Ergonomic advantage of pistol‐grip endoscope in the ENT practice

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

Ergonomics in Otolaryngologic Surgery: A State of the Art Review

“…There was no difference in muscle activation for the hand inserting the scope into the nose (147 6 57 vs 166 6 36 mMA, respectively; P = .145). 29 The use of modified postural chairs that provide support to the sternum and forehead during microlaryngeal surgery significantly increased the time to subjective neck and back fatigue. The mean time to neck fatigue for the standard chair was 348 seconds, as opposed to 1019 seconds with the postural chair (P = .007).…”

“…Using the mean value of triplicated surface electromyography mean amplitude measurements (mMA), Watanabe et al compared muscle activation between a novel endoscope and the conventional endoscope 29 . As compared with a conventional grip endoscope, this novel pistol grip endoscope was shown to reduce muscle activation for the hand that grips the scope (mean ± SD: 143 ± 45 vs 113 ± 29 mMA, respectively; P = .001).…”

“…[21][22][23][24][25][26] Seven studies compared the use of favorable and unfavorable ergonomic surgical positions, and all of these studies demonstrated an objective improvement in musculoskeletal stresses with the use of favorable ergonomic positions. 21,23,25,[27][28][29][30] Importantly, of the studies that used RULA data to quantify risk, only 1 of 8 showed that interventions improved surgeon positioning to a negligible risk category based on the following cutoffs: scores of 1 and 2, negligible risk; 3 and 4, low risk; 5 and 6, medium risk; and .6 very high risk with need for immediate change. 27 Rodman et al noted that during routine otolaryngologic surgery, no surgeons demonstrated a negligible and thus acceptable degree of risk.…”

“…New technologies are emerging to offset the ergonomic risk experienced by otolaryngologists. For example, the pistol grip endoscope is ergonomically favorable to the traditional endoscope and has been shown to be amenable for use in an operative setting 29 . The exoscope affords the potential for improved ergonomics in addition to benefits such as improved video demonstrations for real‐time operative teaching.…”

“…For example, the pistol grip endoscope is ergonomically favorable to the traditional endoscope and has been shown to be amenable for use in an operative setting. 29 The exoscope affords the potential for improved ergonomics in addition to benefits such as improved video demonstrations for real-time operative teaching. Exoscopes provide flexibility in positioning and freedom of the ocular lens.…”