To endo or to micro, that is the question: the musculoskeletal paradigm
Reviewed by Hassan Mohammed

Endoscopic ear surgery is a newer concept compared with the microscopic one. Both could lead to musculoskeletal pain due to the long static posture of surgeons during otologic procedures. The authors conducted a study on eight otolaryngologists, four attendings and four residents, who performed 21 surgeries, 10 of which are endoscopic. They utilised inertial measurement unit (IMU) sensors to measure surgeons’ joints angles. High-risk angles were set to greater than or equal to 10° deviation from a neutral position in either direction. Participants were also asked to fill The National Aeronautics and Space Administration Task Load Index (NASA-TLX). It was demonstrated that residents performed more surgeries with higher-risk neck and back angles compared to attending surgeons. It was also noted that both attending, and residents performed microscopic surgeries with higher-risk back and neck angles compared with endoscopic ones. Attendings reported better performance, and higher levels of pain both before and after operating than residents. Residents reported higher mental, physical, and temporal demand when operating endoscopically than when operating microscopically. Attendings’ subjective pain levels were significantly higher after operating microscopically than after operating endoscopically. When examining just microscopic cases, attendings reported significantly higher levels of mental, physical, and temporal demand as well as greater postoperative pain and total task load burden than did residents. This was not the case with endoscopic cases. Authors addressed the limitations of their study, including the small number of cases, Hawthorne effect (behaviour change due to awareness of being recorded), and not controlling for physical differences between surgeons. Based on this study, it appears that endoscopic ear surgery is more posture friendly than microscopic.

Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope.
Arrighi-Allisan A, Fan C, Wong K, et al.
OTOL NEUROTOL
2023;44(6):542-8.