2025 Proffered Presentations
S151: ERGONOMIC TRENDS IN ENDOSCOPIC SKULL-BASE SURGEONS: A SURVEY TO THE NORTH AMERICAN SKULL BASE SOCIETY
Shreya Mandloi, BS1; Alexander Duffy, MD2; Praneet Kaki, BS1; Elina M Toskala, MD, PhD, MBA1; Marc Rosen, MD1; Christopher Farrell, MD1; James J Evans, MD1; Gurston G Nyquist, MD1; Mindy Rabinowitz, MD1; 1Thomas Jefferson University; 2Medical University of South Carolina
INTRODUCTION: Lack of ergonomic practices in the operating room results in significant musculoskeletal strain. The objective of this study was to obtain a current assessment of self-reported musculoskeletal strain associated with endoscopic endonasal and open skull base surgery as reported by members of the North American Skull Base Society (NASBS).
METHODS: A survey assessing current practices and symptomatology was distributed via email to members of the NASBS, which is a multidisciplinary society comprised of endoscopic and open skull base surgeons. Survey questions focused mainly on endoscopic skull base surgery.
RESULTS: Fifty-seven responses were received. Fifty (38 academic, 6 private, 6 other) were fully completed and thus analyzed. 47% of respondents in academic medicine and 33% of respondents in private practice indicated that they had significant (>4/10) musculoskeletal strain concentrated to their neck due to operating (p=0.70). There was no significant difference in average operating time per week and musculoskeletal strain. Both academic and private surgeons indicated that prolonged standing significantly impacted their neck (p=0.045) and lower back (p=0.041) pain while operating and that maintaining a fixed posture while holding the endoscope significantly impacted neck (p=0.022), shoulder (p=0.015), and lower back pain (p=0.006). Manipulation of endoscopic instruments significantly impacted dominant wrist pain (p=0.037) in both academic and private surgeons. Respondents did not feel that monitor or foot pedal position greatly contributed to their musculoskeletal strain. Additionally, neurosurgeons and rhinologists that operate on the same side of the patient during endoscopic endonasal skull base (EESB) surgery had significantly greater musculoskeletal strain than neurosurgeons and rhinologists that operate on opposite sides of the patient (p=0.031). 90% of respondents indicated that musculoskeletal strain did not impact their practice, increase operative time, or contribute to missed workdays. 74% of respondents indicated that their institution does not provide ergonomic measures or recommendations; however, 50% of respondents stated they would be open to trying interventions to improve musculoskeletal health in the operating room.
DISCUSSION: This study reveals that most endoscopic skull base surgeons experience musculoskeletal strain in the operating room concentrated to their neck and lower back. Operating room factors including prolonged standing, fixed posture with endoscope holding, and manipulation of endoscopic instruments significantly impact musculoskeletal strain. Interestingly, standing on the same side of the patient during EESB surgery led to more reported discomfort than standing on opposite sides of the patient. While the majority of surgeons agree that their current practice produces pain, few are impacted in their daily practice. Most respondents indicated that their institution does not provide ergonomic training and interventions, however, most surgeons report that they would be open to incorporating this into their practice. This study highlights the nature of ergonomic strain experienced during EESB and the need for further study looking into interventions to help improve practices and reduce strain.