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Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis.
Laryngoscope. 2021 12; 131(12):2752-2758.L

Abstract

OBJECTIVES

While it is acknowledged that otolaryngologists performing microlaryngeal surgery can develop musculoskeletal symptoms due to suboptimal body positioning relative to the patient, flexible laryngoscopy and awake laryngeal surgeries (ALSs) can also pose ergonomic risk. This prospective study measured the effects of posture during ergonomically good and bad positions during laryngoscopy using ergonomic analysis, skin-surface electromyography (EMG), and self-reported pain ratings.

STUDY DESIGN

Prospective cohort study.

METHODS

Eight participants trained in laryngoscopy assumed four ergonomically distinct standing positions (side/near, side/far, front/near, front/far) at three different heights (neutral-top of patient's head in line with examiner's shoulder, high-6 inches above neutral, and low-6 inches below neutral) in relation to a simulated patient. Participants' postures were analyzed using the validated Rapid Upper Limb Assessment (RULA, 1 [best] to 7 [worst]) tool for the 12 positions. Participants then simulated ALS for 10 minutes in a bad position (low-side-far) and a good position (neutral-front-near) with 12 EMG sensors positioned on the limbs and torso.

RESULTS

The position with the worst RULA score was the side/near/high (7.0), and the best was the front/near/neutral (4.5). EMG measurements revealed significant differences between simulated surgery in the bad and good positions, with bad position eliciting an average of 206% greater EMG root-mean-squared magnitude across all sampled muscles compared to the good posture (paired t-test, df = 7, P < .01), consistent with self-reported fatigue/pain when positioned poorly.

CONCLUSION

Quantitative and qualitative measurements demonstrate the impact of surgeon posture during simulated laryngoscopy and suggest ergonomically beneficial posture that should facilitate ALSs.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:2752-2758, 2021.

Authors+Show Affiliations

Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, U.S.A.Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. Department of Otolaryngology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A.Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34296439

Citation

Baird, Brandon J., et al. "Surgeon Positioning During Awake Laryngeal Surgery: an Ergonomic Analysis." The Laryngoscope, vol. 131, no. 12, 2021, pp. 2752-2758.
Baird BJ, Tynan MA, Tracy LF, et al. Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis. Laryngoscope. 2021;131(12):2752-2758.
Baird, B. J., Tynan, M. A., Tracy, L. F., Heaton, J. T., & Burns, J. A. (2021). Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis. The Laryngoscope, 131(12), 2752-2758. https://doi.org/10.1002/lary.29717
Baird BJ, et al. Surgeon Positioning During Awake Laryngeal Surgery: an Ergonomic Analysis. Laryngoscope. 2021;131(12):2752-2758. PubMed PMID: 34296439.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis. AU - Baird,Brandon J, AU - Tynan,Monica A, AU - Tracy,Lauren F, AU - Heaton,James T, AU - Burns,James A, Y1 - 2021/07/23/ PY - 2021/05/06/revised PY - 2021/03/29/received PY - 2021/06/05/accepted PY - 2021/7/24/pubmed PY - 2021/11/25/medline PY - 2021/7/23/entrez KW - Electromyography KW - awake laryngeal surgery KW - ergonomics KW - surgical ergonomics SP - 2752 EP - 2758 JF - The Laryngoscope JO - Laryngoscope VL - 131 IS - 12 N2 - OBJECTIVES: While it is acknowledged that otolaryngologists performing microlaryngeal surgery can develop musculoskeletal symptoms due to suboptimal body positioning relative to the patient, flexible laryngoscopy and awake laryngeal surgeries (ALSs) can also pose ergonomic risk. This prospective study measured the effects of posture during ergonomically good and bad positions during laryngoscopy using ergonomic analysis, skin-surface electromyography (EMG), and self-reported pain ratings. STUDY DESIGN: Prospective cohort study. METHODS: Eight participants trained in laryngoscopy assumed four ergonomically distinct standing positions (side/near, side/far, front/near, front/far) at three different heights (neutral-top of patient's head in line with examiner's shoulder, high-6 inches above neutral, and low-6 inches below neutral) in relation to a simulated patient. Participants' postures were analyzed using the validated Rapid Upper Limb Assessment (RULA, 1 [best] to 7 [worst]) tool for the 12 positions. Participants then simulated ALS for 10 minutes in a bad position (low-side-far) and a good position (neutral-front-near) with 12 EMG sensors positioned on the limbs and torso. RESULTS: The position with the worst RULA score was the side/near/high (7.0), and the best was the front/near/neutral (4.5). EMG measurements revealed significant differences between simulated surgery in the bad and good positions, with bad position eliciting an average of 206% greater EMG root-mean-squared magnitude across all sampled muscles compared to the good posture (paired t-test, df = 7, P < .01), consistent with self-reported fatigue/pain when positioned poorly. CONCLUSION: Quantitative and qualitative measurements demonstrate the impact of surgeon posture during simulated laryngoscopy and suggest ergonomically beneficial posture that should facilitate ALSs. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2752-2758, 2021. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/34296439/Surgeon_Positioning_During_Awake_Laryngeal_Surgery:_An_Ergonomic_Analysis_ L2 - https://doi.org/10.1002/lary.29717 DB - PRIME DP - Unbound Medicine ER -