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J Neurol Surg B Skull Base 2022; 83(S 02): e380-e385
DOI: 10.1055/s-0041-1729906
Original Article

Ergonomics in Endoscopic Transsphenoidal Surgery: A Survey of the North American Skull Base Society

Pier Paolo Mattogno
1   Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
2   Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
,
Filippo Marciano
3   Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
,
Michael P. Catalino
4   Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Davide Mattavelli
5   Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
,
Paola Cocca
3   Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
,
Nicola Francesco Lopomo
6   Department of Information Engineering, University of Brescia, Brescia, Italy
,
Piero Nicolai
7   Department of Otolaryngology—Head and Neck Surgery, University of Padua, Padua, Italy
,
Edward R. Laws Jr.
4   Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Ian Witterick
8   Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Shaan M. Raza
9   Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Anand K. Devaiah 
10   Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
,
Liverana Lauretti
2   Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
,
Alessandro Olivi
2   Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
,
Marco M. Fontanella
1   Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
,
Fred Gentili
11   Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
,
Francesco Doglietto 
1   Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Abstract

Objective Different surgical set-ups for endoscopic transsphenoidal surgery (ETS) have been described, but studies on their ergonomics are limited. The aim of this article is to describe present trends in the ergonomics of ETS.

Design and Participants A 33-question, web-based survey was sent to North American Skull Base Society members in 2018 and 116 responded to it (16% of all members). Most respondents were from North America (76%), in academic practice (87%), and neurosurgeons (65%); they had more than 5 years of experience in ETS (73%), had received specific training (66%), and performed at least 5 procedures/mo (55%).

Results Mean reported time for standard and complex procedures were 3.7 and 6.3 hours, respectively. The patient's body is usually positioned in a straight, supine position (84%); the head is in a neutral position (46%) or rotated to the side (38%). Most surgeons perform a binostril technique, work with a partner (95%), and operate standing (94%), holding suction (89%) and dissector (83%); sometimes the endoscope is held by the primary surgeon (22–24%). The second surgeon usually holds the endoscope (72%) and irrigation (42%). During tumor removal most surgeons stand on the same side (65–66%). Many respondents report strain at the dorsolumbar (50%) or cervical (26%) level. Almost one-third of surgeons incorporate a pause during surgery to stretch, and approximately half exercise to be fit for surgery; 16% had sought medical attention for ergonomic-related symptoms.

Conclusion Most respondents value ergonomics in ETS. The variability in surgical set-ups and the relatively high report of complaints underline the need for further studies to optimize ergonomics in ETS.

Keywords

endoscopic transsphenoidal surgery - ergonomics - operating room set-up - patient position - surgeons - survey

Supplementary Material



Publication History

Received: 10 January 2021

Accepted: 07 March 2021

Article published online:
17 May 2021

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