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

Abstract

Abstract 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.