Intraoperative Neck Angles in Endoscopic and Microscopic Otologic Surgeries

Objective: To quantitatively compare the ergonomic risk of otologic surgeries performed with endoscopes and microscopes. Study Design: Observational cross-sectional study. Setting: Operating room of a tertiary academic medical center. Methods: Intraoperative neck angles of otolaryngology attendings, fellows, and residents were assessed during 17 otologic surgeries using inertial measurement unit sensors. Sensors were attached midline between the shoulder blades and on the posterior scalp of participants and were calibrated just prior to beginning each case. Quaternion data were used to calculate neck angles during periods of active surgery. Results: Endoscopic and microscopic cases included similar percentages of time in high-risk neck positions, 75% and 73%, respectively, according to a validated ergonomic risk assessment tool, the Rapid Upper Limb Assessment. However, microscopic cases included a higher percentage of time spent in extension (25%) compared to endoscopic cases (12%) (p <.001). When examining the magnitude of average flexion and extension angles, endoscopic and microscopic cases were not significantly different. Conclusion: Utilizing intraoperative sensor data, we found that both endoscopic and microscopic approaches in otologic surgery were associated with high-risk neck angles, which can result in sustained neck strain. These results suggest that optimal ergonomics may be better achieved by the consistent application of basic ergonomic principles than by changing the technology in the operating room.