47 Patient and Physician Positioning During Anterior Skull Base Surgery Impacts Physician Ergonomics

Aim

The effects of anterior skull base surgery on surgeon’s ergonomics remain unclear and this study explore the impact of patient, surgeon, and screen positioning on surgeon’s ergonomics during the surgery.

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 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.

Conclusions

This simulation raises awareness of risk of musculoskeletal injury in anterior skull base surgery and highlights those certain positional behaviours are better for reducing injury risk than others.

Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method

BACKGROUND

Endoscopic sinus and anterior skull base surgery is considered particularly high risk for severe acute respiratory syndrome coronavirus-2 transmission in the operating theatre setting. In this context, the use of a microscope drape method is proposed, to minimise aerosol spread in the wider operating theatre environment.

METHODS

The efficacy of the method is assessed with a simulation model, using a CMI Concept Air Trace MK2 smoke generator for aerosol generation and a Fluke 985 air particle counter to measure air particles sized 0.3-10 μm in the operating theatre environment.

RESULTS

Aerosol spread was contained almost to baseline levels with the application of the drape barrier and the negative pressure created using suction within the drape.

CONCLUSION

The method is an efficient adjunct that could reduce the risk of aerosol shedding and viral transmission to the operating theatre team. It potentially allows faster operating theatre turnover and more liberal use of powered instruments during endonasal surgery.

A haemangiopericytoma of the ethmoid sinus causing oncogenic osteomalacia: a case report and review of the literature

Oncogenic osteomalacia is a rare cause of osteomalacia. It is caused by a tumour which is generally benign. These tumours, when identified, are often found in the head and neck region. The case is reported here of a haemangiopericytoma isolated in the ethmoid sinus, and the literature regarding tumours at this site is reviewed. Including the present case there are five reported in the world literature of an ethmoid sinus tumour causing oncogenic osteomalacia. The treatment for this disease is excision of the mass, which is where the head and neck specialist's expertise is required.

Otoplasty: experience with a modification using a drill, and literature review

More than 200 techniques have been described for correction of prominent ears, indicating that there is no single, widely accepted procedure that has been adopted by most surgeons. This article presents a simplified surgical method for correction of prominent ears. One hundred and twenty-eight otoplasties were performed on 70 patients using the described technique. The main modification of the technique was the use of a diamond burr drill to thin the cartilage posteriorly. Good aesthetic results were obtained in most patients.

Has the internet overtaken other traditional sources of health information? Questionnaire survey of patients attending ENT outpatient clinics

The aim of this study was to find out whether patients attending ENT clinics obtain health information about their medical condition and to assess satisfaction with the sources of health information, including the internet. Three hundred and thirty patients attending ENT outpatient clinics at District General Hospitals in Wigan and Warrington during June 2001 were asked to complete detailed questionnaires. Fifty-seven per cent of patients attempted to obtain health information before their visit to the specialist clinic. Forty-five per cent of patients had access to the internet, but only 13% used it to obtain health information. General practitioners were the source of health information for 64%, but the NHS-Direct help line was only used by 16%. Patients also trusted the health information provided by their GPs the most. In the twenty-first century, patients turn to their GP as the main source of health information.