Ergonomics in Otolaryngologic Surgery: A State of the Art Review

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.

Association of Vibrotactile Biofeedback With Reduced Ergonomic Risk for Surgeons During Tonsillectomy

“…The surgical workplace has been slow to create easily adopted methods to quantify and mitigate ergonomic risk, perhaps due to a lack of awareness and formal training of ergonomic principles during residency . In this way, deliberate training and education in ergonomics is critical for protecting the workforce.…”

“…Ergonomic interventions in plastic surgery have been associated with fewer errors and self-reported decreased muscular fatigue by taking 20-second breaks to rest muscles every 20 minutes throughout the procedure . Other interventions have included changing patient positioning, surgeon positioning, and novel instruments or support devices . Furthermore, surgeons who exercise regularly (>5 hours per week or >3 days per week) have reduced symptoms of musculoskeletal disorders .…”

“…Furthermore, surgeons who exercise regularly (>5 hours per week or >3 days per week) have reduced symptoms of musculoskeletal disorders . Of the subspecialties of otolaryngology, head and neck surgeons may have a higher ergonomic risk due to more frequently wearing loupes and headlights, nonsitting positions while operating, and procedures that necessitate a direct rather than endoscopic visualization …”

Synthesis of the Types and Trends of Review Articles

“…ese approaches are time-bound and might distort the holistic picture of the development of the given topic (for some strong recent examples of medicinerelated state-of-the-art review, see [34,35]).…”

Female Surgical Ergonomics in Otolaryngology: A National Survey Study

“…7,8 A recent review examined surgical ergonomics in otolaryngology, and found a high prevalence of work-related musculoskeletal disorders. 9 Importantly, the authors identified multiple studies that found effective ergonomic interventions, including the use of novel equipment and instrumentation. Despite this, the use of more ergonomic devices and equipment has not been widely adopted in our field.…”