Cervical Ergonomics in Head and Neck Endocrine Surgery: A Quantitative Assessment of Approaches

Objective: To quantitatively assess the intraoperative cervical ergonomics of head and neck endocrine surgery and compare differences between surgical approaches. Study Design: Cross-sectional assessment. Setting: Operating rooms of an academic tertiary care center. Methods: Intraoperative neck angles of otolaryngology attendings, fellows, and residents were recorded during head and neck endocrine surgeries. Two position sensors were affixed to the surgeon's midline between the scapulae and on the posterior scalp and calibrated at the beginning of each case. Raw quaternion data were analyzed to calculate neck angles during periods of active surgery. Neck flexion greater than 20 degrees and any degree of extension are defined as high-risk by the Rapid Upper Limb Assessment, a validated ergonomics risk tool. Results: Fifteen surgeries (nine transcervical, six transoral) were recorded between five surgeons. Average time spent in active surgery was 58.5 minutes for the transcervical approach and 64.1 minutes for transoral. Percentage of time spent in high-risk neck angles was significantly higher for transcervical than transoral cases (80% [95% CI: 72%-88%] of active operating time vs 42% [95% CI: 31%-60%], P =.0001). Surgeons in transcervical cases spent more time in neck extension than surgeons in transoral cases (36% [95% CI: 19%-43%] vs 12% [95% CI: 3%-23%], P =.04). Transcervical cases resulted in neck movement across a wider range of angles compared to transoral cases, with a standard deviation of 20 versus 12 degrees (P =.02). Conclusion: The transoral approach is favorable to the transcervical approach with respect to cervical ergonomics for head and neck endocrine surgeons.