of Pediatric Otolaryngology. Int J Pediatr Otorhinolaryngol 2024; 176:111765. [PMID: 37980843 DOI: 10.1016/j.ijporl.2023.111765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To assess rates of self-reported work-related pain and knowledge of ergonomic principles among fellowship trained pediatric otolaryngologists within the American Society of Pediatric Otolaryngology (ASPO). We hypothesized that pediatric otolaryngologists experience rates of musculoskeletal pain and injury similar to what has been reported among adult otolaryngologists and other surgical subspecialties. METHODS An IRB-approved survey was distributed to members of ASPO through email listserv. Collected variables included surgeon demographic information, practice settings, surgical volume, procedure types, work-related musculoskeletal pain-related metrics, modifying factors, and knowledge/attitudes on surgical ergonomics. RESULTS A total of 685 ASPO members were approached via email, of which 435 opened the survey email and 118 attending pediatric otolaryngologists completed the survey (response rate 27%). In all, 78% of respondents reported current or prior pain and/or injury attributed to performing surgery, 20% higher than that reported in the previous ergonomics survey of ASPO members in 2012. The most affected areas were neck/cervical spine (63%), shoulders/arms (44%), lower back/lumbar spine (36%), and hands/wrist (31%). Half of the respondents were diagnosed with musculoskeletal condition(s) attributed to performing surgery. Two-thirds required treatment (62% pharmacologic only, 9% pharmacologic and surgical intervention) for their work-related pain. Leveraging intermittent pauses during surgical procedures to adjust body position was the most reported method of addressing pain in the operating room. Only 21% report ever having received ergonomic training during their training or career. CONCLUSION Musculoskeletal pain associated with performing pediatric otolaryngology procedures is highly prevalent and has not attenuated despite increased awareness of surgical ergonomics. Results from this study underscore the need to develop standardized surgical ergonomics curricula for pediatric otolaryngologists and trainees.
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Affiliation(s)
| | - Julie Wei
- University of Central Florida College of Medicine, Orlando, FL, USA.
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7
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Morse E, Harpel L, Born H, Rameau A. Female Surgical Ergonomics in Otolaryngology: A Qualitative Study. Laryngoscope 2023; 133:3034-3041. [PMID: 37096670 PMCID: PMC10593046 DOI: 10.1002/lary.30711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/22/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To explore the surgical ergonomic challenges experienced by women in otolaryngology, identify specific equipment that is ergonomically challenging, and assess the impact of suboptimal ergonomics on female otolaryngologists. METHODS We performed a qualitative study using an interpretive framework rooted in grounded theory. We performed semi-structured qualitative interviews of 14 female otolaryngologists from nine institutions at various stages in training and across subspecialties. Interviews were independently analyzed by thematic content analysis by two researchers and inter-rater reliability was assessed via Cohen's kappa. Differing opinions were reconciled via discussion. RESULTS Participants noted difficulties with equipment including microscopes, chairs, step stools, and tables as well as difficulty using larger surgical instruments, preference for smaller instruments, frustration with lack of smaller instruments, and a desire for a larger spectrum of instrument sizes. Participants reported neck, hand, and back pain associated with operating. Participants suggested modifications to the operative environment, including a wider variety of instrument sizes, adjustable instruments, and more focus and attention on ergonomic issues and the range of surgeon physiques. Participants felt that optimizing their operating room set-up was an additional burden on them, and that lack of inclusive instrumentation affected their sense of belonging. Participants emphasized positive stories of mentorship and empowerment from peers and superiors of all genders. CONCLUSION Female otolaryngologists face unique ergonomic challenges. As the otolaryngology workforce becomes increasingly diverse, it is important to address the needs of a diverse set of physiques to avoid inadvertently disadvantaging certain individuals. LEVEL OF EVIDENCE N/A Laryngoscope, 133:3034-3041, 2023.
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Affiliation(s)
- Elliot Morse
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
| | - Lexa Harpel
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
| | - Hayley Born
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
- Sean Parker Institute for the Vloice, Weill Cornell Medicine, New York New York USA
| | - Anaïs Rameau
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
- Sean Parker Institute for the Vloice, Weill Cornell Medicine, New York New York USA
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Hosoya K, Maeda Y, Komachi T, Sato K, Okubo K. AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery. Braz J Otorhinolaryngol 2023; 89:101292. [PMID: 37579570 PMCID: PMC10448402 DOI: 10.1016/j.bjorl.2023.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE After Endoscopic Sinus Surgery (ESS), packing plays an important role in wound healing and hemostasis. However, the effect of the packing removal procedure on physician stress has not been evaluated. The purpose of this study was to evaluate physician stress during packing removal for patients treated with AQUACEL® Ag Advantage versus KALTOSTAT®. METHODS This retrospective study included 15 patients who underwent packing with ESS for chronic rhinosinusitis performed at two centers; 9 were treated with AQUACEL® Ag Advantage and 6 were treated with KALTOSTAT®. Physician stress during packing removal was evaluated with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). The time required to remove the packing and the number of instruments used in the procedure were recorded. Postoperative bleeding (Boezaart bleeding score) and wound healing were graded. Patient symptoms on the day after surgery and pain during packing removal were assessed using a visual analog scale. RESULTS Computed tomography scores, asthma complications, and blood eosinophil counts were significantly higher in the AQUACEL® Ag Advantage group. Patient symptoms on the day after surgery were not significantly different between the two groups. Physician stress during the task of packing removal was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (35.5 vs. 81.0, p=0.016) according to the NASA-TLX scores. The number of instruments used in the procedure was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (3.0 vs. 6.0, p=0.015). There were no significant differences in procedure time for packing removal, postoperative bleeding, wound healing, or patient pain at the time of packing removal between the groups. CONCLUSION Physicians feel stressed about packing removal. In addition, AQUACEL® Ag Advantage is useful for packing after ESS, requiring fewer instruments for the procedure than KALTOSTAT® and reducing physician stress about the procedure. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Kei Hosoya
- Musashi Kosugi Hospital, Nippon Medical School, Department of Otolaryngology, Nakahara-Ku, Kawasaki, Japan; Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan
| | - Yohei Maeda
- Japan Community Health Care Organization Osaka Hospital, Department of Otorhinolaryngology, Fukushima, Osaka, Japan; Osaka University, Department of Otorhinolaryngology-Head and Neck Surgery, Suita, Japan.
| | - Taro Komachi
- Chiba Hokusoh Hospital, Nippon Medical School, Department of Otolaryngology, Inzai, Japan
| | - Kazuki Sato
- Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan
| | - Kimihiro Okubo
- Nippon Medical School Hospital, Department of Otolaryngology, Head and Neck Surgery, Bunkyo-Ku, Tokyo, Japan
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Walters ZA, Chang KY, Cervenka B, Collar R, Hsieh TY. Ergonomics in Otolaryngologic Surgery: A State of the Art Review. Otolaryngol Head Neck Surg 2023; 168:330-338. [PMID: 35943813 DOI: 10.1177/01945998221117095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Otolaryngology is a surgical field with a high degree of ergonomic risk. The use of head-mounted lighting, loupe magnification, endoscopes, and microscopes is inherent to the field, coupled with repetitive fine motor movements in a constrained anatomic field as well as static, ergonomically unfavorable postures. We seek to review the otolaryngologic literature on ergonomics, including prevalence, severity, and interventions in decreasing work-related musculoskeletal pain. DATA SOURCES Data were derived from clinical peer-reviewed primary literature as well as information provided by residency programs and presented at national and international meetings. REVIEW METHODS A comprehensive review was performed by 3 independent reviewers utilizing an electronic database literature search through PubMed, Embase, and Cochrane Library. Search terms included combinations and variations of the following concepts: ergonomics, surgery, otolaryngology, work related musculoskeletal disorders, chronic cervical pain, musculoskeletal, posture, surveys, microsurgery, endoscopic surgery. Strict objective criteria for inclusion were not used due to the inherent heterogeneity in articles and lack of rigorous empirical evidence. CONCLUSIONS Chronic musculoskeletal pain is prevalent among otolaryngologic surgeons, with many procedures producing high ergonomic risk. Most studies evaluating interventions to decrease ergonomic risks demonstrate promising results, but standardization in methods and outcome reporting is needed. IMPLICATIONS FOR PRACTICE Literature shows that musculoskeletal pain begins in training, and there is a paucity of information related to ergonomic risk in otolaryngology residency curriculums. Work-related musculoskeletal disorders related to poor workplace ergonomics have the potential to limit career longevity and lead to physician burnout. Interventions to mitigate this risk are effective and tend to be well received by physicians.
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Affiliation(s)
- Zoe A Walters
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Katie Y Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Ryan Collar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Tsung-Yen Hsieh
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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10
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Ryan MT, Montgomery EA, Fryer J, Yang AW, Mills C, Watson N, Noller M, Riley CA, Tolisano AM. Ergonomics in Otolaryngology: A Systematic Review and Meta-analysis. Laryngoscope 2023; 133:467-475. [PMID: 35575629 DOI: 10.1002/lary.30216] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To determine the proportion of otolaryngologists with work-related musculoskeletal discomfort (WRMD) and to review objective ergonomic data that contribute to WRMD. STUDY DESIGN Systematic review and meta-analysis. METHODS A comprehensive search of the literature identified 1121 articles for initial review of which 19 (3563 participants) met criteria for qualitative discussion and eight (2192 participants) met criteria for meta-analysis. Random effects meta-analyses were used to estimate the proportion of otolaryngologists reporting WRMD. RESULTS The overall proportion (95% confidence intervals [CI]) of general otolaryngologists reporting WRMD was 0.79 (0.66, 0.88) for any symptoms; 0.54 (0.40, 0.67) for neck symptoms; 0.33 (0.20, 0.49) for shoulder symptoms; and 0.49 (0.40, 0.59) for back symptoms. Surgeons performing primarily subspecialty cases had a lower estimated overall prevalence of WRMD versus those performing general ENT cases, however the odds ratio (OR) was not statistically significant (OR [95% confidence interval] 0.53 [0.22, 1.25]). 23%-84% of otolaryngologists underwent medical treatment for WRMD. 5%-23% took time off work and 1%-6% stopped operating completely as a result of WRMD. 23%-62.5% of otolaryngologists believed WRMD negatively impacted their quality of life. Objective measures of ergonomic posture indicate moderate to severe risk of injury during the routine clinic and surgical procedures with none found to be low risk. CONCLUSIONS Ergonomic stressors among otolaryngologists contribute to a high rate of WRMD across all subspecialties with notable impact on productivity, longevity, and quality of life. Laryngoscope, 133:467-475, 2023.
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Affiliation(s)
- Matthew T Ryan
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Emily A Montgomery
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Jacob Fryer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Alex W Yang
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Channah Mills
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Nora Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Michael Noller
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Charles A Riley
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Anthony M Tolisano
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
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11
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Joo H, Lin Z, Yesantharao L, Formeister E, Razavi C, Patel M, Carey J, Taylor R, Galaiya D. Intraoperative Neck Angles in Endoscopic and Microscopic Otologic Surgeries. Otolaryngol Head Neck Surg 2023; 168:1494-1501. [PMID: 36794784 DOI: 10.1002/ohn.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/19/2022] [Indexed: 02/17/2023]
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.
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Affiliation(s)
- Hyonoo Joo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zihao Lin
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lekha Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eric Formeister
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Christopher Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Millan Patel
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - John Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Russ Taylor
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deepa Galaiya
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Krysinski MR, Walters BK, Aden JK, Mack D, Weitzel EK, Willson T, McMains KC, Chen PG. Ergonomic analysis of hand dysfunction in endoscopic sinus surgery. Int Forum Allergy Rhinol 2023; 13:172-174. [PMID: 35899765 DOI: 10.1002/alr.23066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Mason R Krysinski
- Department of Otolaryngology- Head & Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Benjamin K Walters
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - James K Aden
- Graduate Medical Education, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Douglas Mack
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Erik Kent Weitzel
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Thomas Willson
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA.,Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, Texas, USA
| | - Kevin C McMains
- Department of Otolaryngology- Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA.,Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, Texas, USA
| | - Philip G Chen
- Department of Otolaryngology- Head & Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
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13
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Aaronson NL, Reilly JS. Common Pediatric Otolaryngology Procedures: Ergonomic Considerations. Cureus 2023; 15:e34678. [PMID: 36909121 PMCID: PMC9994041 DOI: 10.7759/cureus.34678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/05/2023] [Indexed: 02/09/2023] Open
Abstract
Background Otolaryngologists in high-volume children's hospitals developed their operating room workflow practices based on the factors of safety, efficiency, and surgeon preference. Recent data show important benefits and potential reduced risks of proper ergonomic positioning for surgeons to prevent injury. These data suggest that the current operating room workflow practices, in addition to prior training, should be monitored and hopefully improved for surgeons' health. Surprisingly, recent studies have suggested the benefits of standing versus sitting on cognitive function. Objective This study reports the workflow norms for seven operating procedures in pediatric otolaryngology. We seek to identify 1) surgeon preferences, 2) when practices become norms, and 3) whether procedure positions are associated with surgeon discomfort or injury. Methods The Otolaryngology Section of the American Academy of Pediatrics was queried employing a 23-question survey. We included demographic information, reasons for preferences, and surgeon-reported pain. We focused on three workflow issues: 1) length of procedures, 2) site selection (operating room bed vs. transport stretcher), and 3) position of the surgeon (sitting vs. standing). Results Sixty-nine American Academy of Pediatrics members completed the survey. The length of the procedure had minimal effect, with 90% sitting for short procedures such as bilateral myringotomy with tubes, myringoplasty, tonsillectomy, and adenoidectomy. All sit for direct laryngoscopy and bronchoscopy. Most stand for the removal of nasal foreign bodies, drainage of neck abscess procedures, and thyroglossal duct cyst excision. Residency training (75%) and personal comfort (81%) were the more frequently cited reasons for preference. Fewer than one in five (16%) reported preexisting neck or back pain, but this doubled (35%) throughout their otolaryngology practice. Conditional distributions of pain showed reports of pain were greater for individuals in practice for over 20 years. Conclusions Pediatric otolaryngologists develop their operating room preferences early during residency training. High rates of neck and back pain (35%) may develop during a surgeon's career. We suggest improved understanding of ergonomics in concert with operating room workflow should be considered during otolaryngology residency training since recent data suggest potential benefits of standing on cognitive function.
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Affiliation(s)
- Nicole L Aaronson
- Department of Surgery, Section of Otolaryngology, Nemours Children's Health, Wilmington, USA.,Department of Otolaryngology, Department of Pediatrics, Thomas Jefferson University Sidney Kimmel School of Medicine, Philadelphia, USA
| | - James S Reilly
- Department of Surgery, Section of Otolaryngology, Nemours Children's Health, Wilmington, USA.,Department of Otolaryngology, Department of Pediatrics, Thomas Jefferson University Sidney Kimmel School of Medicine, Philadelphia, USA
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14
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Jensen MJ, Liao J, Van Gorp B, Sugg SL, Shelton J, Corwin C, Lal G. Incorporating Surgical Ergonomics Education into Surgical Residency Curriculum. JOURNAL OF SURGICAL EDUCATION 2021; 78:1209-1215. [PMID: 33221251 DOI: 10.1016/j.jsurg.2020.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/04/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Education on surgical ergonomics during residency training is lacking. This study aimed to determine the feasibility and impact of incorporating surgical ergonomics lectures into residency curriculum. METHODS A survey was distributed to 42 residents with questions regarding demographics, surgical factors, prevalence of musculoskeletal (MSK) symptoms, and awareness of ergonomic recommendations. The residents then received 2 lectures on ergonomics in surgery. A follow up survey was distributed to evaluate the impact of the lectures. RESULTS Twenty-two residents completed the presession survey. Ninety-one percent reported MSK symptoms attributed to their training. Seventeen residents completed the follow up survey. All reported increased awareness of their own habits while operating and improved understanding of methods to prevent and/or treat work-related injuries. All residents recommended incorporating the lectures as an adjunct to their regular curriculum. CONCLUSIONS The rates of MSK symptoms and/or injury are high among surgeon trainees. Residency is an opportune time to educate on principles of ergonomics and may prevent future injuries.
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Affiliation(s)
- Megan J Jensen
- Departments of Otolaryngology - Head & Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Junlin Liao
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Barbara Van Gorp
- Departments of Physical therapy, University of Iowa, Iowa City, Iowa
| | - Sonia L Sugg
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Julia Shelton
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Claudia Corwin
- Departments of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Geeta Lal
- Departments of Surgery, University of Iowa, Iowa City, Iowa.
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15
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Mattogno PP, Marciano F, Catalino MP, Mattavelli D, Cocca P, Lopomo NF, Nicolai P, Laws ER, Witterick I, Raza SM, Devaiah AK, Lauretti L, Olivi A, Fontanella MM, Gentili F, Doglietto F. Ergonomics in Endoscopic Transsphenoidal Surgery: A Survey of the North American Skull Base Society. J Neurol Surg B Skull Base 2021; 83:e380-e385. [DOI: 10.1055/s-0041-1729906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022] Open
Abstract
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.
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Affiliation(s)
- Pier Paolo Mattogno
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Marciano
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Michael P. Catalino
- Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Davide Mattavelli
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Paola Cocca
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Department of Otolaryngology—Head and Neck Surgery, University of Padua, Padua, Italy
| | - Edward R. Laws
- Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ian Witterick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shaan M. Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Anand K. Devaiah
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Marco M. Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Fred Gentili
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Francesco Doglietto
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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16
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Boyle S, Fitzgerald C, Conlon BJ, Vijendren A. A national survey of workplace-related musculoskeletal disorder and ergonomic practices amongst Irish otolaryngologists. Ir J Med Sci 2021; 191:623-628. [PMID: 33963514 PMCID: PMC8105144 DOI: 10.1007/s11845-021-02642-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022]
Abstract
Background Work-related musculoskeletal disorder (WRMD) is a rising concern for surgeons, particularly those involved in minimally invasive surgery (MIS). Severe WRMD can adversely affect surgeon’s health and foreshorten their careers if not appropriately managed. Aims The aim of this study was to assess the prevalence of WRMD among Irish otolaryngologists and determine their knowledge of the best ergonomic principles. Methods A national survey was distributed electronically to all otolaryngology consultants and non-consultant hospital doctors (NCHDs) in Ireland. The survey assessed respondents’ age, grade, history of WRMD, and treatments sought for WRMD and knowledge of best ergonomic practice. Results Forty-nine of one hundred and two respondents completed the survey. The lifetime prevalence of WRMD among this cohort was 75.5%. Pain was the most commonly experienced symptom at 71.4%. The neck was the most frequently affected location (59.2%). Treatment for WRMD was sought by 36.7% of participants. The majority of respondents (73.5%) were unaware of recommendations made in the field of surgical ergonomics, while 85.7% were interested in learning ergonomic principles. Conclusion This study demonstrates a high prevalence of WRMD amongst otolaryngologists working in Ireland and demonstrates a need for ergonomic training for surgeons.
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Affiliation(s)
- Seamus Boyle
- St. James and Tallaght University Hospitals, Dublin, Ireland.
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17
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Watanabe I, Miyamoto M, Nakagawa H, Saito K. Ergonomic advantage of pistol-grip endoscope in the ENT practice. Laryngoscope Investig Otolaryngol 2021; 6:252-260. [PMID: 33869757 PMCID: PMC8035956 DOI: 10.1002/lio2.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/05/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Recent technology manufactured a nasopharyngeal videoscope with pistol-shaped grip (PG). This study aimed to assess the ergonomic feasibility of this novel device in daily ENT practice. METHODS To assess the ergonomic impact of grip shape on ENT physicians, conventional grip videoscope (CG) and PG were utilized in this study. Surface electromyography (sEMG) was recorded to assess the muscle activity in the upper limb during endoscopy on a training model. Bilateral sEMG recordings were performed including thenar muscle, pronator teres muscle, brachioradialis muscle, and biceps brachii muscle. Mean value of the mean sEMG amplitude throughout the task in triplicated examinations (mMA) with each electrode, total values of four mMAs in both of the grip-side and the insertion tube-side limb muscles, and total value of all eight mMAs were calculated, and compared between CG and PG. Subgroup analyses were also performed in the experienced ENT physicians and the residents. RESULTS PG provided significantly lower mMA values in thenar muscle and brachioradialis muscle of the grip-side limb compared with CG. Total value of four mMAs in PG was significantly lower compared with that in CG in the grip-side limb, and total value of all eight mMAs in PG was significantly lower compared with that in CG. Furthermore, total value of four mMAs in PG was significantly lower compared with that in CG in the grip-side limb, in both of the subgroups. CONCLUSION This is the first study to support the idea that the newly designed pistol-grip endoscope may have an ergonomic advantage over conventional endoscope for otolaryngologists in daily practice. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Itaru Watanabe
- Department of Otolaryngology‐Head and Neck SurgeryKyorin University School of MedicineTokyoJapan
| | - Makoto Miyamoto
- Department of Otolaryngology‐Head and Neck SurgeryKyorin University School of MedicineTokyoJapan
| | - Hideki Nakagawa
- Department of Otolaryngology‐Head and Neck SurgeryKyorin University School of MedicineTokyoJapan
| | - Koichiro Saito
- Department of Otolaryngology‐Head and Neck SurgeryKyorin University School of MedicineTokyoJapan
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18
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Campbell RG, Harvey RJ. How close are we to anterior robotic skull base surgery? Curr Opin Otolaryngol Head Neck Surg 2021; 29:44-52. [PMID: 33337610 DOI: 10.1097/moo.0000000000000683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The application of robotic surgery to anterior skull base disease has yet to be defined despite the potential for improved tumour resection with less morbidity in this region. Complex anatomy and restricted access have limited the development of robotic anterior skull base surgery. RECENT FINDINGS A limited number of transoral robotic surgical anterior skull base procedures have been undertaken; however, there are significant limitations to the utilization of this technology in the anterior skull base. In this article, the advantages, disadvantages and limitations of robotic anterior skull base surgery are discussed. Currently, the major limitation is the size of the robotic endoscope and of the available instrumentation. Technological advancements that provide promise for the future development of robotic anterior skull base surgery are in development, such as single-port robots, flexible instrument systems and miniaturization and growth of minimally invasive platforms. SUMMARY Although transnasal access to the skull base is not possible with the currently available robotic systems, promising technology does exist and is in development. Robotic anterior skull base surgery promises to provide greater access to skull base disease, improve oncologic results, reduce morbidity and to reduce the ergonomic burden on the surgeon.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Department of Otolaryngology - Head and Neck Surgery, Royal Prince Alfred Hospital
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Richard J Harvey
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
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19
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Xu JC, Hanna G, Fong BM, Hsu FPK, Cadena G, Kuan EC. Ergonomics of Endoscopic Skull Base Surgery: A Systematic Review. World Neurosurg 2020; 146:150-155. [PMID: 33189918 DOI: 10.1016/j.wneu.2020.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There has been a significant expansion in endonasal endoscopic skull base surgery (EES) that has been used to address a wide range of intracranial and sinonasal pathologies. Although there exists a large amount of literature on approaches and patient outcomes, there is a paucity of data describing ergonomics in this field. Our goal was to evaluate and summarize the literature on ergonomics in EES. METHODS We systematically reviewed all published, peer-reviewed, English language literature in the PubMed and Web of Science databases as screened by multiple reviewers describing ergonomics as related to EES. RESULTS A total of 50 articles were found that described significant conclusions and descriptions on ergonomics in EES. We found and summarized the different technical aspects of ergonomics as pertaining to EES and provided evidence-based suggestions on operating room and surgeon setup. CONCLUSIONS There are several improvements in EES ergonomics that can decrease fatigue, improve efficiency, and overall surgeon well-being.
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Affiliation(s)
- Jordan C Xu
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - George Hanna
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Brendan M Fong
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Frank P K Hsu
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Gilbert Cadena
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.
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20
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Marciano F, Mattogno PP, Codenotti A, Cocca P, Fontanella MM, Doglietto F. Work-related musculoskeletal disorders among endoscopic transsphenoidal surgeons: a systematic review of prevalence and ergonomic interventions. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2020; 28:459-468. [PMID: 32608333 DOI: 10.1080/10803548.2020.1774160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Endoscopic transsphenoidal surgery is a surgical technique introduced in the last 20 years for the treatment of skull base pathologies and, in particular, pituitary tumours. Although the prevalence of work-related musculoskeletal disorders is usually significantly higher in endoscopists and minimally invasive surgeons compared to other surgical and medical specialties, reviews on the prevalence of disorders among neurosurgeons dedicated to endoscopic transsphenoidal surgery are not available. This article performs a systematic review to identify the work-related musculoskeletal disorders among transsphenoidal neurosurgeons, their prevalence and the ergonomic interventions proposed to reduce risk factors and prevent disorders. The results show that the ergonomics of transsphenoidal neurosurgeons is an under-investigated topic. Indeed, specific prevalence data are not available. In addition, only a few papers suggest interventions and guidelines, but without objective assessment of the outcomes to confirm the ergonomic benefit. Based on these gaps in the literature, a future research agenda is proposed.
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Affiliation(s)
- Filippo Marciano
- Department of Mechanical and Industrial Engineering, University of Brescia, Italy
| | - Pier Paolo Mattogno
- Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Anna Codenotti
- Department of Mechanical and Industrial Engineering, University of Brescia, Italy
| | - Paola Cocca
- Department of Mechanical and Industrial Engineering, University of Brescia, Italy
| | - Marco Maria Fontanella
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Francesco Doglietto
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
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21
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Campbell RG. Robotic surgery of the anterior skull base. Int Forum Allergy Rhinol 2019; 9:1508-1514. [DOI: 10.1002/alr.22435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/24/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Raewyn G. Campbell
- Department of Otorhinolaryngology, Head and Neck SurgeryRoyal Prince Alfred Hospital Sydney NSW Australia
- Department of Otorhinolaryngology, Head and Neck SurgeryMacquarie University Hospital Sydney NSW Australia
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chris O'Brien Lifehouse Sydney NSW Australia
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22
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Work-related musculoskeletal symptoms in otorhinolaryngology and their relationship with physical activity. A nationwide survey. The Journal of Laryngology & Otology 2019; 133:713-718. [PMID: 31317837 DOI: 10.1017/s0022215119001452] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The main objective of this study was to determine the prevalence of work-related musculoskeletal symptoms in otolaryngology and head and neck surgery specialists and trainees in Spain, and to measure the effect that physical exercise could have on muscular discomfort. METHOD A cross-sectional survey was administered between September and December 2017 to practising otolaryngologists. RESULTS Four hundred and three ENT surgeons responded, with a median age of 44.9 years, and 89.8 per cent reported discomfort or physical symptoms that they attributed to surgical practice. More female surgeons reported musculoskeletal symptoms (92.8 per cent vs 87.1 per cent; p = 0.04). When the level of physical activity was compared with the frequency of physical discomfort, no significant difference was found. CONCLUSION This study has shown a high prevalence of musculoskeletal disorders among ENT surgeons in Spain but has failed to demonstrate an important role of physical exercise in the prevention of musculoskeletal disorders.
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23
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Lobo D, Anuarbe P, López-Higuera JM, Viera J, Castillo N, Megía R. Estimation of surgeons' ergonomic dynamics with a structured light system during endoscopic surgery. Int Forum Allergy Rhinol 2019; 9:857-864. [PMID: 31090195 DOI: 10.1002/alr.22353] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/29/2019] [Accepted: 04/28/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to use motion capture to collect body posture information during simulated endoscopic sinus surgery interventions performed by both specialists and residents in standing and sitting positions and to analyze that information with the validated Rapid Upper Limb Assessment (RULA) tool, which allows calculation of a risk index of musculoskeletal overload. METHODS Bilateral endoscopic sinus surgery was performed in 5 cadaver heads by 2 residents, and 4 practicing rhinologists. Musculoskeletal symptoms were evaluated before and after the dissection. Full-body postural data were collected with the help of Kinect and a .NET WPF (Windows Presentation Foundation) software application to record images of the surgical procedures, and then analyzed with the RULA tool to calculate a risk score indicative of the exposure of the individual surgeon to ergonomic risk factors associated with upper extremity musculoskeletal disorders. RESULTS All subjects reported physical discomfort after nasal endoscopic procedures. An overall similar RULA score was obtained by the residents and the practicing rhinologists. The RULA score was slightly lower for the sitting position than for the standing position, mostly due to a lower score in group B (neck, trunk, and leg); however, the RULA score for group A (arm and wrist analysis) was higher, denoting a higher risk for the upper back and arms. CONCLUSION Significant musculoskeletal symptoms were reported after an endoscopic operation by both the resident and the practicing otolaryngologists. All surgeons obtained a high RULA score, meaning that urgent changes are required in the task.
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Affiliation(s)
- David Lobo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - José Miguel López-Higuera
- Universidad de Cantabria, Santander, Spain.,Centro de Investigación Biomédica en Red (CIBER) de Bioingeniería, Biomateriales y Nanomedicina, Madrid, Spain.,Innovation Support Program "InnVal" of the Marques de Valdecilla Research Institute, Santander, Spain
| | - Jaime Viera
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Roberto Megía
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Abstract
PURPOSE OF REVIEW Awareness of ergonomics is growing into surgical specialties including otolaryngology. Most otolaryngologists experience occupational physical discomfort, and daily incorporation of standard ergonomic principles may alleviate some of this pain. RECENT FINDINGS Further demonstration of surgery-related physical discomfort has been documented based on surveys of general otolaryngologists and subspecialty rhinologists. One study utilized surface electromyography to document physical findings directly associated with the endoscopic sinus surgery procedure. However, relatively little work has been published on interventions to relieve task-related pain and body discomfort in rhinology. SUMMARY Surgeon fatigue and bodily injury is a surprisingly frequent occurrence and is more likely to occur in procedures that are mentally challenging, prolonged, and require the surgeon to operate in a fixed position. Endoscopic sinus and skull base surgeons appear particularly susceptible to task-related physical discomfort, and incorporation of ergonomic principles should be a priority.
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Vaisbuch Y, Aaron KA, Moore JM, Vaughan J, Ma Y, Gupta R, Jackler RK. Ergonomic hazards in otolaryngology. Laryngoscope 2018; 129:370-376. [DOI: 10.1002/lary.27496] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Yona Vaisbuch
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Ksenia A. Aaron
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Justin M. Moore
- Department of Neurosurgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - John Vaughan
- Environmental Health and Safety Department; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
| | - Raghav Gupta
- Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Robert K. Jackler
- Department of Otolaryngology-Head and Neck Surgery; Stanford Health Care and Stanford University School of Medicine; Stanford California U.S.A
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The Swansea Floating Endoscopic Assistant: A Surgical Handling Aid. REPORTS 2018. [DOI: 10.3390/reports1030022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Endoscopic sinus surgery is a rapidly advancing area of Otolaryngology. Operations can be lengthy and are often performed by a single surgeon. Repetitive movements can also lead to muscular fatigue. To mitigate against this, we regularly deploy two retractable Flexi™ compact leads, one bigger than the other connected together and suspended from the theatre operating light arm using velcro ties. The leads are then wrapped around the endoscope using a cotton crepe bandage, in a double loop with a reef knot. The larger lead attaches to the focus/zoom adjustment part of the endoscopic camera, and the smaller lead attaches to the scope 20 cm from the tip allowing the scope to float when suspended, with a slight downward tilt towards the patient. The mechanical effect this produces allows an advantageous reduction in the scope’s weight from 404 g un-suspended, to 65 g with the setup described. This subsequently reduces stress on the elbows, shoulders neck and lumbar spine. The Swansea Floating Endoscopic Assistant adheres to basic ergonomic principles and has the potential for application in other areas of Otorhinolaryngology and Skull Base Surgery.
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Labidi M, Watanabe K, Hanakita S, Park HH, Bouazza S, Bernat AL, Froelich S. The Chopsticks Technique for Endoscopic Endonasal Surgery-Improving Surgical Efficiency and Reducing the Surgical Footprint. World Neurosurg 2018; 117:208-220. [PMID: 29886295 DOI: 10.1016/j.wneu.2018.05.229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Variations and additions to the endoscopic endonasal exposure have been proposed around a modular strategy. These extensions are often necessary to provide additional working space and reduce conflict between the instruments and the endoscope. Resection of endonasal structures, which affects negatively the sinonasal quality of life, is thus undertaken not only to obtain tumor exposure but also to improve the maneuverability of the instruments. OBJECTIVE Our objective was to achieve the same skull base exposures and tumor resections and limit the surgical footprint on sinonasal structures and patients' quality of life. METHODS Our team developed a surgical technique in which the endoscope and a malleable rotative aspirator are held by the nondominant hand and the other main instrument in the dominant hand. This modification, which we call the chopsticks technique, allows the surgeon to use minimalistic exposures with an improved dynamic perception of the surgical field and reduced conflicts between the instruments. The endonasal structures that are left intact help support the instruments. The same surgical objectives, in terms of exposure and resection, are achieved. We describe our technique and a series of patients operated with this uninarial 3-instruments technique to discuss relevant operative nuances. CONCLUSIONS We propose a technical modification that allows the surgeons to benefit from the advantages of a bimanual technique while still holding the endoscope. In our opinion, this technique may improve dynamic understanding of the anatomy and surgical efficiency and reduce the footprint of the surgery.
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Affiliation(s)
- Moujahed Labidi
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France; Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Kentaro Watanabe
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Shunya Hanakita
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Hun Ho Park
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | | | - Anne-Laure Bernat
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France; Paris VII-Diderot University, Paris, France
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Azimuddin AF, Weitzel EK, McMains KC, Chen PG. An ergonomic assessment of operating table and surgical stool heights for seated otolaryngology procedures. ALLERGY & RHINOLOGY 2017; 8:182-188. [PMID: 29070277 PMCID: PMC5662545 DOI: 10.2500/ar.2017.8.0215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Musculoskeletal injuries, such as neck and back pain, during a surgeon's career are common. However, studies on ergonomics are limited with regard to seated otolaryngologic procedures. Key elements of an ergonomic operating environment include the height of operating tables and surgical chairs. Surgeons benefit from proper support and positioning to prevent musculoskeletal injuries and reduce occupational risk. Objective: The purpose of this study was to evaluate operating table and surgical seat heights, and determine whether adjustments can be made for various surgeon physiques. Methods: Operating tables and surgical seat dimensions were measured at local hospitals, and the information was complemented by an online search of other models. Results: Five unique operating tables and five unique surgical stools were identified, both in the local hospital and in a search on the Internet. Of available tables, the greatest range was 63.5–124.5 cm, which reaches above the maximum suggested working height of 76.2 cm. The surgical stool with the widest range was adjustable from heights of 50.8–72.4 cm. This combination of operative table and surgical stool provided the greatest range of heights. Conclusion: Of the available tables and stools measured, the combination of surgical table with a range of 63.5–125.7 cm and surgical stool with a range of 50.8–72.4 cm provided the greatest versatility for diverse physician heights. In ergonomic terms, this combination may reduce physical fatigue and create a potentially safer working environment for seated surgeons.
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Affiliation(s)
- Anam F Azimuddin
- From the Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Erik K Weitzel
- Department of Surgery, San Antonio Uniformed Services Health Educational Consortium, Joint Base San Antonio, San Antonio, Texas
| | - Kevin C McMains
- Department of Surgery, San Antonio Uniformed Services Health Educational Consortium, Joint Base San Antonio, San Antonio, Texas
| | - Philip G Chen
- From the Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
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Proietti S, Somani B, Sofer M, Pietropaolo A, Rosso M, Saitta G, Gaboardi F, Traxer O, Giusti G. The "Body Mass Index" of Flexible Ureteroscopes. J Endourol 2017; 31:1090-1095. [PMID: 28835120 DOI: 10.1089/end.2017.0438] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the "body mass index" (BMI) (weight and length) of 12 flexible ureteroscopes (digital and fiber optic) along with the light cables and camera heads, to make the best use of our instruments. MATERIALS AND METHODS Twelve different brand-new flexible ureteroscopes from four different manufacturers, along with eight camera heads and three light cables were evaluated. Each ureteroscope, camera head, and light cable was weighted; the total length of each ureteroscope, shaft, handle, flexible end-tip, and cable were all measured. RESULTS According to our measurements (in grams [g]), the lightest ureteroscope was the LithoVue (277.5 g), while the heaviest was the URF-V2 (942.5 g). The lightest fiber optic endoscope was the Viper (309 g), while the heaviest was the Cobra (351.5 g). Taking into account the entirety of the endoscopes, the lightest ureteroscope was the Lithovue and the heaviest was the Wolf Cobra with the Wolf camera "3 CHIP HD KAMERA KOPF ENDOCAM LOGIC HD" (1474 g). The longest ureteroscope was the URF-P6 (101.6 cm) and the shortest was the LithoVue (95.5 cm); whereas the Viper and Cobra had the longest shaft (69 cm) and URF-V had the shortest shaft (67.2 cm). The URF-V2 had the longest flexible end-tip (7.6 cm), while the LithoVue had the shortest end-tip (5.7 cm) in both directions (up/down), while the URF-V had the shortest upward deflection (3.7 cm). CONCLUSIONS Newer more versatile digital endoscopes were lighter than their traditional fiber optic counterparts in their entirety, with disposable endoscope having a clear advantage over other reusable ureteroscopes. Knowing the "BMI" of our flexible ureteroscopes is an important information that every endourologist should always take into consideration.
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Affiliation(s)
- Silvia Proietti
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Bhaskar Somani
- 2 Department of Urology, University Hospitals Southampton NHS Trust , Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Mario Sofer
- 3 Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel
| | - Amelia Pietropaolo
- 2 Department of Urology, University Hospitals Southampton NHS Trust , Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Marco Rosso
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Giuseppe Saitta
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Franco Gaboardi
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Olivier Traxer
- 4 Department of Urology, GRC Lithiase (Groupe Recherche Clinique), Université Pierre et Marie Curie-Paris VI , Paris, France
| | - Guido Giusti
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
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Ho TVT, Hamill CS, Sykes KJ, Kraft SM. Work-related musculoskeletal symptoms among otolaryngologists by subspecialty: A national survey. Laryngoscope 2017; 128:632-640. [DOI: 10.1002/lary.26859] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/08/2017] [Accepted: 07/19/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Thuy-Van Tina Ho
- Department of Otolaryngology; University of Kansas Medical Center; Kansas City Kansas U.S.A
| | - Chelsea S. Hamill
- Department of Otolaryngology; University of Kansas Medical Center; Kansas City Kansas U.S.A
| | - Kevin J. Sykes
- Department of Otolaryngology; University of Kansas Medical Center; Kansas City Kansas U.S.A
| | - Shannon M. Kraft
- Department of Otolaryngology; University of Kansas Medical Center; Kansas City Kansas U.S.A
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Bolzoni Villaret A, Doglietto F, Carobbio A, Schreiber A, Panni C, Piantoni E, Guida G, Fontanella MM, Nicolai P, Cassinis R. Robotic Transnasal Endoscopic Skull Base Surgery: Systematic Review of the Literature and Report of a Novel Prototype for a Hybrid System (Brescia Endoscope Assistant Robotic Holder). World Neurosurg 2017; 105:875-883. [PMID: 28645603 DOI: 10.1016/j.wneu.2017.06.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although robotics has already been applied to several surgical fields, available systems are not designed for endoscopic skull base surgery (ESBS). New conception prototypes have been recently described for ESBS. The aim of this study was to provide a systematic literature review of robotics for ESBS and describe a novel prototype developed at the University of Brescia. METHODS PubMed and Scopus databases were searched using a combination of terms, including Robotics OR Robot and Surgery OR Otolaryngology OR Skull Base OR Holder. The retrieved papers were analyzed, recording the following features: interface, tools under robotic control, force feedback, safety systems, setup time, and operative time. A novel hybrid robotic system has been developed and tested in a preclinical setting at the University of Brescia, using an industrial manipulator and readily available off-the-shelf components. RESULTS A total of 11 robotic prototypes for ESBS were identified. Almost all prototypes present a difficult emergency management as one of the main limits. The Brescia Endoscope Assistant Robotic holder has proven the feasibility of an intuitive robotic movement, using the surgeon's head position: a 6 degree of freedom sensor was used and 2 light sources were added to glasses that were therefore recognized by a commercially available sensor. CONCLUSIONS Robotic system prototypes designed for ESBS and reported in the literature still present significant technical limitations. Hybrid robot assistance has a huge potential and might soon be feasible in ESBS.
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Affiliation(s)
- Andrea Bolzoni Villaret
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Andrea Carobbio
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Camilla Panni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Enrico Piantoni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Giovanni Guida
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Cassinis
- Department of Information Engineering, University of Brescia, Brescia, Italy
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Ramakrishnan VR, Milam BM. Ergonomic analysis of the surgical position in functional endoscopic sinus surgery. Int Forum Allergy Rhinol 2017; 7:570-575. [DOI: 10.1002/alr.21911] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/21/2016] [Accepted: 12/13/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Vijay R. Ramakrishnan
- Department of Otolaryngology; University of Colorado; Aurora CO
- Department of Neurosurgery; University of Colorado; Aurora CO
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Govil N, DeMayo WM, Hirsch BE, McCall AA. Optimizing Positioning for In-Office Otology Procedures. Otolaryngol Head Neck Surg 2016; 156:156-160. [DOI: 10.1177/0194599816670137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Surgeons often report musculoskeletal discomfort in relation to their practice, but few understand optimal ergonomic positioning. This study aims to determine which patient position—sitting versus supine—is ergonomically optimal for performing otologic procedures. Study Design Observational study. Setting Outpatient otolaryngology clinic setting in a tertiary care facility. Subjects and Methods We observed 3 neurotologists performing a standardized simulated cerumen debridement procedure on volunteers in 2 positions: sitting and supine. The Rapid Upper Limb Assessment (RULA)—a validated tool that calculates stress placed on the upper limb during a task—was used to evaluate ergonomic positioning. Scores on this instrument range from 1 to 7, with a score of 1 to 2 indicating negligible risk of developing posture-related injury. The risk of musculoskeletal disorders increases as the RULA score increases. Results In nearly every trial, RULA scores were lower when the simulated patient was placed in the supine position. When examined as a group, the median RULA scores were 5 with the patient sitting and 3 with the patient in the supine position ( P < .0001). When the RULA scores of the 3 neurotologists were examined individually, each had a statistically significant decrease in score with the patient in the supine position. Conclusion This study indicates that patient position may contribute to ergonomic stress placed on the otolaryngologist’s upper limb during in-office otologic procedures. Otolaryngologists should consider performing otologic procedures with the patient in the supine position to decrease their own risk of developing upper-limb musculoskeletal disorders.
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Affiliation(s)
- Nandini Govil
- Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
| | - William M. DeMayo
- Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
| | - Barry E. Hirsch
- Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
- Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
| | - Andrew A. McCall
- Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
- Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
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Occupational musculoskeletal pain amongst ENT surgeons - are we looking at the tip of an iceberg? The Journal of Laryngology & Otology 2016; 130:490-6. [PMID: 27095554 DOI: 10.1017/s0022215116001006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Surgeons are exposed to a variety of occupational risks, including work-related musculoskeletal disorders. This study investigated the prevalence of these latter disorders amongst UK ENT surgeons and compared this with the existing literature. METHODS A survey containing questions on work-related musculoskeletal disorders was distributed to the entire membership of ENT-UK electronically, with the assistance of its Survey Guardian. A literature review on the subject was then performed. RESULTS A total of 323 completed questionnaires were received (a 24 per cent response rate). Work-related musculoskeletal disorders had been experienced by 47.4 per cent of respondents. There were no statistical differences between the occurrence of work-related musculoskeletal disorders and: grade, length of time spent in the specialty or the subspecialty of respondents. Eighty-five per cent of affected surgeons sought treatment, with 22.9 per cent taking time off work and six surgeons retiring early. The literature review only identified five related studies. CONCLUSION Despite the scarcity of studies, work-related musculoskeletal disorders are common amongst ENT surgeons in the UK. Such disparity highlights the need for more research and appropriate ergonomic intervention within the specialty.
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Vijendren A, Yung M. An overview of occupational hazards amongst UK Otolaryngologists. Eur Arch Otorhinolaryngol 2016; 273:2825-32. [PMID: 27048520 DOI: 10.1007/s00405-016-4024-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/30/2016] [Indexed: 12/16/2022]
Abstract
Occupational-related hazards (OH) are noted to be prevalent within the medical community. However, there is limited evidence of its effects amongst ENT surgeons. A national survey was carried out with the assistance of ENT-UK to investigate the prevalence of various OH amongst ENT doctors in the UK. A literature search was also conducted to search for articles within English literature worldwide on this subject. 70.6 % of the responding 323 ENT surgeons had reported a form of OH throughout their career. Musculoskeletal pain was the most commonly reported (47.4 %) followed by stress/psychiatric morbidities (38.4 %) and sharps injuries (26.6 %). We found no correlation between OH and consultants/non-consultant status, time spent in ENT and subspecialty. Our literature search revealed 16 articles pertaining to OH amongst ENT doctors. OHs are prevalent within the UK ENT community. There is good evidence within literature on musculoskeletal pain, however, higher level studies are required to thoroughly investigate the other hazards.
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Affiliation(s)
- Ananth Vijendren
- Ipswich Hospital Trust, Heath Road, Suffolk, IP4 5PD, UK. .,, 143 Stephendale Road, Fulham, London, SW6 2PR, UK.
| | - Matthew Yung
- Ipswich Hospital Trust, Heath Road, Suffolk, IP4 5PD, UK
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Implementation of a robotic surgical program in gynaecological oncology and comparison with prior laparoscopic series. Int J Surg Oncol 2015; 2015:814315. [PMID: 25785195 PMCID: PMC4345046 DOI: 10.1155/2015/814315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/16/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm) and 264.0 min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100 mL in both groups. Conclusion. Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The robotic surgery team learning curve may be associated with higher rate of morbidity. Further research on the benefits to the surgeon is needed to clarify the whole picture of this versatile novel surgical approach.
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Smith LJ, Trout JM, Sridharan SS, Guyer JR, Owens GE, Chambers AJ, Rosen CA. Comparison of microsuspension laryngoscopy positions: A randomized, prospective study. Laryngoscope 2014; 125:649-54. [DOI: 10.1002/lary.24932] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Libby J. Smith
- University of Pittsburgh Voice Center; Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Jenna M. Trout
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Shaum S. Sridharan
- University of Pittsburgh Voice Center; Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Joan R. Guyer
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Grace E. Owens
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - April J. Chambers
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | - Clark A. Rosen
- University of Pittsburgh Voice Center; Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
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Wong A, Baker N, Smith L, Rosen CA. Prevalence and risk factors for musculoskeletal problems associated with microlaryngeal surgery: a national survey. Laryngoscope 2014; 124:1854-61. [PMID: 24108662 DOI: 10.1002/lary.24367] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Microlaryngeal surgery (MLS) presents ergonomic challenges to surgeons and potential risks for developing musculoskeletal symptoms (MSSx). This study describes prevalence and risk factors of MLS-associated MSSx. STUDY DESIGN Cross-sectional survey. METHODS A questionnaire was administered to members of the American Academy of Otolaryngology-Head and Neck Surgery. Outcome measures related to surgeon demographics, training, MLS experience, operating room setup, experience of MSSx in relation to MLS, treatment sought, and practice changes due to MSSx. RESULTS Response rate was 9.2% (n = 476); 83% reported musculoskeletal symptoms during MLS, and 21% reported rest breaks during MLS. Taking breaks was independently associated with back support lack (odds ratio [OR] = 2.08) and surgery lasting >30 minutes (OR = 1.68). Areas most commonly affected were neck, upper back, shoulder, and lower back. Ten percent reported treatment for MLS-related MSSx. Some respondents reported major practice changes due to MSSx, including fewer cases, ceasing to perform MLS, applying for disability, and early retirement. CONCLUSIONS Musculoskeletal symptoms are common (83%) among surgeons performing microlaryngeal surgery. Findings suggest multiple factors may contribute to development of MSSx in otolaryngologists. Risk factors for MSSx and taking breaks during surgery include average case operating time >30 minutes and absence of back support. Previous studies have identified neck flexion and lack of arm support as associated with risk of musculoskeletal injury. This study demonstrates that MSSx related to surgery do occur in otolaryngologists, and that poor surgical ergonomics may play a role. Surgeons should consider proper support and positioning during MLS to protect their health.
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Affiliation(s)
- Adrienne Wong
- University of Pittsburgh Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Ramakrishnan VR, Montero PN. Ergonomic considerations in endoscopic sinus surgery: lessons learned from laparoscopic surgeons. Am J Rhinol Allergy 2013; 27:245-50. [PMID: 23710962 DOI: 10.2500/ajra.2013.27.3872] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic sinus procedures are increasingly common, and more technically difficult procedures are being undertaken to provide patients with minimally invasive alternatives to traditional open surgical techniques. However, such endoscopic approaches have increasing physical demands on the surgeon. The aim of this review is to summarize current literature on surgical ergonomic principles as they relate to endoscopic sinus and skull base surgery and focus on future needs for our specialty. METHODS Literature review was performed of surgical ergonomics and, particularly, laparoscopic ergonomic principles. RESULTS Existing ergonomic principles for laparoscopic surgery can be applied to endoscopic sinus and skull base surgery and can be expected to offer benefits in terms of surgeon fatigue, physical discomfort, and task efficiency. CONCLUSION 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.
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Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
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Robotic surgery for the sinuses and skull base: what are the possibilities and what are the obstacles? Curr Opin Otolaryngol Head Neck Surg 2013; 21:11-6. [PMID: 23299117 DOI: 10.1097/moo.0b013e32835bc650] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Robotic surgery in otolaryngology - head and neck surgery has become a valuable tool in certain anatomic approaches; however, its application in surgery of the paranasal sinuses and anterior skull base is still in an investigatory phase and requires further evaluation. RECENT FINDINGS Existing robotic surgical systems face particular limitations in their application at the skull base because of instrument size and lack of variability. Unfortunately, only one system is available commercially that is applicable in the head and neck region and FDA approved for use in patients. This system, although advantageous in many otolaryngologic procedures, is difficult to use for endoscopic sinus and skull base surgery. However, other systems that target this anatomic subsite specifically are in development and show promise. Advances in the design of robotic arms, materials, and shape will potentially give surgeons a significant advantage over traditional endoscopic techniques. SUMMARY This article will review the current applications of robotic systems in paranasal sinus and skull base surgery, describe the requirements of a robotic system for use in this type of surgery, and describe a system under development at our institution.
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