Quantitative Assessment of Surgical Ergonomics in Otolaryngology

Abstract

Objectives Objective evaluation of the ergonomic risk of common otolaryngology procedures and assessment of work-related musculoskeletal pain and injury. Study Design Cross-sectional intraoperative assessment and survey. Setting Department of Otolaryngology at a tertiary children’s hospital. Subjects and Methods Sixteen otolaryngology attendings, fellows, and residents participated in a blinded study. Intraoperative ergonomics was assessed for tonsillectomies, adenoidectomies, and tympanostomy tube insertions using the Rapid Upper Limb Assessment (RULA). Follow-up surveys were sent to all participating surgeons to determine the prevalence of musculoskeletal pain and formal ergonomic training. Results Zero percent (N = 0/275) of intraoperative observations were found to have a negligible level of ergonomic risk, with 47% low risk, 37% high risk, and 16% very high risk. Tympanostomy tube insertions conferred less risk than tonsillectomy and adenoidectomy, while the use of headlamp or loupes conferred increased risk. Eighty percent of respondents reported having musculoskeletal pain and 40% reported experiencing pain while operating within the past year. The most common area of pain was the cervical spine. No surgeons reported formal ergonomic training. Conclusions Our study demonstrates an unacceptable level of ergonomic risk for common procedures in otolaryngology. Furthermore, most participants reported experiencing musculoskeletal pain despite the duration of examined procedures being relatively short. The high prevalence of work-related musculoskeletal pain and the lack of ergonomic training in our cohort highlight the need for increased awareness of ergonomics as well as the development of formal ergonomic curricula.

Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis

“…Rodman et al suggest that 80% of otolaryngology survey participants experience some form of musculoskeletal pain. 20 This has been confirmed across many different studies evaluating work-related MSI in otolarynoglogy. 6,21,22 Govil et al performed a comparison of providers while performing cerumen removal using the RULA to come up with specific recommendations about the ergonomic favorability of various positions; however, there remains a need to provide objective measures of ergonomically good and bad positioning during ALS.…”

“…There has been significant emphasis on proper ergonomic positioning within otolaryngology, both in the office and in the operating room. Rodman et al suggest that 80% of otolaryngology survey participants experience some form of musculoskeletal pain 20 . This has been confirmed across many different studies evaluating work‐related MSI in otolarynoglogy 6,21,22 .…”

Ergonomic Analysis of Functional Endoscopic Sinus Surgery Using Novel Inertial Sensors

“…Utilizing REBA-trained observers, Rodman et al demonstrated that trainees operated in significantly higher risk positions than did attendings when performing pediatric otolaryngology surgeries. 8 These angle estimations were privy to human error; however, and the results did not distinguish between neck and upper limb angles when reporting the relative risk of upper body positioning. 8 Our data illustrate that in attendings, rhinologists experience significantly more pain at the conclusion of surgery when compared to their baseline; this finding is supported by previous work in minimally invasive surgery.…”

“…28 This tool assigns scores for the relative health of each major joint angle and has been utilized in a multitude of studies examining the ergonomic risk of surgeons. 4,8,29 Deviations of >10 in either direction from a neutral position are designated as higher risk, with commensurate designations for each additional 10 . In accordance with the REBA, high-risk angles (designated with *) were set to ≥10 degrees deviation from a neutral position in either direction.…”

“…[5][6][7] Objective assessments have historically relied on ergonomists capable of estimating body angles and postural risk from either direct observation or review of surgical video recordings. 8 Technological advancements have recently allowed scientists to record and analyze a subject's joint kinematics in real time. 9 Inertial measurement unit (IMU) sensors, now commercially available (APDM Wearable Technologies; Portland, OR), have demonstrated utility in monitoring the progression of Parkinson's, vestibular disorders, rehabilitation following joint replacement, and other conditions impairing mobility.…”