Ajmera Ankit, Campbell Raewyn G, Lee Jennifer W Y, McGinness Samuel J, Mukherjee Payal
ENT Department, Sydney Adventist Hospital, Sydney, Australia.
Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
ANZ J Surg. 2025 Aug 4. doi: 10.1111/ans.70278.
Surgeons experience one of the highest rates of work-related musculoskeletal disorders, with otologists identified as a high-risk specialty. This is commonly attributed to the frequent use of the operating microscope, as it often necessitates prolonged, ergonomically unfavourable, awkward postures. Robotic 3D-exoscopes have emerged as a potential tool in improving surgical ergonomics without compromising on visualisation. This study compares the ergonomic risk associated with both devices.
A prospective, single centre, ergonomic analysis was conducted on otolaryngologists performing major otologic surgery using the OPMI Sensera operating microscope (Zeiss) and RoboticScope 3D-exoscope (BHS Technologies). Ergonomic risk was evaluated using the Rapid Upper Limb Assessment (RULA) tool and a questionnaire based on the NASA Task Load Index.
Eighteen cases were performed; nine using the 3D-exoscope and nine using the operating microscope. Use of the 3D exoscope significantly reduced ergonomic risk, with a lower mean RULA score (4.0) compared to the microscope (5.9). Subjectively, surgeons reported reduced physical strain, effort and weakness when using the 3D-exoscope compared with the microscope, with similar cognitive and mental workload. Image quality, magnification, colour contrast, ease of use and usability of the 3D-exoscope were rated positively. Further, the 3D-exoscope was also rated highly for its educational value.
3D-exoscopes appear to be more ergonomically favourable and suitable when compared to the operating microscope for major otologic surgery. Continued development and larger scale studies are warranted to improve ergonomics in otologic surgery and can also inform ergonomic improvements across other surgical specialties.
外科医生患与工作相关的肌肉骨骼疾病的比例极高，耳科医生被确定为高风险专业。这通常归因于手术显微镜的频繁使用，因为它常常需要长时间保持不符合人体工程学、别扭的姿势。机器人三维外视镜已成为一种潜在工具，可在不影响可视化的情况下改善手术人体工程学。本研究比较了与这两种设备相关的人体工程学风险。
对使用OPMI Sensera手术显微镜（蔡司）和机器人Scope 3D外视镜（BHS技术公司）进行主要耳科手术的耳鼻喉科医生进行了一项前瞻性、单中心人体工程学分析。使用快速上肢评估（RULA）工具和基于美国国家航空航天局任务负荷指数的问卷对人体工程学风险进行评估。
共进行了18例手术；9例使用3D外视镜，9例使用手术显微镜。使用3D外视镜显著降低了人体工程学风险，其平均RULA评分（4.0）低于显微镜（5.9）。主观上，与显微镜相比，外科医生报告使用3D外视镜时身体疲劳、用力和虚弱感减轻，认知和心理工作量相似。3D外视镜的图像质量、放大倍数、色彩对比度、易用性和可用性得到了积极评价。此外，3D外视镜的教育价值也得到了高度评价。
与手术显微镜相比，3D外视镜在主要耳科手术中似乎在人体工程学上更具优势且更适用。有必要持续开展研发和更大规模的研究，以改善耳科手术中的人体工程学，也可为其他外科专业的人体工程学改进提供参考。
