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Patient and physician positioning during anterior skull base surgery impacts physician ergonomics.
Br J Neurosurg. 2022 Jun; 36(3):394-399.BJ

Abstract

BACKGROUND

The effects of anterior skull base surgery on surgeon's ergonomics remain unclear and this study explores the impact of patient, surgeon and screen positioning on surgeon's ergonomics during anterior skull base surgery using the Rapid Upper Limb Assessment (RULA) tool.

METHOD

A total of 20 different surgical positions involving the operating surgeon, assisting surgeon, patient head position, camera position and screen position/number were simulated. For each position, the ergonomic effects on the upper limb, neck, trunk and lower limb of surgeons were analysed using the Rapid Upper Limb Assessment (RULA) tool.

RESULTS

The lowest RULA score is 2 and the maximum score is 6. The majority of scores ranged from 2 to 3 suggesting the majority of positions have acceptable postures. The average RULA score of the right side of operating surgeon was 2.8 versus 2.95 on the left-side (p = 0.297). For the assisting surgeon, the average RULA score of the right side was 3.65 versus 3.25 for the left side (p = 0.053). The average combined (left and right) RULA score for the operating surgeon was 5.76 versus 6.9 for the assisting surgeon (p < 0.001). Position 17 (operating surgeon to the right of patient, assisting surgeon to the left of patient, central patient head position and two screens) is the most ergonomically favourable position. Position 2 (operating and assisting surgeon to the right of patient, patient head position to the right and one screen position to the left of patient) is the least favourable position.

CONCLUSION

This simulation raises awareness of risk of musculoskeletal injury in anterior skull base surgery and highlights that certain positional behaviours are better for reducing injury risk than others. Two screens should be considered when performing a two-surgeon, four-hand anterior skull base surgery and surgeons should consider applying this to their own ergonomic environment in theatre.

Authors+Show Affiliations

Department of Otolaryngology, NHS Lothian, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK.Department of Otolaryngology, NHS Lothian, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK.Department of Otolaryngology, Royal Hampshire County Hospital, Winchester, Hampshire, UK.Department of Otolaryngology, NHS Lothian, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK.Department of Otolaryngology, Royal Hampshire County Hospital, Winchester, Hampshire, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35642420

Citation

Maniam, Pavithran, et al. "Patient and Physician Positioning During Anterior Skull Base Surgery Impacts Physician Ergonomics." British Journal of Neurosurgery, vol. 36, no. 3, 2022, pp. 394-399.
Maniam P, Lucocq J, Gohil R, et al. Patient and physician positioning during anterior skull base surgery impacts physician ergonomics. Br J Neurosurg. 2022;36(3):394-399.
Maniam, P., Lucocq, J., Gohil, R., Lewis-Morgan, G., & Rokade, A. (2022). Patient and physician positioning during anterior skull base surgery impacts physician ergonomics. British Journal of Neurosurgery, 36(3), 394-399. https://doi.org/10.1080/02688697.2022.2078477
Maniam P, et al. Patient and Physician Positioning During Anterior Skull Base Surgery Impacts Physician Ergonomics. Br J Neurosurg. 2022;36(3):394-399. PubMed PMID: 35642420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient and physician positioning during anterior skull base surgery impacts physician ergonomics. AU - Maniam,Pavithran, AU - Lucocq,James, AU - Gohil,Rohit, AU - Lewis-Morgan,Giles, AU - Rokade,Ashok, Y1 - 2022/06/01/ PY - 2022/6/2/pubmed PY - 2022/6/2/medline PY - 2022/6/1/entrez KW - Skull base KW - anterior KW - cranial fossa KW - ergonomics KW - musculoskeletal pain KW - occupational injuries SP - 394 EP - 399 JF - British journal of neurosurgery JO - Br J Neurosurg VL - 36 IS - 3 N2 - BACKGROUND: The effects of anterior skull base surgery on surgeon's ergonomics remain unclear and this study explores the impact of patient, surgeon and screen positioning on surgeon's ergonomics during anterior skull base surgery using the Rapid Upper Limb Assessment (RULA) tool. METHOD: A total of 20 different surgical positions involving the operating surgeon, assisting surgeon, patient head position, camera position and screen position/number were simulated. For each position, the ergonomic effects on the upper limb, neck, trunk and lower limb of surgeons were analysed using the Rapid Upper Limb Assessment (RULA) tool. RESULTS: The lowest RULA score is 2 and the maximum score is 6. The majority of scores ranged from 2 to 3 suggesting the majority of positions have acceptable postures. The average RULA score of the right side of operating surgeon was 2.8 versus 2.95 on the left-side (p = 0.297). For the assisting surgeon, the average RULA score of the right side was 3.65 versus 3.25 for the left side (p = 0.053). The average combined (left and right) RULA score for the operating surgeon was 5.76 versus 6.9 for the assisting surgeon (p < 0.001). Position 17 (operating surgeon to the right of patient, assisting surgeon to the left of patient, central patient head position and two screens) is the most ergonomically favourable position. Position 2 (operating and assisting surgeon to the right of patient, patient head position to the right and one screen position to the left of patient) is the least favourable position. CONCLUSION: This simulation raises awareness of risk of musculoskeletal injury in anterior skull base surgery and highlights that certain positional behaviours are better for reducing injury risk than others. Two screens should be considered when performing a two-surgeon, four-hand anterior skull base surgery and surgeons should consider applying this to their own ergonomic environment in theatre. SN - 1360-046X UR - https://www.unboundmedicine.com/medline/citation/35642420/Patient_and_physician_positioning_during_anterior_skull_base_surgery_impacts_physician_ergonomics_ L2 - https://www.tandfonline.com/doi/full/10.1080/02688697.2022.2078477 DB - PRIME DP - Unbound Medicine ER -