FESS, fingers and other things--you are not alone!

Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery

OBJECTIVE

The main objective of this study was to develop and evaluate the feasibility and effectiveness of a novel exoskeleton system designed to provide ergonomic assistance to surgeons while preserving or improving the quality of endoscopic sinus and skull base surgical procedures.

METHODS

To evaluate the functionality and ergonomic characteristics of the device, five experiments were conducted in different and increasingly realistic scenarios: silicone model of the nasal cavity, freshly frozen cadavers and finally in a real surgery. Each volunteer's task was recorded and timed. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) rating scale was used to estimate the surgeons' workload while performing the tasks.

RESULTS

Twenty-five volunteers took part in the experiments. Volunteers perceived more comfort and less fatigue and pain when using the armrest than when not using the device (3.3, SD 1.75 vs. 5.9 SD 1.49; p = 0.02). Participants found the device intuitive, comfortable, and improving accuracy and stability with endoscope use.

CONCLUSION

A new system that provides ergonomic assistance to surgeons was tested in simulation surgery with acceptable usability. Initial results in terms of pain and fatigue reduction and efficiency were excellent, justifying further research into this technology.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:79-86, 2024.

An Objective Ergonomic Risk Assessment of Surgeons in Real Time While Performing Endoscopic Sinus Surgery

There are increased reports of high prevalence of work related musculoskeletal symptoms in surgeons performing otolaryngology procedures. However, real time ergonomic risk assessment in the OR is difficult due to issues related to sterility, cooperation and acceptance from surgeons. Although such analyses can provide valid risk estimate and guide corrective actions, they are scarce. Hence, this study was undertaken to assess the postural ergonomic risk on RULA in otolaryngologists while performing Functional Endoscopic Sinus Surgery in OR, in real time. A cross sectional, observational multi-centric study was conducted in tertiary referral hospitals. Spinal, shoulder and elbow movements of 10 surgeons performing FESS were measured intraoperatively using orientation sensor-based, motion-analysis system (Noraxon myomotion). Postural ergonomic risk on RULA was computed using the motion analysis data. RULA is a method of quantifying the physical postural risk of the trunk and upper limb based on the postures adopted by an individual during work. 10 surgeons (9 males and 1 female) with the mean (± SD) age of 38 ± 7.5 years participated in the study. The motion analysis data results indicate that the surgeons often adopt awkward spinal and upper extremity postures during the surgery. All the surgeons scored higher than the acceptable RULA score (1 or 2) with the mean RULA scores being in the range of 6-7. The physical ergonomic risk in surgeons performing FESS is high (> 6 on RULA). There is a need for urgent ergonomic attention to the working environment of FESS surgeon.