Ergonomics in Microscopic and Endoscopic Ear Surgery · Ergonomics in Microscopic and Endoscopic...
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Ergonomics in Microscopic and Endoscopic Ear Surgery
Sujana S. Chandrasekhar, MDPartner, ENT & Allergy Associates, LLP
Clinical Professor of Otolaryngology, Zucker SOM
Clinical Associate Professor of Otolaryngology, Icahn SOM
Secretary-Treasurer, American Otological Society
Past President, American Academy of Otolaryngology-HNS
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I have nothing to disclose.No, within the last 12 months I have not had any type of financial arrangement or
affiliation with commercial interests related to the content of this continuing education activity that requires disclosure.
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er·go·nom·ics/ˌərɡəˈnämiks/
noun
The study of people's efficiency in their working environment –results in adapting the people to the environment AND adapting
the environment to the people.
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Work Related Musculoskeletal Disorders• Are prevalent in surgeons
• Open surgery: 66% to 94% • Conventional laparoscopy: 73% to 100%• Vaginal surgery: 54% to 87%• Robot-assisted surgery: 23% to 80%
• Risk factors for injury• Open surgery: use of loupes, headlamps, and microscopes• Laparoscopic surgery: table and monitor position, long-shafted instruments, poor instrument
handle design• Vaginal surgery: improper table height and twisted trunk position• Robotic surgery: trunk, wrist, and finger strain
• Surgeon WMSDs often result in disability but are under-reported to institutions. Catanzarite T, Tan-Kim J, Whitcomb EL, Menefee S. Ergonomics in Surgery: A Review.Female Pelvic Med Reconstr Surg. 2018 Jan/Feb;24(1):1-12.
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Veterinarian injuries from spay/neuter
https://ergovet.com/pain-spay-neuter-vets/
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Duke Surgery Introduces Ergonomics Program to Improve Surgeon Health
July 2017
• Maintaining neck flexion at less than or equal to 25 degrees can prevent spine and neck strain during long stints in the OR.
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The evolution of transsphenoidal surgery
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Otolaryngo-ergonomics Data• 323 ENTs in the UK Survey (Babar et al, JLO 2003)
• 72% had back pain and/or neck pain• Otology had the highest prevalence
• 377 ENTs in North America (Ho et al, Laryngoscope 2018)• 63.9% reported work-related MSK symptoms
• Rhinology study (Little et al, Int Forum Allergy Rhinol, 2012)• 77% of respondents experienced physical
discomfort or symptoms associated with endoscopic sinus surgery
• Adopting the microscope for thyroid surgery (Davidson et al, H&N 2010)
J Gleysteen, MD Temple U
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The Goldilocks phenomenon – or, one size does not fit all.
• What fits a 6 foot 5 male surgeon isn’t necessarily the best device for a 5 foot 3 female surgeon.
• Most common male glove size is 7.
• Most common female glove size is 6.
S. Preyer, HNO 2016
B. Davidson, H&N 2010
SEES, 2019
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‘Easy Rider’ Microscope Users
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Role for Exoscopes in ‘Heads Up’ Ear Surgery?
Mass Eye and Ear Infirmary
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Line-of-sight for EES/exoscope monitor
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Physician, Look After Thyself
• Be cognizant of your body’s comfort and ergonomics during surgery.
• Take brief breaks every 30 minutes.
• An ounce of prevention is worth several pounds of cure.
Qor360.com