(0404) Cervical Ergonomics in Head and Neck Endocrine Surgery: A Comparative Assessment of Approaches

Introduction: Intraoperative ergonomics impacts the development of work-related musculoskeletal disorders (WRMDs), a set of conditions found to affect most otolaryngologists. Given that neck pain is the most common WRMD, we sought to quantitatively compare the cervical ergonomics of transcervical (TCA) and transoral (TOA) approaches in head and neck endocrine surgery.

Methods: We measured intraoperative neck angles of otolaryngology attendings, fellows, and residents during head and neck endocrine surgeries at a tertiary academic center. Two position sensors (inertial measurement units)–one midline between the shoulder blades and another on the posterior scalp–were affixed to the surgeons and calibrated at the beginning of each case. Raw quaternion data was processed via MATLAB and Python algorithms 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: A total of 12 surgeries (8 TCA, 4 TOA) were recorded between 5 surgeons. Average time spent in active surgery was 61.1 minutes for TCA and 60.6 for TOA. Percentage of time spent in high-risk neck angles was significantly higher for TCA than TOA (82% [95% CI: 75-89%] of active operating time vs 53% [95% CI: 40-66%], p < 0.001). Surgeons in TCA cases spent more time in neck extension than surgeons in TOA cases (45% [95% CI: 33-51%] vs 10% [95% CI: 0-19%], p< 0.001). TCA cases resulted in neck movement across a wider range of angles compared to TOA cases, with a standard deviation of 22 vs 15 degrees (p = 0.017).

Conclusions: TOA is favorable to TCA with respect to cervical ergonomics for head and neck endocrine surgeons. Nevertheless, surgeons spend significant operating time in high-risk neck angles regardless of approach, and operator ergonomics should be improved to reduce the risk of WRMDs.